The Effects of the Breast Cancer Mammography Screening Programme in Women aged 40 to 84 years in Turku, Finland (1987-2009)

The objective of this thesis was to evaluate whether a more extensive mammography screening programme (TurkuMSP) conducted by the city of Turku, had an effect on breast cancer (BC) incidence, survival, or mortality in years 1987 to 2009. Despite the fact that some studies have suggested a 20 percent reduction in BC mortality due to mammography screening, there are findings of harm to subjects, which are claimed to negate the benefits of screening. Thus, the aims of this study are most pertinent. A total of 176 908 screening examinations were performed in 36 000 women aged 40−74 during the years 1987−1997. In all, 685 primary BCs were found in the screened women, either screen-detected (n=531) or during screening intervals (n=154). Survival and BC recurrence rate of women with screen-detected BC was compared to 184 women with clinical BCs detected among individuals who did not take part in the screening. The invitation interval, which may influence the outcome, was studied in the age group 40 to 49 by inviting those born in even calendar years annually for mammography screening and those born in odd years, triennially. In addition, BC incidence and mortality in the total female population of Turku aged 40 to 84 years was compared with the respective figures of Helsinki and the rest of Finland, both during the pre-screening era (1976-1986) and the screening era (1987-2009). The study was designed to compare women by age groups, because women aged 50 to 59 were generally screened in all of Finland, whereas only in Turku women aged 40 to 49 and 60 to 74 were screened in addition. Data regarding cancer recurrence were derived from the Finnish Cancer Registry and data on deaths were collected from Statistics Finland. In survival analyses, screened women with invasive BC had a significantly higher survival rate than the women with clinical BC. The survival benefit started to appear already during the first follow-up years and was evident in all age groups. A marginal survival extension was also seen in screened women when BC had spread to ipsilateral axillary nodes already at diagnosis. Recurrence-free survival rate after BC treatment was significantly more favorable among the screened women compared with women with BC found clinically. The screening invitation interval did not significantly influence BC mortality in the subset of women aged 40 to 49 years. There were no consistent differences in the changes of BC incidence between Turku and the comparison areas during the screening era. In Turku, the BC mortality incidence in women aged 55−69 years was significantly lower during the screening era (from 1987 to 1997) compared with the pre-screening era, whereas no such change was found in the city of Helsinki or Tampere. When comparing the changes in incidence-based BC mortality during years 1987 to 2009 in Turku to those of Helsinki and the rest of Finland, there was a suggestion of more than 20 percent lower mortality in Turku among oldest age group (75-84 years) compared with the reference residential areas, but the differences were not consistently significant. Interpretation of the study results should be made with caution because there were no random control groups, and on the other hand, the number of cases in subgroups was fairly low to yield definite conclusions. Also due to the many statistical analyses, some of the findings may be due to chance. The results are, however, suggestive for a decrease of BC mortality in the elderly age groups due to wide mammography screening. This finding needs confirmation in further studies before recommending an expansion of mammography screening to women up to the age of 74 years

Purje-väylä kartta Saimaan vesillä Kiviluodosta Joensuuhun

0-meridiaani : Greenwich

Nilakka

Kartan esitystekniikka: maastokartta

Purje-väylä kartta Saimaan vesillä Savonlinnasta Kaijaluotoon

0-meridiaani : Greenwich

Karta farvatera ot o[stro]va Muraisari do o[stro]va Hannusari

0-meridiaani : Greenwich

Purje-väylä kartta Saimaan vesillä Sorsakalliosta Papinsaareen

0-meridiaani : Greenwich

Purje-väylä kartta Saimaan vesillä Saviluodosta Muuraissaareen

0-meridiaani : Greenwich

Purje-väylä kartta Saimaan vesillä Lappeenrannasta Petrasaareen

0-meridiaani : Greenwich

Purje-väylä kartta Saimaan vesillä Pienestä Kolloniemestä Savonlinnaan

0-meridiaani : Greenwich

Purje-väylä kartta Kallavedellä Hannusaaresta Kuopioon

0-meridiaani : Greenwich

Purje-väylä kartta Saimaan vesillä Petrasaaresta Pieneen Kolloniemeen

0-meridiaani : Greenwich

Opiskeluaikaisen työssäkäynnin yhteys korkeakouluopiskelijan hyvinvointiin

Tutkielmani aiheena on korkeakouluopiskelijoiden lukukauden aikaisen työssäkäynnin yhteys hyvinvointiin. Ensimmäisessä tutkimuskysymyksessäni jaottelen työajan, vapaa-ajan ja opiskeluajan erikseen tarkastelun kohteeksi, jotta saan selville eri ajankäyttötapojen yhteyden psyykkiseen oireiluun. Tämän asetelman avulla voin paremmin nostaa esille työajan merkitystä yhtenä selittävänä tekijänä vapaa-ajan ja opiskeluajan rinnalla. Koska hyvinvointiin vaikuttavat muutkin tekijät kuin ajankäyttötavat, toisessa tutkimuskysymyksessäni otan huomioon demografiset ja koulutustekijät, tulot ja työllistymisasenteen sekä näiden yhteyden psyykkiseen oireiluun työssäkäynnin rinnalla. Tutkielmani antaa uudenlaisen näkökulman opiskelijoiden työssäkäyntiä koskevaan keskusteluun ja hahmottaa, minkälainen merkitys työllä, vapaa-ajalla ja opiskeluajalla on opiskelijoiden hyvinvointiin. Kohdejoukkona ovat Suomen ammattikorkeakoulujen ja yliopistojen opiskelijat, joista kyselyyn vastasi 3011 henkilöä. Aineistonani on valmis Eurostudent 2010, joka on osa yhteiseurooppalaista Eurostudent IV -tutkimushanketta. Tutkimusmetodeina käytän logistista regressiota ja tulokset esitetään marginaaliefekteinä. Keskeisimmät tulokset ovat, että työssäkäyvillä opiskelijoilla on pienempi todennäköisyys psyykkiseen oireiluun kuin työtä tekemättömillä opiskelijoilla. Vapaa-ajalla on hyvin heikko, mutta kuitenkin merkitsevä, positiivinen yhteys psyykkiseen oireiluun. Opiskeluajalla ei ole yhteyttä psyykkiseen oireiluun. Toisen tutkimuskysymyksen muuttujista nousee selkeästi esille perheellisyyden ja positiivisen työllistymisasenteen yhteys psyykkiseen hyvinvointiin. Tulosten selityksenä on, että työssäkäynnillä on muitakin myönteisiä vaikutuksia opiskelijan hyvinvointiin kuin pelkästään toimeentulon paraneminen. Työssäkäyvät opiskelijat mahdollisesti kehittävät elämänhallintakeinoja, joita kuvastavat myös perheellisyys ja positiivinen työllistymisasenne. Perheellisyys turvaa sosiaaliset suhteet, jotka tukevat hyvinvointia, ja myönteinen suhtautuminen tulevaisuuteen toimii suojaavana tekijänä epävarmuutta vastaan. Toisaalta kyseessä voi olla, että työssäkäyvät opiskelijat ovat alkujaan terveempiä, mikä osittain selittäisi vapaa-ajan yhteyden psyykkiseen oireiluun. Psyykkisesti oireilevat mahdollisesti tarvitsevat enemmän vapaa-aikaa.

Schools as Oral Health Promoters – Evaluation of National Sweet Selling Recommendation and Oral Health Education Material

The aims were to find out 1) if schools’ oral health practices were associated with pupils’ oral health behaviour and whether 2) the national sweet-selling recommendation and 3) distributing oral health material (OHEM) affected schools as oral health promoters. Three independently collected datasets from Finnish upper comprehensive schools (N=988) were used: longitudinal oral health practices data (n=258) with three-year follow up (2007 n=480, 2008 n=508, 2009 n=593) from principals’ online questionnaires, oral health behaviour data from pupils participating in the national School Health Promotion Study (n=970 schools) and oral health education data from health education teachers’ online questionnaires (2008 n=563, 2009 n=477 teachers). Oral health practices data and oral health behaviour data were combined (n=414) to answer aim 1. For aims 2 and 3, oral health practices data and oral health education data were used independently. School sweet selling and an open campus policy were associated with pupils’ use of sweet products and tobacco products during school time. The National Recommendation was quite an effective way to reduce the number of sweet-selling schools, but there were large regional differences and a lack of a clear oral health policy in the schools. OHEM did not increase the proportion of teachers teaching oral health, but teachers started to cover oral health topics more frequently. Women started to use OHEM more often than men did. Schools’ oral health policy should include prohibiting the selling of sweet products in school by legislative actions, enabling healthy alternatives instead, and setting a closed campus policy to protect pupils from school-time sweet consuming and smoking.

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