Hannu Valtonen

The economic impact of dementia in Europe in 2008-cost estimates from the Eurocode project.

Care for demented people is very resource demanding, the prevalence is increasing and there is so far no cure.

Neuropsychiatric symptoms and Quality of Life in patients with very mild and mild Alzheimer's disease

Neuropsychiatric symptoms (NPS) are common manifestations of Alzheimers disease (AD).

Cost-Effectiveness of Population-Level Physical Activity Interventions: A Systematic Review

Objective. This systematic review synthesizes the evidence on the cost-effectiveness of population-level interventions to promote physical activity. Data Source. A systematic literature search was conducted between May and August 2013 in four databases: PubMed, Scopus, Web of Science, and SPORTDiscus. Study Inclusion and Exclusion Criteria. Only primary and preventive interventions aimed at promoting and maintaining physical activity in wide population groups were included. An economic evaluation of both effectiveness and cost was required. Secondary interventions and interventions targeting selected population groups or focusing on single individuals were excluded. Data Extraction. Interventions were searched for in six different categories: (1) environment, (2) built environment, (3) sports clubs and enhanced access, (4) schools, (5) mass media and community-based, and (6) workplace. Data Synthesis. The systematic search yielded 2058 articles, of which 10 articles met the selection criteria. The costs of interventions were converted to costs per person per day in 2012 U.S. dollars. The physical activity results were calculated as metabolic equivalent of task hours (MET-hours, or MET-h) gained per person per day. Cost-effectiveness ratios were presented as dollars per MET-hours gained. The intervention scale and the budget impact of interventions were taken into account. Results. The most efficient interventions to increase physical activity were community rail-trails (

A systematic review of the impact of potentially inappropriate medication on health care utilization and costs among older adults

.006/MET-h), pedometers (

Alcohol use among adolescents, aggressive behaviour, and internalizing problems

.014/MET-h), and school health education programs (

Psychosocial problems in adolescents associated with frequent health care use

.056/MET-h). Conclusion. Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

PMC2 EFFICIENT DATA MINING AND PROBABILISTIC INFERENCE WITH P-COURSE: A BAYESIAN METHOD WITH MULTILEVEL PRIORS FOR MEDICAL APPLICATIONS

Background:Potentially inappropriate medications (PIMs) are defined as those medicines having a greater potential risk than benefit for older adults. In this systematic literature review, we evaluate the current evidence on health care service use and health care costs associated with PIMs among older adults. Methods:A literature search was conducted in August 2015 without publication date restrictions using the databases PubMed and Scopus. Selected articles included in the review of articles were: (1) observational cohort or case-control, or intervention studies; (2) investigating PIM use among older adults aged 65 years or older with outcomes on health care utilization (eg, hospitalization) or health care costs; and (3) use of some published criteria for assessing PIMs. Results:Of 825 abstracts screened, in total 51 articles proceeded to full-text review. Of those full-text articles, 39 articles were included in this review. Most of the articles found that PIMs had a statistically significant effect on health care service use, especially on hospitalization, among older adults. The findings of impact on length of stay or readmissions were inconclusive. Five studies found statistically significant higher medical or total health care costs for PIM users compared those who did not use any PIMs. Conclusions:PIMs can, in addition to health and quality of life problems, also lead to greater health care service use and, thus, higher health care costs. However, the heterogeneity of the study settings makes the interpretation of the results difficult. Further studies, especially on economic issues with country-specific criteria, are needed.

Public health care providers and market competition: the case of Finnish occupational health services

Alcohol use is common among adolescents, but its association with behavioural and emotional problems is not well understood. This study aimed to investigate how self-reported psychosocial problems were associated with the use of alcohol in a community sample consisting of 4074 Finnish adolescents aged 13-18 years. Aggressive behaviour associated with alcohol use and a high level of alcohol consumption, while internalizing problems did not associate with alcohol use. Having problems in social relationships associated with abstinence and lower alcohol consumption. Tobacco smoking, early menarche and attention problems also associated with alcohol use.

Patient characteristics and fairness

BACKGROUND The prevalence of somatic, mental and behavioural problems increases in puberty. Nevertheless, compared to adults, health service utilization by adolescents, and associated factors such as risky health behaviours, have been poorly explored. In order to improve health care services, there is a need for further research on adolescents frequently using primary health care. OBJECTIVES We aimed to investigate adolescents who seek help for health issues, and examine whether particular socio-economic or psychological factors predict frequent primary health care use. METHODS Finnish adolescents aged 13-18 years (N = 793) attending comprehensive, upper secondary and vocational schools participated in the study in 2005. Data were collected using a questionnaire that included the Youth Self Report (YSR), as well as questions on the psychosocial background of the adolescents and substance use. Data regarding the frequency of use of health services were gathered from medical records of the local public health care services. RESULTS Altogether, 288 in the sample had used primary health care services making a combined total of 1411 health care visits. Female gender associated with frequent primary health care use. Furthermore, a high level of alcohol consumption and mental health symptoms in girls, and increased self-reported somatic complaints in the YSR in boys were associated with frequent primary health care use. Attending upper secondary school was related to less frequent primary health care use. CONCLUSION Few adolescents frequently use primary health care, but they account for a considerable proportion of all adolescent health care visits. There are higher levels of alcohol consumption, as well as socio-economic, educational and gender differences among adolescent frequent primary health care users.

Incident Use of a Potentially Inappropriate Medication and Hip Fracture in Community-Dwelling Older Persons With Alzheimer’s Disease:

•Predictions are sequential by nature: choice regarding the next parameter, test or drug depends on the previous inference and earlier experience. •This sequence provides valuable information for relevance, which P-Course’s hill-descending screening utilizes: the greedy algorithm starts with an empty predictor set, evaluates all possible changes at each iteration, applies the parameter leading to the best improvement in log score (indicator for prediction distribution) and stops when no improvement is gained in the score. RESULTS: •P-Course introduces a rare possibility to utilize multiple priors to improve model’s accuracy and area under ROC curve (AUC) in exploratory/confirmatory analysis. •P-Course offers several functionalities through a graphical user interface. •First, the data is uploaded in ASCII format through “Administration”. •Then, in “Properties”, the dependent variable and independent variables (automatic/manual/ignore) are chosen. •In “Priors”, likelihood or weights with multilevel priors (direct/reversed) are chosen. •The overall quality of the models, defaults, and case-by-case predictions can be tested with e.g. leave-one-out crossvalidation, with a new data set (substitution) or with a stratum excluded from the teaching set (portioning) through “Prediction”. •Likelihood, posterior and inverse probability predictions are available in the “Java Playground”. •Severe over-learning is rarely observed. •The approach is supported by theory and predictions. CONCLUSIONS: •P-Course can utilize scarce, censored and complex data for e.g. segmentation, stratification, prediction, merging, data reduction, variable screening, interaction and adverse event identification, value of information (VOI), sensitivity analysis, inversion, diagnostics, and decision support. EFFICIENT DATA MINING AND PROBABILISTIC INFERENCE WITH P-COURSE: A BAYESIAN METHOD WITH MULTILEVEL PRIORS FOR MEDICAL APPLICATIONS Erkki J.O. Soini1,2, Janne A. Martikainen2, Jussi Lahtinen3, Petri Myllymaki3, Petri Kontkanen3, Hannu Valtonen1, Olli-Pekka Ryynanen4