Suchergebnisse

Tuki- ja liikuntaelimistön vaivat suomalaisilla varusmiehillä: fyysisen kunnon merkitys riskitekijänä ja lihaskuntoharjoittelun sekä neuvonnan vaikuttavuus äkillisten vammojen ja alaselkäkivun ehkäisyssä Varusmiesten tuki- ja liikuntaelimistön vaivojen aiheuttamia palveluksesta poissaoloja voidaan merkittävästi vähentää lihaskuntoharjoittelulla ja neuvonnalla. 70 prosenttia varusmiehistä hakeutuu varuskunnan terveysasemalle tuki- ja liikuntaelimistön vaivojen takia asepalveluksen kuuden ensimmäisen kuukauden aikana. UKK-instituutin tekemän tutkimuksen mukaan syynä hoitoon hakeutumiseen ovat enimmäkseen rasitusvammat alaraajoissa, alaselkäkipu ja nivelten nyrjähdykset. Kahdella kolmasosalla hoitoa hakeneista varusmiehistä oli enemmän kuin yksi tuki- ja liikuntaelimistön vaiva. Tutkimuksen yhteydessä varusmiehille toteutetun lihaskunto- ja neuvontaohjelman avulla äkillisiä nilkkavammoja voitiin vähentää lähes yhteen kolmasosaan ja alaselkäkivusta aiheutuvat palveluksesta poissaolopäivät vähenivät alle puoleen. Varusmiespalveluksen aikana ilmaantuvia tuki- ja liikuntaelimistön vaivoja ennakoi huono kestävyyskunto yhdistettynä huonoon lihaskuntoon. Myös vyötärölihavuus, suuri painoindeksi, aiemmat tuki- ja liikuntaelimistön vaivat sekä huono koulumenestys ennustavat tuki- ja liikuntaelimistön vaivoja varusmiesaikana. Yleisimmät syyt palveluksen keskeytymiseen ovat tuki- ja liikuntaelimistön vaivat ja toisaalta mielenterveyden ongelmat. Tutkimusjakson aikana joka kymmenes varusmies keskeytti palveluksen terveydellisten syiden takia kahden ensimmäisen palvelusviikon jälkeen. UKK-instituutti tutki varusmiesten tuki- ja liikuntaelinvaivojen yleisyyttä ja riskitekijöitä Porin Prikaatissa Säkylässä yhteistyössä Pääesikunnan, Sotilaslääketieteen keskuksen ja Porin Prikaatin kanssa. Tutkimuksessa seurattiin vuosina 2006—2008 neljää saapumiserää, joihin kuului yhteensä 2 057 varusmiestä. Tutkimukseen valittiin komppaniat, joihin ei ollut erityisiä pääsyvaatimuksia tai ennakkohakua, joten tutkimusjoukko on edustava otos suomalaisista nuorista miehistä. Lihaskuntoharjoittelun ja neuvonnan vaikutuksia vammamääriin ja palveluksesta poissaoloihin tutkittaessa kaksi komppaniaa satunnaistettiin harjoitteluryhmään. Toiset kaksi komppaniaa muodostivat kontrolliryhmän, jossa varusmiehet noudattivat normaalia palvelusohjelmaa. Harjoitusryhmän varusmiehet osallistuivat tasapainoa, kehonhallintaa, liiketaitoa, lihaskuntoa ja liikkuvuutta kehittävään harjoitusohjelmaan, jossa keskityttiin erityisesti alaselälle turvallisen asennon hallintaan. Neuvonnassa opastettiin, miten alaselän asennonhallinta onnistuu varusmiespalveluksen arkirutiineissa ja vapaa-ajalla. Harjoittelukomppanioissa äkillisten nilkkavammojen riski laski 66 % ja alaselkäkivusta aiheutuvien poissaolopäivien määrä väheni 58 % verrattuna kontrolliryhmään. Vastaavanlaista lihaskuntoharjoittelua ja neuvontaa voidaankin suositella integroitavaksi osaksi viikoittaista varusmiespalvelusohjelmaa. Henri Taanilan väitöskirja Musculoskeletal disorders in male Finnish conscripts: Importance of physical fitness as a risk factor, and effectiveness of neuromuscular exercise and counseling in the prevention of acute injuries, and low back pain and disability (Tuki- ja liikuntaelimistön vaivat suomalaisilla varusmiehillä: fyysisen kunnon merkitys riskitekijänä ja lihaskuntoharjoittelun sekä neuvonnan vaikuttavuus äkillisten vammojen ja alaselkäkivun ehkäisyssä) tarkastetaan Tampereen yliopistossa 22.3.2013. Vastaväittäjänä on liikuntalääketieteen professori Urho Kujala Jyväskylän yliopistosta. ; The core of the Finnish Defence Forces is based on mandatory military service. Although the majority of European countries count on professional soldiers in their defence strategy, the Finnish conscription system has maintained its high coverage: approximately 80% of young men in Finland enter into military service. The purpose of this dissertation was to investigate the occurrence, nature, severity, injury mechanisms and risk factors of musculoskeletal disorders (MSDs) including low back pain (LBP) and medical discharge in physically active male Finnish conscripts, and examine whether a neuromuscular training with injury prevention counseling, designed to enhance body control, motor skills and knowledge of prevention methods, was effective in preventing acute musculoskeletal injuries and LBP in conscripts during military training. First, the occurrence, anatomical location, severity and etiology including injury mechanisms and intrinsic risk factors for MSDs among conscripts were examined in studies I and II. Two successive cohorts of 18 to 28-year-old male conscripts (N = 944, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Associations between MSDs and risk factors were examined by multivariate Cox's proportional hazard models. Among 944 conscripts, there were 1629 MSDs and 2879 health clinic visits due to MSDs. The event-based incidence rate for MSD was 10.5 (95% confidence interval (CI): 10.0–11.1) per 1000 person-days. Most MSDs were in the lower extremities (65%) followed by the back (18%), upper extremities including shoulders (11%), head (2%) and other parts of the body (3%). Overuse-related MSDs (70%) were more than twice as prevalent as traumatic MSDs (30%). The majority (69%) of disorders were classified as minor leading to a maximum 3-day exemption from military training, while mild (4-7 off-duty days) MSDs accounted for 20%, moderate (8-28 off-duty days) for 8% and severe (>28 off-duty days) for 3% of all cases. Fractures, bone stress injuries, dislocations and internal knee injuries represented the most severe injuries. Of the traumatic causes of acute MSDs, falling down (17%) and collision with an object (16%) were most commonly associated with MSDs. Marching and running (36%) were the most common activities associated with overuse-related MSDs, followed by carrying and lifting loads (10%). Predictive associations between intrinsic risk factors and MSDs were examined using multivariate Cox's proportional hazard models. The strongest baseline factors associated with MSDs were poor result in the combined outcome of a 12-minute running test and back lift test (hazard ratio (HR) 2.9; 95% CI: 1.9–4.6). In addition, obesity measured as high waist circumference (WC) (HR 1.7; 95% CI: 1.3–2.2) or high body mass index (BMI) (HR 1.8; 95% CI: 1.3–2.4), earlier musculoskeletal symptoms (HR 1.7; 95% CI: 1.3–2.1) and poor school success (educational level and grades combined; HR 2.0; 95% CI: 1.3–3.0) were associated with MSDs. Further and more specifically, the third study examined incidence, severity and predictors of LBP. Four successive cohorts of male conscripts without LBP before military entry (N = 982) were followed for 6 months. Conscripts who suffered from LBP were identified and treated at the garrison clinic. The cumulative incidence of LBP was 16%. Of those 27% (n=42) had recurrent LBP, while the LBP incidence rate was 1.2 (95% CI: 1.0–1.4) per 1000 person-days. The majority (75%) of LBP was classified as minimal, leading to a maximum 3-day exemption from military training, while mild LBP accounted for 15%, moderate for 7%, and severe for 3% of all cases. Five previously symptomless conscripts were discharged prematurely due to LBP. Conscripts with low educational level had increased risk for incidence of LBP (HR 1.6, 95% CI: 1.1–2.3). Moreover, conscripts with low dynamic trunk muscle endurance and low aerobic endurance simultaneously (i.e. having co-impairment) at baseline had increased risk for incidence of LBP. The strongest risk factor was co-impairment of trunk muscular endurance in tests of back-lift and push-up (HR 2.8; 95% CI: 1.4–5.9). The fourth study examining occurrence, reasons and risk factors of military discharge found that low physical fitness is a strong predictor of health problems leading to premature discharge from military service. Of 1411 participants, 9.4% (n=133) were discharged prematurely for medical reasons after the 2-week run-in period, mainly musculoskeletal (44%, n=59) and mental and behavioral (29%, n=39) disorders. Low levels of physical fitness assessed with a 12-min running test (HR 3.3; 95% CI: 1.7–6.4), poor school success (HR 4.6; 95% CI: 2.0-11.0), poor self-assessed health (HR 2.8; 95% CI: 1.6–5.2), and not belonging to a sports club (HR 4.9; 95% CI: 1.2–11.6) were most clearly associated with medical discharge in a graded manner. The following two studies investigated the effect of neuromuscular exercise (NME) with injury prevention counseling to decrease the risk of acute musculoskeletal injuries (study V) and LBP (study VI) during military service. Participants were conscripts of four successive age cohorts (N = 1912). In the pre-study year, before adoption of the intervention, two successive cohorts of four companies (N = 944) were followed prospectively for 6 months to study the baseline incidence of acute injuries and LBP. Then the group randomization was carried out. In the intervention year, two new cohorts of the same companies (N = 968) were followed for 6 months: 501 conscripts participated in NME (intervention group: anti-tank and engineer companies) and 467 conscripts conducted their service as usual in the control group (signal and mortar companies). A NME program and educational counseling were used to reduce acute extremity injuries, and LBP and disability. The NME program was aimed to enhance conscripts' motor and muscular performance with emphasis on the control of the lumbar neutral zone (NZ) and specifically avoiding full lumbar flexion. Counseling was based on the cognitive-behavior modeling. The aims were to increase awareness of military tasks that could lead to acute injuries or were potentially harmful to the lower back, and to enhance understanding and skills to perform them in a less risky manner. In the intervention companies, the risk for acute ankle injury decreased significantly compared to the control companies (adjusted HR 0.34; 95% CI: 0.15–0.78, p=0.011). This risk decline was observed in conscripts with low, as well as moderate-to-high, baseline fitness. In the latter group of conscripts, the risk of upper extremity injuries also decreased significantly (adjusted HR 0.37; 95% CI 0.14–0.99, p=0.047). In addition, the intervention companies tended to have fewer time losses due to injuries (adjusted HR 0.55; 95% CI 0.29–1.04). In the study VI, effectiveness of the NME and counseling for reducing the incidence of LBP and disability was investigated in conscripts with a healthy back, assessed by a questionnaire and routine medical screening by a physician at the beginning of military service. Altogether 472 (23%) conscripts were excluded from the analyses due to previous LBP. Total number of off-duty days due to LBP was significantly decreased in the intervention companies compared to the controls (adjusted HR 0.42; 95% CI 0.18–0.94, p = 0.035). The number of LBP cases, number of health clinic visits due to LBP, and number of the most severe cases showed a similar decreasing trend, but without statistical significance. The findings indicated that exercise and education to improve control of the lumbar NZ had a prophylactic effect on LBP-related off-duty service days in the military environment, and may provide a target for the primary prevention of LBP. The findings of this thesis indicate that MSDs, especially those involving lower extremities and low back, are common among a population-based sample of Finnish conscripts during physically demanding military service. However, a neuromuscular warm-up program with injury prevention counseling designed to enhance motor skills and body control especially considering lumbar NZ, and knowledge of prevention methods can clearly decrease the risk for acute ankle injuries and LBP. Hence, neuromuscular training programs can be recommended to be included in the weekly training schedules of conscripts. Injury prevention counseling especially at the beginning of military service would help to control the injury risk. A similar neuromuscular training as a warm-up or cool-down program for sports and physical exercise as well as in school sports lessons would offer means to reduce the burden of injuries and LBP, and consequently enhance the positive effects of regular physical activity on health.

Terveydenhuollon henkilöstön tietosuojaosaamisen tutkimus on toistaiseksi rajoittunut tarkastelemaan vain yhtä osa-aluetta kerrallaan, ilman moniulotteista kokonaiskuvan hahmotusta. Terveydenhuollossa tietosuojaosaaminen toteutuu tietosuojakäyttäytymisenä. Tietosuojaosaaminen ilmenee kykynä käsitellä henkilötietoja hyvin. Tietosuojaosaamisen ytimessä toimii oikein toteutettu hyvä tiedonhallinta, oikein käsitellyt henkilötiedot ja hallitut tietovarannot. Varmistamalla tietosuojaosaaminen ja toimintatapojen oikea toteutus voidaan välttää pahimmat tietosuojariskit, sekä tehostaa organisaatioiden ja työntekijöiden toimintaa.
Tämän tutkimuksen tarkoituksena on kuvata oppimisen teorian ulottuvuuksien ilmenemistä vankiterveydenhuollon ammattilaisten tietosuoja- ja tietoturvaosaamisessa. Tutkimuksessa hyödynnetään koko Vankiterveydenhuollon henkilöstölle tehtyä tietosuojaosaamista koskevaa poikkileikkaavaa kyselytutkimusta. Tutkimuksen tulokset kuvataan Knud Illeriksen oppimisen teorian ulottuvuuksia hyödyntäen. Tietosuoja- ja tietoturvaosaamisen merkitys vankiterveydenhuollossa korostuu, sillä vankiterveydenhuollossa potilas- ja henkilötietojen käsittelyä ohjaavat terveydenhuollon lainsäädännön lisäksi laki vankiterveydenhuollon yksiköstä, joka määrittää poikkeavuudet potilaan tietojenluovutukseen.
Tutkimuksen tuloksista heijastuu terveydenhuollon henkilöstön tietosuojaosaamisen moniulotteisuus. Tietosuojaosaamisen ja tietoturvakäyttäytymisen toteutuminen terveydenhuollossa ei ole riippuvaista vain yksilön käymistä koulutuksista, vaan toimintaympäristöllä ja kohdennetulla ohjeistuksella on merkittävä vaikutus tietosuojan toteutumiseen. Aikaisempien tutkimusten perusteella terveydenhuollon tietosuojaosaamisen tutkiminen on painottunut työympäristön ja yksilön sisäisten kannustimien tarkasteluun, sekä tietosuojarikkeisiin vaikuttavien tekijöiden tunnistamiseen. Tämä tutkimus tukee näkemystä tietosuojaosaamisen moniulotteisuudesta ja aiheen kansallisesta ja kansainvälisestä tutkimusaukosta.

The Northern Finland Birth Cohort 1986 (N = 8,061) was used to investigated the joint associations of physical activity and sedentary behavior with academic achievement. Logistic regression analysis was used to evaluate how classes formed by latent class analysis (LCA) according to overall physical activity, sports club membership, viewing TV, using a computer, reading books and magazines, other sedentary activities, and sleep were associated with grade‐point average. When adjusted for gender, self‐rated health, and mother's education, physically active adolescents and generally active adolescents were about twice as likely to have high grade‐point average compared with sedentary TV viewers.

Background Military service in Finland is compulsory for all male citizens and annually about 80% of 19-year-old men enter into the service. The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth. On the other hand, activity-induced injuries among young are true public health issue. The purpose of the present prospective cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors. Methods Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months. At the beginning of the service, the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified. Predictive associations between injuries and their risk factors were examined by multivariate Cox's proportional hazard models. Results Of the 1411 participants, 27% sustained an acute injury and 51% suffered from overuse injury. Concerning acute injuries, highest risk for severe injuries were detected among conscripts with low fitness level in both the standing long-jump and push-up tests (hazard rate, HR=5.9; 95% CI: 1.6‒21.3). A history of good degree in school sports was not a protective factor against acute injuries. High waist circumference and, on the other hand, being underweight according to BMI increased the HR for overuse injuries. Brisk leisure time physical activity before military entry was a protective factor against overuse injuries. Poor result in Cooper's test was a warning signal of elevated risk of overuse injuries. Conclusion We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training. The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries. Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees. This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries. ; BioMed Central open access

Abstract Background Musculoskeletal disorders (MSDs) are the main reason for morbidity during military training. MSDs commonly result in functional impairment leading to premature discharge from military service and disabilities requiring long-term rehabilitation. The purpose of the study was to examine associations between various risk factors and MSDs with special attention to the physical fitness of the conscripts. Methods Two successive cohorts of 18 to 28-year-old male conscripts ( N = 944, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Associations between MSDs and risk factors were examined by multivariate Cox's proportional hazard models. Results During the six-month follow-up of two successive cohorts there were 1629 MSDs and 2879 health clinic visits due to MSDs in 944 persons. The event-based incidence rate for MSD was 10.5 (95% confidence interval (CI): 10.0-11.1) per 1000 person-days. Most MSDs were in the lower extremities (65%) followed by the back (18%). The strongest baseline factors associated with MSDs were poor result in the combined outcome of a 12-minute running test and back lift test (hazard ratio (HR) 2.9; 95% CI: 1.9-4.6), high waist circumference (HR 1.7; 95% CI: 1.3-2.2), high body mass index (HR 1.8; 95% CI: 1.3-2.4), poor result in a 12-minute running test (HR 1.6; 95% CI: 1.2-2.2), earlier musculoskeletal symptoms (HR 1.7; 95% CI: 1.3-2.1) and poor school success (educational level and grades combined; HR 2.0; 95% CI: 1.3-3.0). In addition, risk factors of long-term MSDs (≥10 service days lost due to one or several MSDs) were analysed: poor result in a 12-minute running test, earlier musculoskeletal symptoms, high waist circumference, high body mass index, not belonging to a sports club and poor result in the combined outcome of the 12-minute running test and standing long jump test were strongly associated with long-term MSDs. Conclusions The majority of the observed risk factors are modifiable and favourable for future interventions. An appropriate intervention based on the present study would improve both aerobic and muscular fitness prior to conscript training. Attention to appropriate waist circumference and body mass index would strengthen the intervention. Effective results from well-planned randomised controlled studies are needed before initiating large-scale prevention programmes in a military environment.

Abstract Background Musculoskeletal disorders (MSDs) are an important cause for morbidity in military service. They result in disabilities needing long-term rehabilitation and functional impairment leading to premature discharge from military service. The purpose of the study was to investigate the incidence and nature of MSDs in Finnish conscripts. Methods Two successive arrivals of 18–28-yr-old male conscripts ( N = 955, median age 19) were followed for six months. MSDs, including overuse and acute injuries, treated at the garrison clinic were identified and analysed. Results During the 12-month study period there were 437 outpatient clinic visits in 955 persons. The occurrence rate was 33% during 6-month service while the event-based incidence was 3.3 per 1000 person-days. Occurrence peaked in summer months. The most common types of MSDs were low back pain (LBP, 20%), lower limb overuse injuries (16%) and sprains or strains (13%). Disorders mostly occurred in combat training in combat gear (40%) and during marching on foot or bicycle (28%). Overuse-related MSDs were more prevalent (66%) than traumatic ones (34%). One-third (34%) of the MSDs were recurrent and 66% were new ones. Disorders of the back and the knee were most frequently recurrent conditions (44% for both). Fractures, knee ligament ruptures, dislocations and muscle strains accounted for the highest number of service days lost. Twenty-four (2.5%) out of 955 conscripts were prematurely discharged due to MSDs. Conclusion Preventive measures during military service should be targeted at decreasing low back pain and lower limb overuse injuries, because these inflict the largest burden of MSDs and tend to have a chronic nature.

Abstract Background Military service in Finland is compulsory for all male citizens and annually about 80% of 19-year-old men enter into the service. The elevated risk for many chronic diseases and loss of function among those who are inactive and unfit can be often detected already in youth. On the other hand, activity-induced injuries among young are true public health issue. The purpose of the present prospective cohort follow-up study was to evaluate predictive associations between acute or overuse injuries and their various intrinsic risk factors. Methods Four successive cohorts of conscripts who formed a representative sample of Finnish young men were followed for 6 months. At the beginning of the service, the risk factors of injuries were measured and recorded and then the acute and overuse injuries treated at the garrison clinic were identified. Predictive associations between injuries and their risk factors were examined by multivariate Cox's proportional hazard models. Results Of the 1411 participants, 27% sustained an acute injury and 51% suffered from overuse injury. Concerning acute injuries, highest risk for severe injuries were detected among conscripts with low fitness level in both the standing long-jump and push-up tests (hazard rate, HR=5.9; 95% CI: 1.6‒21.3). A history of good degree in school sports was not a protective factor against acute injuries. High waist circumference and, on the other hand, being underweight according to BMI increased the HR for overuse injuries. Brisk leisure time physical activity before military entry was a protective factor against overuse injuries. Poor result in Cooper's test was a warning signal of elevated risk of overuse injuries. Conclusion We confirmed previous findings that low level of physical fitness is predictor for musculoskeletal injuries during intensive physical training. The U-shaped relationship between body composition and overuse injuries was noticed indicating that both obesity and underweight are risk factors for overuse injuries. Persons with excellent sports skills according to their earlier degrees in school sports had similar HR for acute injuries than those with poorer degrees. This indicates that school-age sports skills and fitness do not carry far and therefore preventive programmes are needed to prevent activity-induced injuries.

Abstract Background The rapidly increasing number of activity-induced musculoskeletal injuries among adolescents and young adults is currently a true public health burden. The objective of this study was to investigate whether a neuromuscular training programme with injury prevention counselling is effective in preventing acute musculoskeletal injuries in young men during military service. Methods The trial design was a population-based, randomised study. Two successive cohorts of male conscripts in four companies of one brigade in the Finnish Defence Forces were first followed prospectively for one 6-month term to determine the baseline incidence of injury. After this period, two new successive cohorts in the same four companies were randomised into two groups and followed prospectively for 6 months. Military service is compulsory for about 90% of 19-year-old Finnish men annually, who comprised the cohort in this study. This randomised, controlled trial included 968 conscripts comprising 501 conscripts in the intervention group and 467 conscripts in the control group. A neuromuscular training programme was used to enhance conscripts' motor skills and body control, and an educational injury prevention programme was used to increase knowledge and awareness of acute musculoskeletal injuries. The main outcome measures were acute injuries of the lower and upper limbs. Results In the intervention groups, the risk for acute ankle injury decreased significantly compared to control groups (adjusted hazards ratio (HR) = 0.34, 95% confidence interval (95% CI) = 0.15 to 0.78, P = 0.011). This risk decline was observed in conscripts with low as well as moderate to high baseline fitness levels. In the latter group of conscripts, the risk of upper-extremity injuries also decreased significantly (adjusted HR = 0.37, 95% CI 0.14 to 0.99, P = 0.047). In addition, the intervention groups tended to have less time loss due to injuries (adjusted HR = 0.55, 95% CI 0.29 to 1.04). Conclusions A neuromuscular training and injury prevention counselling programme was effective in preventing acute ankle and upper-extremity injuries in young male army conscripts. A similar programme could be useful for all young individuals by initiating a regular exercise routine. Trial registration ClinicalTrials.gov identifier number NCT00595816 .

Data from the 1986 Northern Finland Birth Cohort Study (n = 4,645) were used to examine the influence of mid‐adolescent (age 15) school outcomes on late‐adolescent (ages 17–19) risk of criminal conviction. Consistent with social‐developmental theories of offending, we found that poor academic performance and reduced school attachment increase the risk of criminal conviction independently of pre‐existing differences in antisocial propensity and other confounding factors identified in prior research. Moreover, in support of an integrated model, our research suggests that academic performance and school attachment mediate the effects of childhood antisociality and learning difficulties on late‐adolescent risk of criminal conviction. The implications of findings for policy and future research are discussed.

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3–8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mother's age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalence's of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers. ; All phases of this study were supported by a European Union's Seventh Framework Programme grant, 278350, as part of The Determinants to Reduce Health Inequity Via Early Childhood, Realising Fair Employment, and Social Protection (DRIVERS) research programme. The Czech ELSPAC Study (CZ-ELSPAC) was supported by the Ministry of Education of the Czech Republic: CETOCOEN plus project (CZ02101/00/00/15_003/0000469) and RECETOX Research Infrastructure (LM2015051). The Northern Finland Birth Cohort (FI-NFBC8586) received financial support from the Academy of Finland; Biocenter, University of Oulu, Finland; the European Commission EUROBLCS, Framework 5 Award QLG1-CT-2000-01643); EU FP7 EurHEALTHAgeing-277849; the Medical Research Council, UK (PrevMetSyn/SALVE); and the MRC Centenary Early Career Award. The Amsterdam Born Children and their Development Study (NLABCD) received funding from the Netherlands Organization for Health Research and Development (ZonMw) Grant (TOP, 40-00812-98-11010). The All Babies in Southeast Sweden Study (SE-ABIS) has received financial support from the Juvenile Diabetes Research Foundation, Swedish Child Diabetes Foundation (Barndiabetesfonden), The Research Council of South-east Sweden (FORSS), Swedish Research Council K2005-72X-11242-11A, and ALF/County Council of O ̈stergo ̈tland. The INMA study was funded in part by grants from the European Union (FP7-ENV-2011-282957 and HEALTH.2010.2.4.5-1), Spain (Instituto de Salud Carlos III and The Ministry of Health), the Conselleria de Sanitat of the Generalitat Valenciana, department of Health of the Basque Government, the Provincial Government of Gipuzkoa, and the Generalitat de Catalunya-CIRIT. Family and Children of Ukraine (UA-FCOU) study was supported by US NIH Fogarty International Center and National Academy of Medical Sciences of Ukraine. KML is funded by a Medical Research Council UK doctoral training studentship.

Highly prevalent and typically beginning in childhood, asthma is a burdensome disease, yet the risk factors for this condition are not clarified. To enhance understanding, this study assessed the cohort-specific and pooled risk of maternal education on asthma in children aged 3-8 across 10 European countries. Data on 47,099 children were obtained from prospective birth cohort studies across 10 European countries. We calculated cohort-specific prevalence difference in asthma outcomes using the relative index of inequality (RII) and slope index of inequality (SII). Results from all countries were pooled using random-effects meta-analysis procedures to obtain mean RII and SII scores at the European level. Final models were adjusted for child sex, smoking during pregnancy, parity, mothers age and ethnicity. The higher the score the greater the magnitude of relative (RII, reference 1) and absolute (SII, reference 0) inequity. The pooled RII estimate for asthma risk across all cohorts was 1.46 (95% CI 1.26, 1.71) and the pooled SII estimate was 1.90 (95% CI 0.26, 3.54). Of the countries examined, France, the United Kingdom and the Netherlands had the highest prevalences of childhood asthma and the largest inequity in asthma risk. Smaller inverse associations were noted for all other countries except Italy, which presented contradictory scores, but with small effect sizes. Tests for heterogeneity yielded significant results for SII scores. Overall, offspring of mothers with a low level of education had an increased relative and absolute risk of asthma compared to offspring of high-educated mothers. ; Funding Agencies|European Unions Seventh Framework Programme as part of The Determinants to Reduce Health Inequity Via Early Childhood, Realising Fair Employment [278350]; Social Protection (DRIVERS) research programme; Ministry of Education of the Czech Republic: CETOCOEN plus project [CZ02101/00/00/15_003/0000469]; RECETOX Research Infrastructure [LM2015051]; Academy of Finland [FI-NFBC8586]; Biocenter, University of Oulu, Finland; European Commission EUROBLCS, Framework 5 Award [QLG1-CT-2000-01643]; EU [FP7 EurHEALTHAgeing-277849]; Medical Research Council, UK (PrevMetSyn/SALVE); MRC Centenary Early Career Award; Netherlands Organization for Health Research and Development (ZonMw) Grant (TOP) [40-00812-98-11010]; Juvenile Diabetes Research Foundation; Swedish Child Diabetes Foundation (Barndiabetesfonden); Research Council of South-east Sweden (FORSS); Swedish Research Council [K2005-72X-11242-11A]; ALF/County Council of Ostergotland; European Union, Spain (Instituto de Salud Carlos III) [FP7-ENV-2011-282957, HEALTH. 2010.2.4.5-1]; European Union, Spain (Ministry of Health) [FP7-ENV-2011-282957, HEALTH. 2010.2.4.5-1]; Conselleria de Sanitat of the Generalitat Valenciana; Department of Health of the Basque Government; Provincial Government of Gipuzkoa; Generalitat de Catalunya-CIRIT; US NIH Fogarty International Center; National Academy of Medical Sciences of Ukraine; Medical Research Council UK doctoral training studentship

Background A healthy start to life is a major priority in efforts to reduce health inequalities across Europe, with important implications for the health of future generations. There is limited combined evidence on inequalities in health among newborns across a range of European countries. Methods Prospective cohort data of 75 296 newborns from 12 European countries were used. Maternal education, preterm and small for gestational age births were determined at baseline along with covariate data. Regression models were estimated within each cohort and meta-analyses were conducted to compare and measure heterogeneity between cohorts. Results Mother's education was linked to an appreciable risk of preterm and small for gestational age (SGA) births across 12 European countries. The excess risk of preterm births associated with low maternal education was 1.48 (1.29 to 1.69) and 1.84 (0.99 to 2.69) in relative and absolute terms (Relative/Slope Index of Inequality, RII/SII) for all cohorts combined. Similar effects were found for SGA births, but absolute inequalities were greater, with an SII score of 3.64 (1.74 to 5.54). Inequalities at birth were strong in the Netherlands, the UK, Sweden and Spain and marginal in other countries studied. Conclusions This study highlights the value of comparative cohort analysis to better understand the relationship between maternal education and markers of fetal growth in different settings across Europe. ; All phases of this study were supported by a European Union's Seventh Framework Programme grant, 278350, as part of The Determinants to Reduce Health Inequity Via Early Childhood, Realising Fair Employment, and Social Protection (DRIVERS) research programme. The Czech ELSPAC Study was supported by the Ministry of Education of the Czech Republic (LM2011028, LO1214) and the Grant Agency of the Masaryk University (MUNI/M/1075/2013). The Northern Finland Birth Cohort (NFBC8586) received financial support from the Academy of Finland, Biocenter, University of Oulu, Finland, the European Commission (EURO-BLCS, Framework 5 award QLG1-CT-2000-01643), EU FP7 EurHEALTHAgeing -277849, the Medical Research Council, UK ( PrevMetSyn/SALVE) and the MRC Centenary Early Career Award.