Contribution of modern biotechnology of lactic acid bacteria to development of health-promoting foods

Selostus: Terveysvaikutteisten elintarvikkeiden tuottamista edesauttavat maitohappobakteerien molekyyligeneettiset tutkimukset

Pressure to change and resistance against it: consumer perceptions and acceptance of nutritionally modified foods

Selostus: Muutospaineet ja muutosvastarinta: kuluttajien suhtautuminen ravitsemuksellisesti muunnettuihin elintarvikkeisiin

Bully-victims: Prevalence, psychosocial adjustment, and responsiveness to intervention

In this thesis, a unique subgroup involved in the bullying phenomenon, the bully-victims, are identified and examined. Despite the increasing attention on the bully-victims in recent years, their prevalence, psychosocial adjustment, and response to anti-bullying programs has not been clearly determined. Three empirical studies were conducted in this thesis to examine the prevalence of bully-victims. Moreover, in study I, the psychosocial adjustment of bully-victims was compared with that of pure bullies, pure victims, and non-involved students. In study II, different forms of bullying and victimization were compared among pure bullies, pure victims, bully-victims, and non-involved students. In study III, the effectiveness of anti-bullying programs, in particular, the KiVa program, on bully-victims was demonstrated. Overall, bully-victims formed the smallest group comparing with pure bullies, pure victims, and non-involved students, and in general differed from pure bullies rather than pure victims in terms of subjective experience of maladjustment. They employed more verbal, physical, and cyberbullying perpetration, but not indirect bullying; and they were more victimized by verbal, physical, cyber, and indirect bullying. The KiVa anti-bullying program in Finland is effective in reducing the prevalence of bully-victims.

Suorituskyvyn johtamisjärjestelmän jalkauttamisen ja tehokkaan käyttämisen edistäminen bioenergia- ja lämpöliiketoimialalla

Tämän tutkimuksen tavoitteena on selvittää suorituskyvyn johtamisjärjestelmän jalkauttamisen, tehokkaan käyttämisen ja jatkuvan parantamisen kulttuurin luomisen edistäviä tekijöitä bioenergia- ja lämpöliiketoimialalla. Tämä tutkimus tukee kohdeorganisaation suorituskyvyn johtamisjärjestelmän implementointiprosessia. Tutkimuksen mukaan suorituskyvyn johtamisjärjestelmän jalkauttamista tukee kolme tärkeää tekijää: johdon ja henkilöstön sitoutuminen, mittariston hyödyllisyyden näkeminen ja mittariston rakenne ja sisältö. Johdon ja henkilöstön sitoutumista sekä mittariston hyödyllisyyden näkemistä edistävät oikeanlainen viestintä, mittariston ymmärtäminen ja liiketoimintaa tukevat mittarit. Mittareiden käyttöönottoa edistävät ymmärrettävät ja luotettavat mittarit sekä kannustimet. Tutkimuksen mukaan suorituskykymittariston tehokasta käyttämistä tukevat mittareiden ajantasaisuus ja mittaustiedon hyödyntäminen liiketoiminnassa. Mittariston tehokasta käyttämistä edistävät mittariston muutosherkkyys, käyttäjäläheinen kehittäminen ja mittareiden liittäminen palkitsemiseen. Jatkuvan parantamisen kulttuurin luomista edistävät mittaristoon ja organisaatioon liittyvät tekijät mm. organisaatiokulttuuri ja johtamistyyli sekä mittariston muutosherkkyys.

Workplace Social Capital and Employee Health

Työyhteisön sosiaalinen pääoma ja työntekijöiden terveys Monien tutkimusten mukaan sosiaalinen pääoma vaikuttaa terveyteen. Vaikka työssä käyvä väestönosa on merkittävän osan valveillaoloajastaan työyhteisössä, siellä kertyvää sosiaalista pääomaa on toistaiseksi tutkittu vähän. Tässä tutkimuksessa selvitettiin työyhteisön sosiaalisen pääoman ja kuntatyöntekijöiden terveyden välistä yhteyttä pitkittäisasetelmassa hyödyntäen Kuntasektorin henkilöstön seurantatutkimuksen aineistoa vuosilta 2000–2005. Yhteensä 48592 kuntatyöntekijää vastasi kyselyyn vuosina 2000–02 (vastausprosentti 68 %). Heistä 35914 (77 %) osallistui myös seurantatutkimukseen vuosina 2004–05. Tutkimuksessa kehitettiin kyselyyn perustuva työyhteisön sosiaalisen pääoman mittausmenetelmä. Työntekijän omaan arvioon perustuvan sosiaalisen pääoman lisäksi mitattiin työyhteisön sosiaalista pääomaa käyttämällä samassa työyhteisössä työskentelevien muiden työntekijöiden keskimääräistä arviota sosiaalisesta pääomasta. Terveyttä mitattiin kysymyksellä koetusta terveydestä. Masennusta arvioitiin sekä kysymällä lääkärin toteamasta masennuksesta että masennuslääkeostoilla Kelan lääkerekistereistä. Analyyseihin otettiin mukaan vain ne kuntatyöntekijät, jotka olivat lähtötilanteissa terveitä eli kokivat terveytensä hyväksi tai heillä ei ollut aiempaa diagnosoitua tai lääkehoitoa vaatinutta masennusta. Tulosten analysointiin käytettiin monitasomallinnusta. Tulokset vakioitiin sosiodemografisten tekijöiden ja terveyskäyttäytymisen suhteen. Neljän vuoden seurannassa sekä jatkuvasti vähäinen että vähenevä yksilön sosiaalinen pääoma työssä lisäsi riskiä koetun terveyden heikkenemiseen niillä kuntatyöntekijöillä, jotka eivät vaihtaneet työpaikkaa seurannan aikana ja jotka seurannan alussa kokivat terveytensä hyväksi. Tulos ei selittynyt sosiodemografisilla tekijöillä tai terveyskäyttäytymisen eroilla. Tuloksen merkittävyyttä tuki havainto, että myös työtoverien arvioon perustuva sosiaalinen pääoma ennusti oman terveyden huononemista seuranta-aikana. Niillä työntekijöillä, jotka työskentelivät sellaisissa työyhteisöissä, joissa koko seurannan ajan oli vähiten sosiaalista pääomaa, oli lähes 1.3 -kertainen riski terveyden heikentymiseen. Vähäinen omaan arvioon perustuva sosiaalinen pääoma työssä ennusti myös masennuksen ilmaantuvuutta lähtötilanteessa ei-masentuneilla lähes neljän vuoden seurannassa. Matalaan sosiaaliseen pääomaan liittyi 20–50 % suurempi todennäköisyys sairastua masennukseen seurannan aikana niin itseraportoidun lääkärin totea-man masennuksen kuin masennuslääkeostojen perusteella. Tätä tulosta ei kuitenkaan pystytty toistamaan käyttämällä oman arvion sijasta työtoverien arviota työyhteisön sosiaalisesta pääomasta. Tutkimusta sosiaalisen pääoman vaikutusta masennuksen ilmaantumiseen jatkettiin selvittämällä miten sosiaalisen pääoman eri ulottuvuudet vaikuttivat masennuksen ilmaantumiseen. Tulosten mukaan sosiaalisen pääoman vertikaalinen komponentti (työntekijöiden ja esimiesten välinen luottamus, vastavuoroisuus ja jaetut arvot ja normit, jotka edesauttavat yhteistyötä) sekä horisontaalinen komponentti (työntekijöiden välisissä suhteissa yhteistyöstä, luottamuksesta ja vastavuoroisuudesta syntyvä sosiaalinen pääoma) vaikuttivat itsenäisesti masennusriskiin. Tutkimuksen perusteella korkea työyhteisön sosiaalinen pääoma saattaa vaikuttaa edullisesti työntekijöiden terveyteen. Jos näin on, olisi tärkeää edistää työyhteisöjen sosiaalista pääomaa ja kannustaa sellaiseen toimintaan, joka lisää suvaitsevaisuutta, luottamusta ja vastavuoroisuutta sekä työntekijöiden kesken että työntekijöiden ja esimiesten välillä.

Very preterm infants in Finland - Use of health care services and economic consequences during the first five years of life

The aim of this thesis was to study the health, the hospitalisations, and the use of communal health care services in very preterm children during the first five years of life. In addition, the effect of very preterm birth and prematurity-related morbidities on the costs of hospitalisations, other health care services and the cost per quality adjusted life years (QALY) were studied. This population-based study included all very preterm children (gestational age (GA) <32 weeks or birth weight<1501g, N=2 064) and full-term controls (GA 37+0−41+6, N=200 609) born in Finland during 2000-2003. The data sources included national register data, costing data from the participating hospitals and parental questionnaires. This study showed that most very preterm infants born in Finland survived without prematurity-related morbidities diagnosed during the first years of life. They required relatively little hospital care after the initial discharge, which accounted for the vast majority of the total four-year hospitalisation costs. However, a minority of children born very preterm later developing morbidities had a long initial length of stay and more re-admissions and outpatient visits during the five-year follow-up period. In particular, the number and costs of non-emergency outpatient visits were considerable in individuals with prematurity-related morbidities. The need and costs of hospitalisations decreased clearly with each follow-up year, even in individuals with morbidities. The health-care related costs during the fifth year of life in children born very preterm without prematurity-related morbidities were close to the costs in infants born healthy at term. The cost per QALY of 19,245 € was at an acceptable level already by four years of age in the very preterm population as a whole. Prematurity-related later morbidities and decreasing GA increased the costs per QALY. As the initial hospital stay accounted for a great majority of the total four-year costs, and the costs of hospitalisation decreased with each follow-up year, the cost per QALY is likely to decrease with age. In conclusion, the majority of costs arising after the initial hospitalisation were associated with morbidities related to prematurity. Therefore offering high-quality neonatal care to prevent later morbidities in very preterm survivors has a long-term impact on the cost per QALY. In addition, this study indicates that when estimating the costs of prematurity after the first year of life, one should calculate not only the hospitalisation costs, but also other costs for social welfare services, primary care, and therapies, as these exceed the hospitalisation costs in very preterm infants during the fifth year of life.

Social capital and health : variations, associations and challenges

Although social capital and health have been extensively studied during the last decade, there are still open issues in current empirical research. These concern for instance the measurement of the concept in different contexts, as well as the association between different types of social capital and different dimensions of health. The present thesis addressed these questions. The general aim was to promote the understanding of social capital and health by investigating the oldest old and the two major language groups in Finland, Swedish- and Finnish-speakers. Another aim was to contribute to the discussion on methodological issues in social capital and health research. The present thesis investigated two empirical data sets, Umeå 85+ and Health 2000. The Umeå 85+ study was a cross-sectional study of 163 individuals aged 85, 90, and 95 or older, living in the municipality of Umeå, Sweden, in the year of 2000. The Health 2000 survey was a national study of 8,028 persons aged 30 or above carried out in Finland in 2000-2001. Different indicators of structural (e.g. social contacts) and cognitive (e.g. trust) social capital, as well as health indicators were used as variables in the analyses. The Umeå 85+ data set was analyzed with factor analysis, as well as univariate and multivariate analysis of variance. The Health 2000 data was analyzed with logistic regression techniques. The results showed that the Swedish-speakers in the Finnish data set Health 2000 had consistently higher prevalence of social capital compared to the Finnish-speakers even after controlling for central sociodemographic variables. The results further showed that even if the language group differences in health were small, the Swedishspeakers experienced in general better self-reported health compared with the Finnish-speakers. Common sociodemographic variables could not explain these observed differences in health. The results imply that social capital is often, but not always, associated with health. This was clearly seen in the Umeå 85+ data set where only one health indicator (depressive symptoms) was associated with structural social capital among the oldest old. The results based on the analysis of the Health 2000 survey demonstrated that the cognitive component of social capital was associated with self-rated health and psychological health rather than with participation in social activities and social contacts. In addition, social capital statistically reduced the health advantage especially for Swedish-speaking men, indicating that high prevalence of social capital may promote health. Finally, the present thesis also discussed the issue of methodological challenges faced with when analyzing social capital and health. It was suggested that certain components of social capital such as bonding and bridging social capital may be more relevant than structural and cognitive components when investigating social capital among the two language groups in Finland. The results concerning the oldest old indicated that the structural aspects of social capital probably reflect current living conditions, whereas cognitive social capital reflects attitudes and traits often acquired decades earlier. This is interpreted as an indication of the fact that structural and cognitive social capital are closely related yet empirically two distinctive concepts. Taken together, some components of social capital may be more relevant to study than others depending on which population group and age group is under study. The results also implied that the choice of cut-off point of dichotomization of selfrated health has an impact on the estimated effects of the explanatory variables. When the whole age interval, 35-64 years, was analyzed with logistic regression techniques the choice of cut-off point did not matter for the estimated effects of marital status and educational level. The results changed, however, when the age interval was divided into three shorter intervals. If self-rated health is explored using wide age intervals that do not account for age-dependent covariates there is a risk of drawing misleading conclusions. In conclusion, the results presented in the thesis suggest that the uneven distribution of social capital observed between the two language groups in Finland are of importance when trying to further understand health inequalities that exist between Swedish- and Finnish-speakers in Finland. Although social capital seemed to be relevant to the understanding of health among the oldest old, the meaning of social capital is probably different compared to a less vulnerable age group. This should be noticed in future empirical research. In the present thesis, it was shown that the relationship between social capital and health is complex and multidimensional. Different aspects of social capital seem to be important for different aspects of health. This reduces the possibility to generalize the results and to recommend general policy implementations in this area. An increased methodological awareness regarding social capital as well as health are called for in order to further understand the cfomplex association between them. However, based on the present data and findings social capital is associated with health. To understand individual health one must also consider social aspects of the individuals’ environment such as social capital.

Exploring Customer-Oriented Service Offerings in Public Health: Developing Integrated Health Care Services for Rural Areas

Väestön ikääntyminen pakottaa yhteiskunnan ja julkisen terveydenhuollon muutoksiin. Jotta ikääntyvien ihmisten kotona asuminen voidaan mahdollistaa, palvelujärjestelmän pitää mukautua muuttuvaan tilanteeseen. Tämän diplomityön tarkoituksena on tunnistaa asiakaslähtöisiä lähellä asiakasta tarjottavia palvelukokonaisuuksia. Tutkimuksen teoreettinen viitekehys muodostuu asiakasarvon luomisesta ja palvelutarjoamista. Tarkasteluryhmänä on Etelä-Karjalan alueen 60–90-vuotiaat ja käytetty aineisto on kerätty vastaajilta postitse lähetetyllä kyselyllä. Tutkimus on eksploratiivinen ja tulosten tulkinnassa on hyödynnetty määrällisen tutkimuksen ja verkostoanalyysin menetelmiä. Työn keskeisimmät tulokset ovat tunnistetut asiakassegmentit ja heidän tarpeidensa pohjalta muodostetut palvelupaketit. Tulokset indikoivat asiakkaiden tarpeita ja tuloksia on analysoitu myös tuottajan näkökulmasta. Empiiristen tulosten lisäksi teoriaviitekehystä on kehitetty eteenpäin, jotta palvelukeskeiset teoriat voidaan ymmärtää yritysten näkökulman lisäksi asiakkaan näkökulmasta.

Perceptions of health club exercise among middle-aged women

The goal of this Master’s Thesis is to investigate the typical perceptions of health club exercise among middle-aged women. This study is conducted for a Finnish health club Viva Wellness Club due to their interest to examine the perceived barriers of middle-aged women to exercise at their health club. In addition, the behavioral beliefs, normative beliefs, motivation and facilitating factors concerning health club exercise are studied. The social aspect of health clubs as social environments is taken into account. The study is conducted qualitatively with semi-structured interviews Eight customers from Viva Wellness Club are interviewed. The findings revealed that the consumers perceived health club exercise as important, effective, diverse and convenient. Despite the fact that some differences were found, the perceptions about exercise in general concurred with the contestants’ perceptions about health club exercise. The perceived barriers to health club exercise encompassed lack of time, tiredness, health restrictions, weather, family commitments and feelings of embarrassment about one’s appearance and condition.

Cardiovascular health from childhood to adulthood – with special reference to early vascular changes. The Cardiovascular Risk in Young Finns Study

Background: Recent recommendations aim to improve cardiovascular health (CVH) by encouraging the general population to meet positive and modifiable ideal CVH metrics: not smoking, being physically active, and maintaining normal weight, blood pressure, blood glucose and total cholesterol levels and a healthy diet. Aims: The aim of the present study was to report the prevalence of ideal CVH in children and young adults and study the associations of CVH metrics with markers of subclinical atherosclerosis. Participants and methods: The present thesis is part of the Cardiovascular Risk in Young Finns Study (Young Finns Study). Data on associations of CVH metrics and subclinical atherosclerosis were available from 1,898 Young Finns Study participants. In addition, joint analyses were performed combining data from the International Childhood Cardiovascular Cohort (i3C) Consortium member studies from Australia and the USA. Results: None of the participants met all 7 CVH metrics and thus had ideal CVH in childhood and only 1% had ideal CVH as young adults. The number of CVH metrics present in childhood and adulthood predicted lower carotid artery intima-media thickness, improved carotid artery distensibility and lower risk of coronary artery calcification. Those who improved their CVH status from childhood to adulthood had a comparable risk of subclinical atherosclerosis to participants who had always had a high CVH status. Conclusions: Ideal CVH proved to be rare among children and young adults. A higher number of ideal CVH metrics and improvement of CVH status between childhood and adulthood predicted a lower risk of subclinical atherosclerosis.

Evaluation of novel programs in health counseling – their effectiveness in the oral health of young children, and their acceptance by parents and professionals in public dental service.

Aim and design: To evaluate family-based health counseling for young children, and to study the significance of adding parental self-care or the training of professionals to the programs. The effectiveness and acceptability of the programs were evaluated by comparing two new programs with an earlier one. Subjects and methods: The study was carried out in Vantaa, which was divided into three study areas. The subjects consisted of children born in 2008, particularly fi rstborn children, while children born in 2006 formed the historical control. The fi rst of the new programs emphasized oral hygiene and use of fl uoride, and the second program focused on proper diet and use of xylitol. The main outcome measure was mutansstreptococci (MS) in the dental biofi lm of two-year-olds, and the opinions of parents and dental professionals were evaluated using questionnaires. Results: The programs found wide acceptance among dental professionals. There were no group-related differences found in the MS scores of the two-year-olds. However, all groups combined, father’s advanced level of education and child’s proper use of xylitol were associated with negative MS scores. In the opinion of parents, the oral healthcare guidance at least somewhat met their expectations. Conclusions: The present fi ndings suggest that providing training and support for professionals in health education is important. The addition of parental self-care to supplement programs aimed at young children does not improve the program, although it may improve parental readiness to change their own health habits. Counseling for families might be best carried out through a routine patient-centered program.

Cardiovascular health and fitness after childhood acute lymphoblastic leukaemia

The last few decades have turned childhood acute lymphoblastic leukaemia (ALL) from a virtually incurable disease to a disease with 80–90% survival rates. However, this has not come without a cost. Various late effects of the treatment are nowadays well acknowledged, and the survivors have increased cardiovascular (CV) morbidity and mortality. While the treatment of ALL may have direct toxic effects on various organ systems, lifestyle factors affect the CV risk of the survivors as well. Data on CV health and fitness after treatment with common Nordic protocols since 1986 has been scarce. This thesis aimed to study CV health and fitness and the effects of a 3-month exercise intervention in 16–30-year-old long-term survivors of childhood ALL. Fitness was poor especially in female survivors. One third reported ≤1h of moderate physical activity (PA) weekly. While the levels of other CV risk factors were similar in survivors and controls, attenuations in vascular endothelium and cardiac function were found when using advanced echocardiographic methods. The exercise programme improved fitness, insulin resistance, endothelial function as well as measures of cardiac function. While the results do not allow definite conclusions on whether the subclinical signs of cardiac and vascular endothelial dysfunction are due to the treatment of ALL or sedentary lifestyle/poor fitness after treatment, the results are interesting and emphasize the effects of PA in this population. The results indicate beneficial effects of PA on the heart health in ALL survivors and suggest that they should be encouraged to physically active lifestyle.

Promoting Healthy Lifestyles with Personalized, APOE Genotype Based Health Information: The Effects on Psychological-, Health Behavioral and Clinical Factors

There is an increasing demand for individualized, genotype-based health advice. The general population-based dietary recommendations do not always motivate people to change their life-style, and partly following this, cardiovascular diseases (CVD) are a major cause of death in worldwide. Using genotype-based nutrition and health information (e.g. nutrigenetics) in health education is a relatively new approach, although genetic variation is known to cause individual differences in response to dietary factors. Response to changes in dietary fat quality varies, for example, among different APOE genotypes. Research in this field is challenging, because several non-modifiable (genetic, age, sex) and modifiable (e.g. lifestyle, dietary, physical activity) factors together and with interaction affect the risk of life-style related diseases (e.g. CVD). The other challenge is the psychological factors (e.g. anxiety, threat, stress, motivation, attitude), which also have an effect on health behavior. The genotype-based information is always a very sensitive topic, because it can also cause some negative consequences and feelings (e.g. depression, increased anxiety). The aim of this series of studies was firstly to study how individual, genotype-based health information affects an individual’s health form three aspects, and secondly whether this could be one method in the future to prevent lifestyle-related diseases, such as CVD. The first study concentrated on the psychological effects; the focus of the second study was on health behavior effects, and the third study concentrated on clinical effects. In the fourth study of this series, the focus was on all these three aspects and their associations with each other. The genetic risk and health information was the APOE gene and its effects on CVD. To study the effect of APOE genotype-based health information in prevention of CVD, a total of 151 volunteers attended the baseline assessments (T0), of which 122 healthy adults (aged 20 – 67 y) passed the inclusion criteria and started the one-year intervention. The participants (n = 122) were randomized into a control group (n = 61) and an intervention group (n = 61). There were 21 participants in the intervention Ɛ4+ group (including APOE genotypes 3/4 and 4/4) and 40 participants in the intervention Ɛ4- group (including APOE genotypes 2/3 and 3/3). The control group included 61 participants (including APOE genotypes 3/4, 4/4, 2/3, 3/3 and 2/2). The baseline (T0) and follow-up assessments (T1, T2, T3) included detailed measurements of psychological (threat and anxiety experience, stage of change), and behavioral (dietary fat quality, consumption of vegetables, - high fat/sugar foods and –alcohol, physical activity and health and taste attitudes) and clinical factors (total-, LDL- HDL cholesterol, triglycerides, blood pressure, blood glucose (0h and 2h), body mass index, waist circumference and body fat percentage). During the intervention six different communication sessions (lectures on healthy lifestyle and nutrigenomics, health messages by mail, and personal discussion with the doctor) were arranged. The intervention groups (Ɛ4+ and Ɛ4-) received their APOE genotype information and health message at the beginning of the intervention. The control group received their APOE genotype information after the intervention. For the analyses in this dissertation, the results for 106/107 participants were analyzed. In the intervention, there were 16 participants in the high-risk (Ɛ4+) group and 35 in the low-risk (Ɛ4-) group. The control group had 55 participants in studies III-IV and 56 participants in studies I-II. The intervention had both short-term (≤ 6 months) and long-term (12 months) effects on health behavior and clinical factors. The short-term effects were found in dietary fat quality and waist circumference. Dietary fat quality improved more in the Ɛ4+ group than the Ɛ4- and the control groups as the personal, genotype-based health information and waist circumference lowered more in the Ɛ4+ group compared with the control group. Both these changes differed significantly between the Ɛ4+ and control groups (p<0.05). A long-term effect was found in triglyceride values (p<0.05), which lowered more in Ɛ4+ compared with the control group during the intervention. Short-term effects were also found in the threat experience, which increased mostly in the Ɛ4+ group after the genetic feedback (p<0.05), but it decreased after 12 months, although remaining at a higher level compared to the baseline (T0). In addition, Study IV found that changes in the psychological factors (anxiety and threat experience, motivation), health and taste attitudes, and health behaviors (dietary, alcohol consumption, and physical activity) did not directly explain the changes in triglyceride values and waist circumference. However, change caused by a threat experience may have affected the change in triglycerides through total- and HDL cholesterol. In conclusion, this dissertation study has given some indications that individual, genotypebased health information could be one potential option in the future to prevent lifestyle-related diseases in public health care. The results of this study imply that personal genetic information, based on APOE, may have positive effects on dietary fat quality and some cardiovascular risk markers (e.g., improvement in triglyceride values and waist circumference). This study also suggests that psychological factors (e.g. anxiety and threat experience) may not be an obstacle for healthy people to use genotype-based health information to promote healthy lifestyles. However, even in the case of very personal health information, in order to achieve a permanent health behavior change, it is important to include attitudes and other psychological factors (e.g. motivation), as well as intensive repetition and a longer intervention duration. This research will serve as a basis for future studies and its information can be used to develop targeted interventions, including health information based on genotyping that would aim at preventing lifestyle diseases. People’s interest in personalized health advices has increased, while also the costs of genetic screening have decreased. Therefore, generally speaking, it can be assumed that genetic screening as a part of the prevention of lifestyle-related diseases may become more common in the future. In consequence, more research is required about how to make genetic screening a practical tool in public health care, and how to efficiently achieve long-term changes.