Jouni Jaakkola - Profile on Academia.edu (original) (raw)

Papers by Jouni Jaakkola

Scientific Reports, Feb 15, 2016

American Journal of Respiratory and Critical Care Medicine, Oct 15, 2022

HK and AG are both senior authors and contributed equally to this work. HK and AG designed the st... more HK and AG are both senior authors and contributed equally to this work. HK and AG designed the study. CL, JC and RC are joint first authors with equal contribution. CL, JC, and RC coordinated the work, conducted the statistical analysis, and took the lead in drafting the manuscript and interpreting the results. FS, ST, YG, EL, SB, NS, CN, NR, RG, JM, MLB, and JS provided substantial scientific input in interpreting the results and drafting the manuscript.

BMJ Open Respiratory Research, Mar 1, 2019

This study aims to assess the effects of smoking on pre-bronchodilator and post-bronchodilator lu... more This study aims to assess the effects of smoking on pre-bronchodilator and post-bronchodilator lung function measures that reflect both larger and smaller airways in adults with newly onset asthma. ► Among adults with newly onset asthma, lung function measures (FEV 1 , FEF 25-75% ) were significantly reduced in current regular smokers and in recent former smokers (ie, quit less than a year ago) when compared with never smokers; furthermore, doseresponse patterns were found between daily smoking rate or life-time cumulative smoking and lung function measures. ► This study is the first to clarify the effects of smoking on smaller airways lung function, measured as forced expiratory flows, in a larger sample of patients with adult-onset asthma, and to provide effect estimates for lung function parameters measured both prior to and after the bronchodilation test.

International Journal of Environmental Research and Public Health, Sep 9, 2022

We assessed potential relations between indicators of indoor dampness and mold exposures at home ... more We assessed potential relations between indicators of indoor dampness and mold exposures at home and the level of asthma control among adults. The present population-based cross-sectional study, the Northern Finnish Asthma Study (NoFAS), included 1995 adult subjects with bronchial asthma who replied to study questionnaires (response rate: 40.4%). The Asthma Control Test (ACT) was used as the measure of asthma control. We calculated the mean difference in ACT score (ACT difference ) and the risk ratio (RR) of poor asthma control (ACT ≤ 19) for the exposure and reference groups and applied Poisson regression to adjust for potential confounding. Exposure to indoor dampness at home was related to a significantly reduced level of asthma control (ACT difference : -0.83, 95% CI: -1.60 to -0.07), especially among men (ACT difference : -2.68, 95% CI: -4.00 to -1.37). Water damage (aRR = 1.29, 95% CI: 1.01, 1.65) and indoor dampness, especially among men (aRR = 1.92, 95% CI: 1.15, 3.20), increased the risk of poor asthma control. We provide evidence that exposure to indoor dampness at home reduces asthma control among adults, especially in men. Indoor visible mold and mold odor were not significantly related to asthma control. Advice on how to prevent indoor dampness at home should be an important part of asthma management.

PLOS ONE, Sep 21, 2012

Introduction: Pesticide poisoning is an important public health problem worldwide. The study aime... more Introduction: Pesticide poisoning is an important public health problem worldwide. The study aimed to determine the risk of all-cause and cause-specific inpatient mortality and to identify prognostic factors for inpatient mortality associated with unintentional insecticide and herbicide pesticide poisonings. We performed a retrospective cohort study of 3,986 inpatients recruited at hospitalization between 1999 and 2008 in Taiwan. We used the International Classification of Disease, 9th ed., Clinical Modification external causes of injury codes to classify poisoning agents into accidental poisoning by insecticides and herbicides. Comparisons in mortality rates were made between insecticide poisoning patients and herbicide poisoning patients by using the Cox proportional hazards models to estimate multivariable-adjusted hazard ratios (HRs) and their 95% confidence intervals (CIs). Results: There were 168 deaths during 21,583 person-days of follow-up evaluation (7.8 per 1,000 person-days). The major causes of mortality for insecticide poisonings were the toxic effect of organophosphate and coma, and the major causes of mortality for herbicide poisonings were the toxic effect of other pesticides and the toxic effect of organophosphate. The mortality for herbicide exposure was fourfold higher than that for insecticide exposure. The factors associated with inpatient mortality were herbicide poisonings (HR = 4.58, 95% CI 3.29 to 6.37) and receiving mechanical ventilation treatment (HR = 3.85, 95% CI 2.73 to 5.42). We demonstrated that herbicides stand out as the dominant agent for poisoning-related fatalities. The control of and limiting access to herbicide agents and developing appropriate therapeutic regimens, including emergency care, should be priorities.

The European respiratory journal, Jun 1, 1991

The objective of this study was to estimate the effect of cigarette smoking on ventilatory lung f... more The objective of this study was to estimate the effect of cigarette smoking on ventilatory lung function among young adults with special emphasis on the recognltlon of susceptible subgroups. In a cross-sectional study of 1,044 adults aged 15-40 yrs, a statistically significant linear relationship between quantity of smoking In cigaretteyears and level of forced expiratory volume In one second (FEV 1 ) was found. Among current cigarette smokers, FEY 1 level was on average 35 ml lower for each 100 cigarette-years of exposure (corresponding to smoking of ten cigarettes per day for 10 yrs) compared to lifelong non• smokers In a linear regression adjusted for confounding. Potentially susceptible subgroups were studied by Introducing Inter• action terms between quantitative smoking and gender, wheezing, atopy, asthma, childhood respiratory Illness and exposure to environmental tobacco smoke during the growth period, to the additive linear regression model explaining the FEY level. Wheezing was found to modify the effect of smoking signlficanth: the FEY 1 level was on average 68 ml lower for each 100 cigarette-years due to Interaction between smoking and wheezing. An introduction of the Interaction term eliminated the independent effect of smoking. The results suggest that the detrimental effect of smoking on FEY 1 In young adults may be limited to Individuals with wheezing. Thus, the presence of wheezing among smokers Indicates a higher risk for low level of ventllatory lung function compared to smokers who do not wheeze.

Allergy, May 10, 2018

An emerging topic in clinical research of obstructive lung diseases has been the rather recent re... more An emerging topic in clinical research of obstructive lung diseases has been the rather recent recognition of the asthma COPD overlap syndrome, shortened as ACOS (1). There are several questions still unanswered concerning this newly recognized diagnostic entity. The clinical and functional data of ACOS patients do not seem to correspond well with the similar features in patients with asthma or COPD alone (1). In addition, the occurrence of ACOS in many parts of the world is still unknown. Furthermore, ACOS patients seem to have a different clinical evolution compared to the patients with either asthma or COPD alone (2). Thus, further research is needed to identify factors that determine the clinical characteristics as well as prognosis of ACOS. We estimated the prevalence of ACOS among newly-diagnosed adult-onset asthma patients in Southern Finland, and assessed personal, behavioral and hereditary determinants of ACOS among asthma patients. The study population constituted 521 newly-diagnosed asthma patients from The Finnish Environmental and Asthma Study (FEAS), a population-based incident casecontrol study of adult-onset asthma among working-aged population (3). Information was based on an extensive questionnaire, standardized clinical examination, and spirometry. The asthma patient was defined to have ACOS if his/her spirometry showed persistent airflow obstruction with a post-bronchodilator FEV1/FVC less than 70% of predicted (see Online Supporting Information: Methods). The prevalence of ACOS among adults with newly diagnosed asthma was 6.6% (95% confidence interval, CI 4.2-9.1%). Following the case definition, the ACOS cases had considerably lower pre-and post-bronchodilator FEV1 and FEV1/FVC levels than the asthma-only cases (Table ). In Poisson regression, adjusting for potential confounding, the ACOS cases were older (adjusted Prevalence Ratio [PR]: 3.22; 95% CI 1.39-7.47), more often men (2.63; 1.14-6.07), had lower level of education (1.36; 0.56-3.30), and were more often current (7.91; 2.25-27.81) or former smokers (3.23; 0.81-12.87) than the asthma-only cases (Table ). Allergic diseases, especially allergic rhinitis, were less common among the ACOS cases than among the asthma-only cases (Table ). Correspondingly, allergic diseases showed a protective effect for ACOS in the Poisson regression model. Allergic symptoms were consistently less common among the ACOS cases than among the asthma-only cases (Table ). Having additionally other respiratory diseases was more common among the ACOS cases than among the asthma-only cases (Table ). In unadjusted models, having these other diseases strongly increased the risk of ACOS, but in the models adjusting for age, gender, education, and smoking status, these effects were statistically non-significant. Chronic respiratory symptoms, including breathlessness, wheezing, mucus production, and cough, were slightly less common among the ACOS cases compared to the asthma-only cases, with the exception of mucus production (Table ). Of respiratory symptoms, breathlessness, wheezing and cough associated with a lower, but statistically non-significant, risk for ACOS compared to the risk for asthma-only cases. The ACOS cases showed or reported less often any positive allergy findings in skin prick tests or in Phadiatop analysis. In contrast, we found no difference in total IgE levels between the two groups. Similarly, the allergic symptoms, positive skin prick test results or positive Phadiatop test results associated with a lower, statistically nonsignificant risk of ACOS compared to the asthma-only cases. Parental asthma and especially siblings having asthma, was more common among the ACOS cases than among the asthma-only cases, while parental allergy and siblings having allergy-only (i.e. they did not have asthma) were less common among the ACOS cases (Table ). In the Poisson regression models, familial asthma was related to an increased risk of ACOS, while the tendency for a protective effect related to a relative's allergy was limited to parental allergy.

BMC Medical Research Methodology, Mar 5, 2012

Background: Asthma is among the most common chronic diseases in working-aged populations and occu... more Background: Asthma is among the most common chronic diseases in working-aged populations and occupational exposures are important causal agents. Our aims were to evaluate the best methods to assess occurrence, public health impact, and burden to society related to occupational or work-related asthma and to achieve comparable estimates for different populations. Methods: We addressed three central questions: 1: What is the best method to assess the occurrence of occupational asthma? We evaluated: 1) assessment of the occurrence of occupational asthma per se, and 2) assessment of adult-onset asthma and the population attributable fractions due to specific occupational exposures. 2: What are the best methods to assess public health impact and burden to society related to occupational or work-related asthma? We evaluated methods based on assessment of excess burden of disease due to specific occupational exposures. 3: How to achieve comparable estimates for different populations? We evaluated comparability of estimates of occurrence and burden attributable to occupational asthma based on different methods. Results: Assessment of the occurrence of occupational asthma per se can be used in countries with good coverage of the identification system for occupational asthma, i.e. countries with well-functioning occupational health services. Assessment based on adult-onset asthma and population attributable fractions due to specific occupational exposures is a good approach to estimate the occurrence of occupational asthma at the population level. For assessment of public health impact from work-related asthma we recommend assessing excess burden of disease due to specific occupational exposures, including excess incidence of asthma complemented by an assessment of disability from it. International comparability of estimates can be best achieved by methods based on population attributable fractions. Conclusions: Public health impact assessment for occupational asthma is central in prevention and health policy planning and could be improved by purposeful development of methods for assessing health benefits from preventive actions. Registry-based methods are suitable for evaluating time-trends of occurrence at a given population but for international comparisons they face serious limitations. Assessment of excess burden of disease due to specific occupational exposure is a useful measure, when there is valid information on population exposure and attributable fractions.

American Journal of Epidemiology, Aug 9, 2011

There is inconclusive evidence suggesting a possible association of asthma with increased risk of... more There is inconclusive evidence suggesting a possible association of asthma with increased risk of caries. The authors conducted a systematic review and meta-analysis to synthesize the evidence on the relation between asthma and caries. They performed an Ovid Medline (US National Library of Medicine) database search of literature published from 1950 through May 2010 using the Medical Subject Headings ''asthma'' and ''caries.'' Summary effect estimates were calculated with fixed-and random-effects models, and determinants of heterogeneity were studied in meta-regression analysis. The meta-analysis was based on 11 articles providing estimates of the effect of asthma on primary dentition and 14 articles on permanent dentition. Summary effect estimates for the relation between asthma and caries from the random-effects models were 2.73 (95% confidence interval: 1.61, 4.64) and 2.04 (95% confidence interval: 1.44, 2.89), respectively. Factors identified as determinants of heterogeneity were geographic region for primary dentition and publication year, sample size, asthma definition, and information on the use of asthma medication for permanent dentition. Evidence from this analysis suggests that asthma doubles the risk of caries in both primary and permanent dentition. Publication bias diagnostics and simulation suggested possible overestimation of the summary odds ratio for permanent dentition but not for primary dentition. Physicians and dentists should recommend preventive measures against caries for persons with asthma. asthma; dental caries; meta-analysis; review Abbreviations: CI, confidence interval; dfs, number of decayed and filled surfaces in primary dentition; dft, number of decayed and filled teeth in primary dentition; dmf, number of decayed, missing (due to caries), and filled teeth or surfaces in primary dentition; DMF, number of decayed, missing (due to caries), and filled teeth or surfaces in permanent dentition; dmfs, number of decayed, missing, and filled surfaces in primary dentition; DMFS, number of decayed, missing, and filled surfaces in permanent dentition; dmft, number of decayed, missing, and filled teeth in primary dentition; DMFT, number of decayed, missing, and filled teeth in permanent dentition; NOS, Newcastle-Ottawa Quality Assessment Scale; OR, odds ratio.

Environmental Health, Mar 28, 2014

Background: Both temperature and humidity may independently or jointly contribute to the risk of ... more Background: Both temperature and humidity may independently or jointly contribute to the risk of influenza infections. We examined the relations between the level and decrease of temperature, humidity and the risk of influenza A and B virus infections in a subarctic climate. Methods: We conducted a case-crossover study among military conscripts (n = 892) seeking medical attention due to respiratory symptoms during their military training period and identified 66 influenza A and B cases by PCR or serology. Meteorological data such as measures of average and decline in ambient temperature and absolute humidity (AH) during the three preceding days of the onset (hazard period) and two reference periods, prior and after the onset were obtained. The average temperature preceding the influenza onset was -6.8 ± 5.6°C and AH 3.1 ± 1.3 g/m 3 . A decrease in both temperature and AH during the hazard period increased the occurrence of influenza so that a 1°C decrease in temperature and 0.5 g decrease per m 3 in AH increased the estimated risk by 11% [OR 1.11 (1.03 to 1.20)] and 58% [OR 1.58 (1.28 to 1.96)], respectively. The occurrence of influenza infections was positively associated with both the average temperature [OR 1.10 per 1°C (95% confidence interval 1.02 to 1.19)] and AH [OR 1.25 per g/m 3 (1.05 to 1.49)] during the hazard period prior to onset. Our results demonstrate that a decrease rather than low temperature and humidity per se during the preceding three days increase the risk of influenza episodes in a cold climate.

The Journal of Allergy and Clinical Immunology, Nov 1, 2013

Background: A substantial proportion of the world's population is exposed to indoor dampness-rela... more Background: A substantial proportion of the world's population is exposed to indoor dampness-related exposures. Since the 1990s, studies have assessed the relation between indoor dampness and mold and rhinitis, but the evidence has been inconclusive. No previous meta-analysis has been reported on this topic. Objective: We conducted a systematic review and meta-analysis of studies on the relations between indoor dampness and mold and the risk of different types of rhinitis and investigated whether these relations differ according to the type of exposure. Methods: A systematic search of the Ovid MEDLINE and EMBASE databases was conducted (1950 through August 2012), and reference lists of relevant articles were reviewed. Crosssectional, case-control, and cohort studies in children or adults were selected according to a priori criteria and evaluated by 3 authors independently. Results: Thirty-one studies on rhinitis, allergic rhinitis (AR), or rhinoconjunctivitis were included. In meta-analyses the largest risk was observed in relation to mold odor (rhinitis: 2.18 [95% CI, 1.76-2.71]; AR: 1.87 [95% CI, 0.95-3.68]). The risk related to visible mold was also consistently increased (rhinitis: 1.82 [95% CI, 1.56-2.12]; AR: 1.51 [95% CI, 1.39-1.64]; rhinoconjunctivitis: 1.66 [95% CI, 1.27-2.18]). In addition, exposure to dampness was related to increased risk of all types of rhinitis. Conclusion: This meta-analysis provides new evidence that dampness and molds at home are determinants of rhinitis and its subcategories. The associations were strongest with mold odor, suggesting the importance of microbial causal agents. Our results provide evidence that justifies prevention and remediation of indoor dampness and mold problems, and such actions are likely to reduce rhinitis. (

BMJ Open, Aug 1, 2018

Objective To test the a priori hypothesis that the association between cold spells and ischaemic ... more Objective To test the a priori hypothesis that the association between cold spells and ischaemic sudden cardiac death (SCD) is modified by the severity of coronary stenosis. Methods The home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged ≥35 in the Province of Oulu, Finland, were linked to 51 years of weather data. Cold spell was statistically defined for each home address as unusually cold weather pertinent to the location and time of year. We estimated the occurrence of cold spells during the hazard period (7 days preceding death) and reference periods (the same calendar days over 51 years) in a casecrossover setting applying conditional logistic regression, controlling for temporal trends and stratifying by severity of coronary stenosis. results The association between cold spells and ischaemic SCD was stronger among patients with 75%-95% stenosis (OR 2.03; 95% CI 1.31 to 3.17), and weaker to non-existent among patients with <75% stenosis (OR 0.97; 95% CI 0.37 to 2.55) or coronary total occlusion (100% stenosis) (OR 1.01; 95% CI 0.52 to 1.96). Lack of calcium-channel blockers and statin therapy seemed to accentuate the role of stenosis during cold spells. Conclusions We provide evidence that the association between cold spells and ischaemic SCD is modified by the severity of coronary stenosis. The findings suggest that disturbances in coronary circulation play part in the pathogenesis of SCD during cold weather.

American Journal of Public Health, Oct 1, 1996

Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic dr... more Serum folate concentrations during pregnancy in women with epilepsy: relation to antiepileptic drug concentra- tions, number of seizures, and fetal out- come. BMJ. 1983;287:577-579. 10. Centers for Disease Control and Prevention. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR 1992;41(No. RR-14).

Human Reproduction, Jul 25, 2007

BACKGROUND: Organic solvents are among the most common exposures in the workplace. Our objective ... more BACKGROUND: Organic solvents are among the most common exposures in the workplace. Our objective was to elaborate the relationship between prenatal occupational solvent exposure and fetal growth as well as duration of pregnancy, and to quantify the impact of occupational organic solvent exposure. METHODS: We conducted a population-based study of 1670 singleton newborns of women who participated in The Finnish Prenatal Environment and Health Study after their delivery (response rate 94%) and who were working during pregnancy (65%). Exposure information was based on questions about exposure to solvents at work before and during pregnancy. The health outcomes, based on information from a questionnaire and the Finnish Medical Birth Registry, were low birth weight (<3000 g), small-for-gestational-age and preterm delivery (<37 weeks). RESULTS: In logistic regression analysis, the risk of the baby being small-for-gestational-age was related to any exposure to solvents 3 months before or during pregnancy with an adjusted odds ratio (OR) of 1.67 [95% confidence interval (CI) 5 1.02-2.73]. Also the adjusted OR for low birth weight was elevated with exposure, although it did not reach statistical significance (1.17; 95% CI 5 0.71-1.93). The population attributable fraction for small-for-gestational-age was 2.3% for all pregnant women. CONCLUSIONS: Work exposure to organic solvents may reduce intrauterine growth by increasing the risk of the baby being small-for-gestational-age.

The European respiratory journal, Dec 1, 1996

The objective of the study was to assess the relationship between breastfeeding and lower respira... more The objective of the study was to assess the relationship between breastfeeding and lower respiratory tract infections (LRTIs) during the first year of life, with special reference to maternal smoking. A cohort of 3,754 children born in 1992-1993 in the City of Oslo, Norway was recruited and data were collected at birth, 6 and 12 months of age. Complete information was obtained from 3,238 children (follow-up rate 86%). The main outcome was an episode of a LRTI, such as pneumonia, bronchitis or bronchiolitis, based on a self-administered questionnaire addressed to parents when the child was 6 and 12 months old. The outcome was specified as physician-diagnosed. In logistic regression analysis adjusting for confounding, maternal smoking increased the risk of LRTIs in children breastfed for 0-6 months (odds ratio (AOR) 1.7; 95% confidence interval (95% CI) 1.2-2.4), but not essentially when the child was breastfed for more than 6 months (AOR 1.1; 95% CI 0.7-1.6). Short-term breastfeeding (0-6 months) and no maternal smoking was related to an adjusted AOR of LRTIs of 1.3 (95% CI 1.0-1.7), and short-term breastfeeding combined with maternal smoking was related to an adjusted AOR of 2.2 (95% CI 1.6-3.1), as compared with long-term breastfeeding and no maternal smoking. The present study indicates a protective effect of long-term breastfeeding on the risk of lower respiratory tract infection during the first year of life. The results suggest that the protective effect is strongest in children exposed to environmental tobacco smoke.

Scientific Reports, Aug 19, 2019

We conducted a randomized controlled trial to test the hypothesis that a 24-week exercise interve... more We conducted a randomized controlled trial to test the hypothesis that a 24-week exercise intervention improves asthma control in adults. Adults with mild or moderate asthma were randomly assigned to either the exercise intervention group (iG) or the reference group (RG). participants in iG received an individualized exercising program, including aerobic exercise at least three times a week for ≥30 minutes, muscle training, and stretching. The primary outcome was asthma control, measured by Asthma Control Test (ACT), asthma-related symptoms, and peak expiratory flow (PEF) variability. We estimated the risk (i.e. probability) of improvement in asthma control and the risk difference (RD) between IG and RG. Of 131 subjects (67 IG/64 RG) entered, 105 subjects (51/54) completed the trial (80%), and 89 (44/45) were analysed (68%). The ACT became better among 26 (62%) participants in IG and among 17 (39%) participants in RG. The effect of intervention on improving asthma control was 23% (RD = 0.23, 95% CI 0.027-0.438; P = 0.0320). the intervention also reduced shortness of breath by 30.1% (RD = 0.301, 95% CI 0.109-0.492; P = 0.003). The change in PEF variability was similar in both groups. Regular exercise improves asthma control measured by the ACT, while has little effect on PEF variability. The World Health Organization has estimated that 235-250 million people worldwide are affected by asthma 1 . Approximately 4.3% of the global adult population have asthma 2 . In spite of advancements in pharmacological treatment, poor asthma control continues to lead to a substantial number of health care visits and hospitalizations, and to lower quality of life. Asthma is a chronic inflammatory disease of the airways, characterized by airway obstruction and bronchial hyperresponsiveness (BHR). The most common symptoms of asthma include cough, wheezing, shortness of breath/breathlessness, and chest tightness 3 . Aerobic exercise often provokes asthma-related symptoms, and may, therefore, lead to an aversion to physical exercise among asthmatics 4 . Previously, subjects with asthma were advised by their doctor to avoid exercise. However, regular aerobic exercise has been shown to produce substantial health benefits among healthy subjects. Because of these findings, more recently an interest has arisen on whether exercise might also be beneficial for asthma patients. Our previous systematic review and meta-analysis provided evidence that regular physical exercise improves physical fitness among adult asthmatics, but the evidence was insufficient to assess the effects of exercise on asthma control and quality of life 5 . To fill in this gap in knowledge, we conducted The Regular Exercise and Asthma Control Trial (REACT) to test the hypothesis that regular exercise improves asthma control. participants. We assessed 195 subjects for eligibility (see the criteria in Table ); 13 subjects were not eligible and 18 declined to participate after the introduction to the study (Fig. ). The remaining 164 subjects were randomly allocated into the intervention group (n = 82) and the reference group (n = 82). They received detailed information on the study and were asked to perform a step test. Additional 33 subjects were disqualified in the run-in phase. The remaining 131 subjects received the allocated active (n = 67) or reference intervention (n = 64). The entry time to the intervention was defined by the performance of the first spiroergometry testing. These two groups were broadly similar at the baseline, including the amount of regular exercise performed, the mean level

BMJ Open, 2020

► Identification of individual studies based on a clearly defined and extensive search strategy b... more ► Identification of individual studies based on a clearly defined and extensive search strategy based on a priori set inclusion and exclusion criteria. ► In addition, secondary references were included. ► The study-specific effect estimates were converted into comparable effect estimates for exposure corresponding to 10 pollen grains increase per cubic metre of air. ► Publication bias was assessed by visual inspection of the funnel plots and by applying Begg's and Egger's tests. ► The number of studies available for the subanalyses investigating effects on various outcomes was quite low.

PLOS ONE, Dec 2, 2014

Background: About 41% of households globally, mainly in developing countries rely on solid fuels ... more Background: About 41% of households globally, mainly in developing countries rely on solid fuels for cooking with consequences for fetal growth and development. Previous reviews were limited in scope, assessing only two outcomes (birth weight, stillbirth). With important evidence accumulating, there is a need to improve the previous estimates and assess additional outcomes. We conducted a systematic review and meta-analysis to evaluate the quality and strength of available evidence on household air pollution (HAP) and the whole range of adverse pregnancy outcomes. Methods: PubMed, Ovid Medline, Scopus and CINAHL were searched from their inception to the end of April 2013. All epidemiological study designs were eligible for inclusion in the review. The random-effects model was applied in computing the summary-effect estimates (EE) and their corresponding 95% confidence interval (CI). Results: Of 1505 studies screened, 19 studies satisfied the inclusion criteria. Household combustion of solid fuels resulted in an 86.43 g (95% CI: 55.49, 117.37) reduction in birth weight, and a 35% (EE51.35, 95% CI: 1.23, 1.48) and 29% (EE51.29, 95% CI: 1.18, 1.41) increased risk of LBW and stillbirth respectively. Conclusion: Combustion of solid fuels at home increases the risk of a wide range of adverse pregnancy outcomes. Access to clean household energy solutions is the surest way to combat HAP and mitigate their adverse effects.

The European respiratory journal, Oct 1, 1997

Archives of Disease in Childhood, Oct 1, 1996

To assess the relation between early acute otitis media and exposure to respiratory pathogens med... more To assess the relation between early acute otitis media and exposure to respiratory pathogens mediated by siblings and other children, a prospective cohort of 3754 Norwegian children born in 1992-3 was followed up from birth to 12 months. Of these, 25% had one or more episodes of acute otitis media during the first year. Results from multiple logistic regression analysis adjusted for confounding showed that siblings' attendance at daycare is the most important risk factor for early acute otitis media (adjusted odds ratio, OR.dj = 1.9). The total number of children in the daycare setting is another determinant for early acute otitis media (ORadj = 2.0 in groups of four or more other children and ORadj = 1.3 in groups of one to three other children, as compared to those who are cared for alone). Having siblings in daycare outside the home and the number of children in the daycare setting are the most important determinants for early acute otitis media.

Scientific Reports, Feb 15, 2016

American Journal of Respiratory and Critical Care Medicine, Oct 15, 2022

BMJ Open Respiratory Research, Mar 1, 2019

International Journal of Environmental Research and Public Health, Sep 9, 2022

PLOS ONE, Sep 21, 2012

The European respiratory journal, Jun 1, 1991

Allergy, May 10, 2018

BMC Medical Research Methodology, Mar 5, 2012

American Journal of Epidemiology, Aug 9, 2011

Environmental Health, Mar 28, 2014

The Journal of Allergy and Clinical Immunology, Nov 1, 2013

BMJ Open, Aug 1, 2018

American Journal of Public Health, Oct 1, 1996

Human Reproduction, Jul 25, 2007

The European respiratory journal, Dec 1, 1996

Scientific Reports, Aug 19, 2019

BMJ Open, 2020

PLOS ONE, Dec 2, 2014

The European respiratory journal, Oct 1, 1997

Archives of Disease in Childhood, Oct 1, 1996

Barentsin alue muuttuu – miten Suomi sopeutuu? Ympäristön, ilmaston ja yhteiskunnallisten muutos... more Barentsin alue muuttuu – miten Suomi sopeutuu?

Ympäristön, ilmaston ja yhteiskunnallisten muutosten yhteisvaikutukset ja niiden seuraukset leimaavat arktisen alueen kehitystä seuraavina vuosikymmeninä. Muutoksiin sopeutuminen vaatii varautumista alueen toimijoilta. Suomi osana euroarktista aluetta sopeutuu muutoksiin monin tavoin. Barentsin alue on erityinen arktinen alue: teollisesti ja infrastruktuuriltaan kehittynyt, suhteellisen tiheästi asuttu sekä monikulttuurinen verrattuna muihin arktisiin alueisiin.

Raportissamme tarkastelemme muutoksiin sopeutumista Suomen sopeutumiskyvyn ja hallinnan näkö-kulmista. Tavoitteena on tuottaa kokonaisvaltaista tietoa Barentsin alueen muutoksista, niiden vaikutuk-sista sekä pitkän aikavälin sopeutumisesta nimenomaan suomalaisesta näkökulmasta suomalaisille päättäjille. Näin voidaan tukea sopeutumista edistävää päätöksentekoa. Raportti sisältää myös suosi-tuksia sopeutumisen edistämiseksi.

Raportti perustuu suomalaisten asiantuntijoiden tekemään työhön Arktisen neuvoston ja Arktisen alueen ympäristön tilaa arvioivan ohjelman (AMAP) arktisen alueen sopeutumisen vaihtoehtoja tarkastele-vassa ”Adaptation Actions for a Changing Arctic” (AACA) -hankkeessa. Asiantuntijat ovat valmistelleet AACA-hankkeessa englanninkielisen Barentsin alueen muutoksia, niiden vaikutuksia ja sopeutumista koskevan osaraportin, joka julkaistaan vuonna 2017 (AMAP 2017).