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Background. Giant cell arteritis (GCA) is an autoimmune vasculitis affecting medium- and large-sized arteries. Vascular inflammation may lead to narrowing of the arterial lumen, and acute occlusion may result in vision loss and stroke. The classical symptoms include headache, fever, and jaw claudication. However, there is an increasing recognition of atypical presentations. Case Presentation. We report a case of a 70-year-old woman presenting with fluctuating manic symptoms and confusion, in addition to headache and musculoskeletal pain. After diagnosis of GCA, treatment with corticosteroids gradually improved the somatic symptoms. Conclusion. Corticosteroids led to a temporary exacerbation of manic symptoms, which improved after 3 to 4 weeks of continuous treatment, indicating that the symptoms were most likely associated with GCA. The patient manifested with clinical features and a clinical course that has, to our knowledge, not been described or published before. Therefore, GCA may be an underdiagnosed disease in psychiatric populations and should be considered in case of atypical, new-onset psychiatric disorders in the elderly.

The effects of marriage on criminal behavior have been studied extensively. As marriages today are typically preceded by cohabiting relationships, there is a growing need to clarify how different relationship types are associated with criminality, and how these effects may be modified by relationship duration, partner’s criminality, and crime type. We used Finnish longitudinal register data and between- and within-individual analyses to examine how cohabitation and marriage were associated with suspected crime. The data included 638,118 residents of Finland aged 0–14 in 2000 and followed for 17 years for a suspected crime: having been suspected of violent, drug, or any crime. Between-individual analyses suggested that those who were cohabiting or married had a 40–65% lower risk of being suspected of a crime compared to those who were single, depending on the type of crime. The within-individual analysis showed a 25–50% lower risk for suspected crime when people were cohabiting or married compared to time periods when they were single. Those in a relationship with a criminal partner had 11 times higher risk for suspected crime than those in a relationship with a non-criminal partner. Forming a cohabiting relationship with a non-criminal partner was associated with reduced criminality. The risk reduction was not fully explained by selection effects due to between-individual differences. Marriage did not introduce further reduction to criminality. Our findings demonstrate that selection effects partly explain the association between relationship status and criminality but are also compatible with a causal effect of cohabitation on reduced risk of being suspected of a crime.

Background We sought to clarify the impact of adolescent alcohol misuse on adult physical health and subjective well-being. To do so, we investigated both the direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction and the indirect effects on these outcomes attributable to subsequent alcohol problems. Method The sample included 2733 twin pairs (32% monozygotic; 52% female) from the FinnTwin16 study. Adolescent alcohol misuse was a composite of frequency of drunkenness, frequency of alcohol use, and alcohol problems at ages 16, 17, and 18.5. The early midlife outcomes included somatic symptoms, self-rated health, and life satisfaction at age 34. The mediators examined as part of the indirect effect analyses included alcohol problems from the Rutgers Alcohol Problem Index at ages 24 and 34. Serial mediation and co-twin comparison models were applied and included covariates from adolescence and early midlife. Results There were weak direct associations between adolescent alcohol misuse and early midlife physical health and life satisfaction. However, there was stronger evidence for indirect effects, whereby young adult and early midlife alcohol problems serially mediated the relationship between adolescent alcohol misuse and early midlife somatic symptoms (beta = 0.03, 95% CI [0.03, 0.04]), self-rated health (beta = -0.02, 95% CI [-0.03, -0.01]), and life satisfaction (beta = -0.03, CI [-0.04, -0.02]). These serial mediation effects were robust in co-twin comparison analyses. Conclusions These results provide evidence that alcohol problems are a primary driver linking adolescent alcohol misuse and poor health outcomes across the lifespan.

Low resting heart rate (HR) is a known risk indicator for the development of antisocial behavior (ASB) and other clinical problems. Stimulation seeking and fearlessness have been explored as factors underlying the HR/ASB relationship, but these have often been conflated, which has complicated interpretation. We examined HR’s associations with ASB and other outcomes in terms of biobehavioral traits described by the triarchic model of psychopathy using data ( N = 710) from a longitudinal study of ASB risk. Low resting HR in childhood was related to adult ASB, and covariance between ASB and traits of disinhibition and boldness largely accounted for this association. In addition, low childhood HR was related to greater externalizing problems and fewer internalizing problems in adulthood; disinhibition accounted for the former association, and boldness accounted for the latter. Findings indicate a role for both disinhibition and boldness in associations between early HR and later clinical outcomes and have implications for theory and practice.

This is the author's original version and has not been peer reviewed.Background: Population research indicates that smoking behaviors in Finland have varied over time by sex and birth cohort. Smoking behaviors are influenced by genes and the environment; like the behaviors themselves, these underlying influences are not necessarily stable over time and may be modifiable by national drug policy. Methods: We utilized longitudinal mixed effects models and causal-common-contingent twin models to evaluate sex and cohort effects on tobacco consumption and the underlying genetic and environmental variance components in a birth cohort sample of same-sex twins born in Finland between 1880-1957, assessed in 1975, 1981, 1990, and 2011. Results: We identified significant main effects of age, sex, and cohort on quantity of cigarette consumption, as well as significant agecohort and sexcohort interactions. We also identified sex and cohort effects on the liability to initiate regular smoking and the magnitude of variation underlying quantity of cigarette consumption. That said, the sources of variation did not differ between groups; in other words, heritability and environmental contributions to both traits were not different between the four sexcohort groups. Conclusions: Our results indicate sex and cohort effects on the prevalence of smoking and its underlying variation. Our results on changing prevalence mirror existing population-level research in Finnish samples, but we did not identify differences in heritability found in other studies of cohort effects in tobacco use. These results highlight the importance of considering age, cohort, and timing of policy changes when evaluating changes in substance consumption across time.

Introduction The increased risk of venous thromboembolism associated with the use of hormonal contraception is well recognized, but evidence regarding hormonal contraception containing natural estradiol is limited. This study aimed to assess the associations between the patterns of use of different systemic hormonal contraceptives and the risk of venous thromboembolism during 2017-2019. Material and Methods All fertile-aged women (15-49 years) living in Finland in 2017 and using hormonal contraception in 2017 and their 1:1 age- and residence-matched controls not using hormonal contraception in 2017 (altogether 587 559 women) were selected from the Prescription Centre. All incident venous thromboembolism cases during 2018-2019 and their 4:1 age-matched controls were further analyzed in a prospective nested case-control design to assess the associations between the use (starting, stopping, continuous vs no use) of different hormonal contraception types and venous thromboembolism. Results Altogether, 1334 venous thromboembolism cases occurred during the follow-up period (incidence rate 1.14 per 1000 person-years, 95% confidence interval [CI] 1.08-1.20), with an incidence rate ratio of hormonal contraception vs no hormonal contraception use of 1.42 (95% CI 1.27-1.58). Compared with non-use, starting the use of gestodene and ethinylestradiol (adjusted odds ratio [aOR] 2.85; 95% CI 1.62-5.03), drospirenone and ethinylestradiol (aOR 1.55; 95% CI 0.98-2.44), desogestrel and ethinylestradiol (aOR 1.97; 95% CI 0.99-3.92), and transdermal patch releasing norelgestromin and ethinylestradiol (aOR 5.10; 95% CI 1.12-23.16), as well as continuing the use of gestodene and ethinylestradiol (aOR 2.60; 95% CI 1.61-4.21), drospirenone and ethinylestradiol (aOR 1.55; 95% CI 1.02-2.37), cyproterone-acetate and estrogen/ethinylestradiol (aOR 1.66; 95% CI 1.06-2.61), and vaginal ring releasing etonogestrel and ethinylestradiol (aOR 3.27; 95% CI 1.95-5.48) were associated with venous thromboembolism risk. Regarding the type of estrogen, the highest risk was associated with current use (vs non use in the previous 180 days) of ethinylestradiol-containing preparations (aOR 2.20; 95% CI 1.82-2.65), followed by estradiol-containing preparations (aOR 1.39; 95% CI 1.04-1.87) with no risk for progestin-only hormonal contraception. Current use of estradiol-containing preparations was not associated with venous thromboembolism risk after exclusion of cyproterone-acetate and estrogen/ethinylestradiol (aOR 1.05; 95% CI 0.66-1.66). Conclusions An increased risk of venous thromboembolism is associated with ethinylestradiol-containing combined preparations. The use of estradiol-containing combined preparations confers only a slightly increased risk, possibly driven by cyproterone-containing combined oral contraceptives, whereas the use of progestin-only contraception is not associated with venous thromboembolism.

In this paper, several convergence results for fine $p$-(super)minimizers on quasiopen sets in metric spaces are obtained. For this purpose, we deduce a Caccioppoli-type inequality and local-to-global principles for fine $p$-(super)minimizers on quasiopen sets. A substantial part of these considerations is to show that the functions belong to a suitable local fine Sobolev space. We prove our results for a complete metric space equipped with a doubling measure supporting a $p$-Poincar\'e inequality with $1, Comment: arXiv admin note: text overlap with arXiv:2106.13738

Background Intellectual disability (ID) is associated with violent and sexual offending and victimization, but the importance of neuropsychiatric comorbidity and severity of disability remains unclear. Methods In a register-based cohort study of people born in Sweden 1980–1991 (n = 1 232 564), we investigated associations of mild and moderate/severe ID with any, violent and sexual crimes, and with assault victimization, stratified by comorbid autism and attention deficit hyperactivity disorder (ADHD). We defined ID by attendance at a special school or registered diagnosis and obtained data on criminal convictions and injuries or deaths due to assaults from nationwide registers until end of 2013. Results Compared to people without ID, autism or ADHD, men and women with mild or moderate/severe ID and comorbid ADHD had elevated risks of violent crimes [range of hazard ratios (HRs) 4.4–10.4] and assault victimization (HRs 2.0–7.7). Women with mild ID without comorbidities or with comorbid autism also had elevated risks of violent crimes and victimization (HRs 1.8–4.6) compared to women without ID, autism or ADHD. The relative risks of sexual offending and victimization were elevated in men and women with ID without comorbidities (HRs 2.6–12.7). The highest risks for sexual offending in men (HRs 9.4–11.0) and for sexual assault victimization in women (HRs 11.0–17.1) related to ID and comorbid ADHD. Conclusions The elevated risk of violent offending and assault victimization in people with ID is largely explained by comorbid ADHD, whereas ID is independently associated with sexual crimes and victimization, even though absolute risks are low.

Background Previous register-based studies on comorbidity have mainly focused on gambling disorder (GD) and psychiatric disorders. However, knowledge on somatic health of persons with GD is also needed. This nationwide register-based study aims to examine the gender-specific prevalence rates of chronic diseases and conditions among the Finnish adults with GD. Methods This study utilizes aggregated data of persons aged 18 and over with GD diagnosis (corresponding to pathological gambling, ICD-10; F63.0) in 2011-2020. The data were retrieved from the Finnish nationwide health registers: Register of Primary Health Care visits and Care Register for Health Care, including specialised outpatient and inpatient health care, and inpatient social care. All diagnostic groups were included. Corresponding figures for the total population with same age range were presented as reference numbers. Results The preliminary results showed that 2,617 persons with the median age of 33.5-36.0 were diagnosed with GD (men n = 1,858; women n = 759). Despite the fact that the prevalence rates of the general population were not age-adjusted, many chronic diseases and conditions were more prevalent among persons with GD compared with the general population. The prevalence rates of psychiatric disorders (87.5% vs 29.2%) and nervous system diseases (23.9% vs 15.2%) were particularly high. Musculoskeletal diseases (61.6% vs 55.8%) and digestive diseases (30.2% vs 27.6%) were also slightly more prevalent. Memory disorders (1.1% vs 5.3%), cardiovascular diseases (25.3% vs 41.0%), and cancer (15.6% vs 24.4%) were less prevalent. Among persons with GD, all comorbid diseases were more prevalent among women than among men. Conclusions Psychiatric disorders and nervous system diseases are exceptionally prevalent in persons with GD. These findings highlight the need for health and social care professionals to recognize that persons with GD may additionally have other disorders that need attention. Key messages • Mental disorders are the most common comorbidity among persons with GD, however, many somatic chronic diseases are also common. • Comorbidities are more common among women with GD than among men with GD.

Background Studies have found an association between problem gambling and poverty. However, there is relatively little research on social inequalities and problem gambling using population representative data. Methods A population-representative self-report web-based and postal survey with register-based linkage was conducted in the three geographical areas of Finland. Participants (n = 7186, aged 18 or older) were randomly selected from the population register. Sociodemographic factors and social welfare benefits were studied among gambling groups and their statistical difference were examined by χ2 test. Seven logistic regression models were calculated, where unemployment, social security benefits and low income were treated as dependent variables and where sex, age, family structure and education were controlled as covariates. The results were presented as odds ratios (OR) with 95% confidence intervals (CIs). Results Problem and at-risk gambling (ARG) was more common among people who were unemployed [PG: χ2=6.4 (1), P Conclusions The most important task of gambling policy should be reducing gambling-related harms and diminishing social inequality. However, even in government organized system where gambling profits are used for common good, profits come from the most socially disadvantaged people thereby exacerbating inequality.

Background Parental substance abuse (SA) of alcohol and drugs is associated with offspring mortality, including sudden infant death syndrome (SIDS), in infancy, but research on cause-specific mortality and mortality in later childhood is scarce. Methods Using population-based register data on all births in Sweden in 1973–2013 (N = 4.2 million) and Cox regressions, we examined the associations of mother’s and father’s SA registered between 2 years before and 12 years after the child birth with offspring all-cause and cause-specific mortality in infancy and childhood. Results Parental SA was associated with increased offspring all-cause and natural-cause mortality in infancy, but not in the neonatal period, and with external-cause mortality in ages 1–9. Risk of SIDS was 130–280% higher in infants with parental SA compared to infants with no parental SA. Adjusting for parental socioeconomic and immigrant status and severe psychiatric disorders, paternal SA was associated with 66% higher mortality due to communicable diseases and infections in infancy, and both maternal and paternal SA were associated with 40–174% higher mortality due to accidents in infancy and in ages 1–9. The associations between parental SA and offspring mortality were similar for male and female offspring. Conclusions Child mortality is rare in contemporary Sweden, and parental SA has variable associations with elevated offspring mortality throughout the first 10 years of life, excluding the neonatal period, which is indicative of insufficient recognition of children at risk. Preventive measures should be long-term and targeted to both parental and offspring behaviour.

The current analysis will examine the joint effect of early life risk factors (environmental, clinical, and behavioral) and genetic liability in the form of polygenic risk scores for predicting SUDs in adulthood across four longitudinal cohorts.

In this study, mires are regarded as living heritage and experienced landscapes. Mires form a cultural context for interface, where the mindscape of human-mire relationships are represented and renewed by diverse types of art projects. As a part of the global concern on climate crisis among artists, intertwined environmental challenges are highlighted through mire art projects. Based on the 12 semi-structured interviews in Finland, artists’ subjective perceptions, expressions and experiences on mires and art in mire landscapes are examined. Artists use culturally sustainable methods, e.g., they engage local tensions and mire users in their art projects. Mire art highlights the flora and fauna of mire and illustrates changes in mire. Mire art mediates the relation between future, society and environment by participating in public discussion on the protection and environmental values of mire. The biocultural heritage of mires consists of e.g., value of biodiversity, local knowledge, experienced landscapes and place related memories.

BackgroundEvidence regarding the role of hormonal contraception (HC) as a risk factor for attempted suicide (AS) is inconclusive. The aim was to assess the associations of use of different types of systemic hormonal contraceptives with the risk of AS in women aged 15–49 years.MethodsData were retrieved from national registers in Finland. The AS incidence in 2018-2019 was assessed in a population-based cohort of women (n=587,823) according to their HC use in 2017. To examine the risk of AS related to HC use in the six months preceding the suicide attempt (i.e. current use), we used a nested case-control design with 1:4 ratio (n=4090), and applied multivariable conditional logistic regression models.ResultsDuring the follow-up 1.174,346 million person-years were cumulated and 818 AS cases observed (incidence rate=0.70, 95% CI=0.63–0.83 per 1000 person-years). The incidence rate ratio of HC (n=344 cases) vs. no-HC (n=474 cases) was 0.73 (95% CI=0.63–0.83). Use of HC, and specifically of combined hormonal contraceptives was associated with a lower AS risk compared to non-use when controlling for marital status, socioeconomic status, education, chronic diseases and recent delivery (OR=0.55, 95% CI=0.42–0.73), but not when further adjusting for recent psychiatric hospitalizations and current use of psychotropic medications (OR=0.68, 95% CI=0.45–1.02). Current use of progestogen-only preparations was not associated with AS.ConclusionsHC use appeared not associated with an increased AS risk in fertile-aged women. The choice of the best and safest contraceptive option should take individual mental health status, including assessment of suicidal risk, into account.

Funder: Jacobs Foundation; doi: https://doi.org/10.13039/501100003986, Estimates from genome-wide association studies (GWAS) of unrelated individuals capture effects of inherited variation (direct effects), demography (population stratification, assortative mating) and relatives (indirect genetic effects). Family-based GWAS designs can control for demographic and indirect genetic effects, but large-scale family datasets have been lacking. We combined data from 178,086 siblings from 19 cohorts to generate population (between-family) and within-sibship (within-family) GWAS estimates for 25 phenotypes. Within-sibship GWAS estimates were smaller than population estimates for height, educational attainment, age at first birth, number of children, cognitive ability, depressive symptoms and smoking. Some differences were observed in downstream SNP heritability, genetic correlations and Mendelian randomization analyses. For example, the within-sibship genetic correlation between educational attainment and body mass index attenuated towards zero. In contrast, analyses of most molecular phenotypes (for example, low-density lipoprotein-cholesterol) were generally consistent. We also found within-sibship evidence of polygenic adaptation on taller height. Here, we illustrate the importance of family-based GWAS data for phenotypes influenced by demographic and indirect genetic effects.

Background: Gambling is associated with many conditions that can compromise young people’s health and wellbeing, such as substance use and poor school achievement. Conversely, low school achievement can be linked to lower socio-economic position. Thus, the aim of this study is to examine whether compulsory school achievement is linked with gambling participation and gambling expenditure (GE) later in youth and whether GE is linked with lower socio-economic position. Methods: The Finnish Gambling Harms survey data (n = 7186) were used. The data were collected in three regions during spring 2017. Participants aged 18–29 years old were selected from the data. Past-year GE was examined using two measures: weekly gambling expenditure (WGE, in €) and relative gambling expenditure (RGE, in %). Logistic regression and log-linear regression models for past-year gambling, WGE and RGE were created. Results: Persons who had no more than a mediocre grade point average (GPA) had a 25% higher WGE and 30% higher RGE in 2016 than those who had an outstanding GPA in the compulsory school. Compared with persons with an outstanding GPA, those with a satisfactory to very good GPA spent 13% more on gambling, and their RGE was 17% higher. Additionally, those with lower socio-economic status (SES) had a higher WGE and RGE compared with higher SES. Conclusions: Even after controlling for other crucial background characteristics, early life success, in the form of compulsory school outcomes, seems to correlate with gambling expenditures later in youth. This suggests that the gambling behaviour can be linked to the cognitive ability of an individual. Our findings also imply that gambling could be more heavily concentrated on individuals that are already more socially disadvantaged. However, it is worth noting that individual factors such as traumas, antisocial personality, anxiety and depression are all associated with gambling and poor academic achievement. Overall, this suggests that various educational tools at a younger age can be effective in preventing gambling-related problems in later life.

Trust is a key ingredient in collaboration between security operations centers (SOCs). The collaboration can enhance defense and preparedness against cyberattacks, but it is also important to limit the attacker's ability to infer their potential for success from the communication between SOCs. This paper presents a proof-of-concept for a granular information sharing scheme. The information about a security incident is encrypted and the SOCs can decide with great precision which users or user groups can access it. The information is presented in a web-based dasboard visualization, and a user can communicate with other SOCs in order to access relevant incident information.

Purpose: Tamsulosin has been associated with dementia, but the results have been inconsistent. Concerns have been raised about using exposure assessment time too close to the outcome. We investigated the association between use of α1-adrenoceptor antagonists indicated for benign prostate hyperplasia and risk of Alzheimer's disease (AD) using different exposure windows. Methods: The study (24 602 cases and 98 397 matched controls) included men from the Finnish nationwide nested case–control study on Medication and Alzheimer's disease (MEDALZ). Cases received clinically verified AD diagnosis during 2005–2011 and were community-dwelling at the time of diagnosis. Use of tamsulosin and alfuzosin in 1995–2011 was identified from the Prescription Register and categorized based on whether it had occurred within 3 years before AD diagnosis (lag time) or before that. Dose–response analysis using defined daily doses of drug (DDDs) was conducted. Associations were investigated with conditional logistic regression, adjusted for confounders and mediators. Results: The use of α1-adrenoceptor antagonists before lag time associated with an increased risk of AD (OR 1.24 [1.20–1.27]). After adjustment for comorbidities and concomitant drug use throughout the assessment time (confounders) and healthcare contacts within the lag period (mediators), the association weakened (aOR 1.10 [1.06–1.14]). We found no evidence of dose–response-relationship when comparing the users of higher than median DDDs to the users of lower than median DDDs. Conclusion: Our findings, especially the lack of dose–response-relationship and attenuation after mediator adjustment, do not provide strong support for the previous hypothesis on α1-adrenoceptor antagonists as a risk factor for dementia. publishedVersion

Objectives: We examine how parental criminality is associated with offspring education at different educational stages from primary to tertiary education and conduct separate analyses for non-violent and violent crimes and incarceration, and for paternal and maternal criminality.Methods: We use Swedish total population register data of 513,886 children and their parents and estimate both population-level linear probability models and cousin fixed-effects models.Results: Parental criminality was negatively associated with all stages of offspring education. In population-level models accounting for parental education, the strongest associations were observed for parental violent crimes and incarceration with offspring secondary education completion (beta: -0.16 to -0.18). Cousin fixed-effects models suggested that family-level unobserved heterogeneity played a role in the associations as they were reduced when analyzing cousins differently exposed to parental criminality.Conclusions: Parental criminality is negatively associated with offspring educational attainment, and the associations are in part due to shared familial factors. The association is different at different educational stages and for parental violent vs. non-violent crime.

Publisher Copyright: © 2022 The Author(s) Background: Use of hormonal intrauterine devices has grown during the last decades. Although hormonal intrauterine devices act mostly via local effects on the uterus, measurable concentrations of levonorgestrel are absorbed into the systemic circulation. The possible metabolic changes and large-scale biomarker profiles associated with hormonal intrauterine devices have not yet been studied in detail. Objective: To examine through the metabolomics approach the metabolic profile of patients using hormonal intrauterine devices and how this metabolic profile is affected by duration and discontinuation of use. Study Design: The study consisted of cross-sectional analyses of 5 population-based surveys (FINRISK and FinHealth studies), spanning from 1997 to 2017. All fertile-aged participants (18–49 years) in the surveys with available information on hormonal contraceptive use and metabolomics data (n=5649) were included in the study. Altogether, 211 metabolic measures of users of hormonal intrauterine devices (n=1006) were compared with those of nonusers of hormonal contraception (n=4643) via multivariable linear regression models. To allow comparison across multiple measures, association magnitudes were reported in standard deviation units of difference in biomarker concentration compared with the reference group. Results: After adjustment for covariates, levels of 141 metabolites differed in current users of hormonal intrauterine devices compared with nonusers of hormonal contraception (median difference in biomarker concentration, 0.09 standard deviation): lower levels of particle concentration of larger lipoprotein subclasses, triglycerides, cholesterol and derivatives, apolipoproteins A and B, fatty acids, glycoprotein acetyls, and aromatic amino acids. The metabolic pattern of hormonal intrauterine device use did not change according to duration of use. When comparing previous users and never-users of hormonal intrauterine devices, no significant metabolic differences were observed. Conclusion: The use of hormonal intrauterine devices was associated with several moderate metabolic changes previously associated with reduced arterial cardiometabolic risk. The metabolic effects were independent of duration of use of the hormonal intrauterine devices. Moreover, the metabolic profiles were similar after discontinuation of hormonal intrauterine device use and in never-users.

BackgroundThe genetic and environmental underpinnings of simultaneous changes in weight and alcohol consumption are poorly known.ObjectiveWe sought to quantify the environmental and genetic components underlying parallel changes in weight and alcohol consumption, and to investigate potential covariations between them.MethodsThe analysis comprised 4461 adult participants (58% women) from the Finnish Twin Cohort. Four measures of alcohol consumption and body mass index (BMI) were available over a 36-year follow-up. Trajectories of each trait were described by growth factors, defined as intercepts (i.e., baseline) and slopes (i.e., change over follow-up), using Latent Growth Curve Modeling. Growth values were used for male (190 MZ pairs, 293 DZ pairs) and female (316 MZ pairs, 487 DZ pairs) same-sex complete twin pairs in multivariate twin modeling. The variance and covariance of growth factors were then decomposed into genetic and environmental components.ResultsThe baseline heritabilities were similar in men (BMI: h2=79%; alcohol consumption: h2=49%) and women (h2=77%; h2=45%). Heritabilities of BMI change were similar in men (h2=52%) and women (h2=57%), but higher in men for change in alcohol consumption (h2=45%) than in women (h2=31%). Significant genetic correlations between BMI at baseline and change in alcohol consumption were observed in both men (r =-0.17(95% Confidence Interval: -0.29,-0.04)) and women (r=-0.18(−0.31,-0.06)). The genetic components of baseline and longitudinal change were correlated for both BMI and alcohol consumption with sex differences. Non-shared environmental factors affecting changes in alcohol consumption and BMI were correlated in men (r=0.18(0.06,0.30)). Among women, non-shared environmental factors affecting baseline alcohol consumption and the change in BMI were correlated (r=-0.11(−0.20,-0.01)).ConclusionsWe provide evidence of genetic correlations between BMI and change in alcohol consumption. Independent of genetic effects, change in BMI and change in alcohol consumption covary.

Fusarium basal rot (FBR) of onion is a serious disease problem worldwide. The Fusarium species causing FBR can also produce mycotoxins that are potentially harmful to humans and animals. In this study, a multiple reaction monitoring technique with ultra-high-performance liquid chromatography–tandem mass spectrometry (MRM UHPLC-MS/MS) was developed and validated for onion matrix to study Fusarium mycotoxins in the harvested onions. This study was focused on fumonisins B1, B2, and B3 (FB1, FB2, and FB3), beauvericin (BEA), and moniliformin (MON), which are the main mycotoxins produced by Fusarium oxysporum and Fusarium proliferatum. In the in-house validated protocol, the onion samples were extracted with methanol:water (3:1) using magnetic stirring for 15 min. FBs and BEA were determined directly from the filtered extracts, whereas MON required sample concentration prior to analysis. No cleanup of extracts was needed prior to analysis. The target mycotoxins were separated on an Acquity UPLC system BEH C18 column with gradient elution. Mycotoxins were identified and quantified using 13C-FB1 as internal standard. Minor matrix effect was compensated using multi-point matrix-matched calibration curves with uninfected onion sample. For the mycotoxins studied, a good linearity was obtained (R2 ≥ 0.99) and the recoveries were in the range of 67–122%, with the highest standard deviation for MON, 22%. The limits of quantification were from 2.5 to 10 ng g−1 in onion matrix. The method was successfully employed for the analysis of mycotoxins in harvested onions showing FBR symptoms and found to be infected with F. oxysporum and F. proliferatum.

Parents with substance misuse provide their children with a potentially risky rearing environment. According to the evolutionary life history theory, such environments steer individuals towards faster reproductive strategy. However, parents providing their children with hazardous environments may also pass on genes associated with early parenthood. In register data on individuals born in Sweden 1973–1993 (N = 2,176,128), the hazard ratio of entering parenthood by age 25 was 1.70 (95% CI 1.69–1.72) and 1.85 (1.82–1.89) among offspring of fathers and mothers with substance misuse, respectively, compared to others. In analyses using an offspring-of-siblings design in three types of parental sibling pairs (half siblings, full siblings and dizygotic twins, and monozygotic twins) increasingly controlling for genetic confounding, associations between parental substance misuse and offspring's early reproduction gradually attenuated. Our results suggest that the association between parental substance misuse and earlier parenthood in offspring is at least partly genetically confounded. Life history theory should be further tested with genetically informative research designs.

Background: Patient-reported outcomes (PROS) are widely accepted measures for evaluating outcomes of surgical interventions. As patient-reported information is stored in electronic health records, it is essential that there are valid electronic PRO (ePRO) instruments available for clinicians and researchers. The aim of this study was to evaluate the validity of electronic versions of five widely used foot and ankle specific PRO instruments. Methods: Altogether 111 consecutive elective foot/ankle surgery patients were invited face-to-face to participate in this study. Patients completed electronic versions of the Foot and Ankle Ability Measure (FAAM), the Foot and Ankle Outcome Score (FAOS), the modified Lower Extremity Function Scale (LEFS), the Manchester-Oxford Foot Questionnaire (MOXFQ), and the Visual Analogue Scale Foot and Ankle (VAS-FA) on the day of elective foot and/or ankle surgery. Construct validity, coverage, and targeting of the scales were assessed. Results: Based on general and predefined thresholds, construct validity, coverage, and targeting of the ePRO versions of the FAAM, the FAOS, the MOXFQ, and the VAS-FA were acceptable. Major issues arose with score distribution and convergent validity of the modified LEFS instrument. Conclusions: The ePRO versions of the FAAM, the FAOS, the MOXFQ and the VAS-FA provide valid scores for foot and ankle patients. However, our findings do not support the use of the modified LEFS as an electronic outcome measure for patients with orthopedic foot and/or ankle pathologies. (C) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

This study utilised static triaxial and dynamic cone penetration tests to examine the identification of changes in strength in soil materials as a result of an increase in moisture content. The applicability of a light dynamic cone penetrometer device in railway environments was also studied. On a broader scale, the aim was to find an investigation method suited to field locations that identify low-quality or persistently moist materials directly from the structure. The triaxial tests found an apparent increase in shear strength when the water content dropped below 7%. Based on the series of laboratory tests, the dynamic cone penetrometer reacted strongly to material density, but the impact of moisture content was also evident. Furthermore, the results showed that dynamic cone resistance is a reasonably unfeasible metric for assessing the structural quality of materials consisting primarily of sand, due to the number of factors affecting the resistance. In the laboratory tests, the lowest dynamic cone resistances were measured in the material with the highest structural quality. publishedVersion

Cultivar resistance is essential for the management of Fusarium head blight (FHB) disease in oat production. However, the breeders lack methods suitable for phenotyping disease resistance and resistance sources. In this paper we compared two oat genotypes, a rejected variety BOR31 and a landrace VIR7766, with four different traits that could reflect resistance to FHB in a greenhouse environment. Spray and point inoculations were used to inoculate Fusarium graminearum into flowering oat plants. When spray-inoculated, VIR7766 was significantly more resistant against the initial infection than BOR31, measured by the number of Fusarium-infected kernels and by DON accumulation. In the point-inoculated oats, the loss of fresh weight in the inoculated spikelet correlated well with the increasing F. graminearum biomass in the spikelet, measured six days after inoculation. However, no difference in the growth of the fungus was observed between the tested oat genotypes by point inoculation. We speculate that once the infection is established, the ability of the oat plant to resist the spread of the infection within a spikelet is low in the genotypes studied, although oat, in general, due to its panicle structure, is considered to have a high resistance against Fusarium infection.

Tic disorders are associated with multiple social adversities, but little is known about the experience of violent assault (including sexual assault) and criminality in this group.To establish if Tourette syndrome (TS) and chronic tic disorder (CTD) are associated with an increased risk of experiencing violent assault and criminal convictions.In this cohort study, all individuals living in Sweden at any time between January 1, 1973, and December 31, 2013, were identified from Swedish nationwide health and administrative registers. Cox proportional hazards regression models were used to estimate the risk of violent assault and criminal convictions among people with TS or CTD, compared with the general population and unaffected full siblings. Data analyses were conducted between September 1 and October 22, 2021.The Swedish version of the International Classification of Diseases, Eighth Revision (ICD-8), ICD-9, and ICD-10 diagnoses of TS or CTD in the Swedish National Patient Register.Records of sexual and nonsexual violent assault and death due to violent assaults were obtained from the National Patient Register and the Cause of Death Register, respectively. Convictions for violent and nonviolent criminal offenses were obtained from the Crime Register. Covariates included sex and birth year.The study cohort included 13 819 284 individuals living in Sweden between 1973 and 2013. A total of 7791 individuals with TS or CTD were identified (median [IQR] age at first diagnosis, 13.4 [10.0-21.8] years; 5944 [76%] male). Compared with unaffected individuals from the general population, people with TS or CTD had a 2-fold increased risk of experiencing any violent assault (sexual and nonsexual) (adjusted hazard ratio [aHR], 2.21; 95% CI, 2.00-2.43), a 3-fold increased risk of violent convictions (aHR, 3.13; 95% CI, 2.92-3.36), and a 1.6-fold increased risk of nonviolent crime convictions (aHR, 1.62; 95% CI, 1.54-1.71). Among people with TS or CTD, 37.0% (114 of 308; 95% CI, 31.6%-42.4%) of individuals who had experienced violent assault also had a violent crime conviction, compared with 17.9% (16 067 of 89 920; 95% CI, 17.6%-18.1%) in the general population. Exclusion of individuals with attention-deficit/hyperactivity disorder and substance use disorders partially attenuated the associations. Similarly, within-sibling models attenuated but did not eliminate the associations (any violent assault: aHR, 1.32; 95% CI, 1.08-1.61; violent crime: aHR, 2.23; 95% CI, 1.86-2.67; nonviolent crime: aHR, 1.34; 95% CI, 1.20-1.50).Results of this cohort study suggest that most individuals with TS or CTD are not assaulted nor are perpetrators of crime. However, individuals with TS or CTD diagnosed in specialist settings were more likely to both experience violent assault and be perpetrators of violence compared with the general population. The risk was highest in individuals with comorbid attention-deficit/hyperactivity disorder and substance use disorders. The increased risk found in specialty clinics will need to be better understood in the general population.

Aim: Prevalence studies on gambling have largely relied on survey samples. Little is known about the diagnosed prevalence of gambling disorder (GD) based on register data. This study examines the annual prevalence rate of GD between 2011 and 2020 among Finns by gender and age. Methods: Aggregated data on the diagnosis of GD (corresponding to pathological gambling, code F63.0 in the ICD-10) were retrieved from the following national registers: Register of Primary Health Care Visits, and Care Register for Health Care, including specialised outpatient and inpatient health care, and inpatient Care Register for Social Welfare. Primary and secondary diagnoses of adults were included. Average population during a calendar year (4,282,714–4,460,177 individuals) was utilised to calculate annual prevalence. Results: The annual prevalence of diagnosed GD in the population increased from 0.005% ( n = 196) to 0.018% ( n = 804) within nine years. In 2011, the annual prevalence rate was 0.006% for men and 0.003% for women, compared to rates in 2020 of 0.025% and 0.011%. Gender discrepancy was relatively stable across years: 27.2–33.8% of the diagnoses were for women. The prevalence of GD varied between age groups within genders. GD was most prevalent among 18–44-year-olds. The prevalence rates increased the most among 30–44-year-old women. Conclusion: The extremely low prevalence rate of GD implies that the problem remains under-diagnosed, yet, it has increased among all age groups across genders, except for women aged 60 years or older. Active efforts are needed to increase awareness of GD among both primary and specialised healthcare professionals and the public for better recognition and early detection.

Substance use disorders (SUDs) incur serious social and personal costs. Risk for SUDs is complex, ranging from social conditions to individual genetic variation. We examined whether models that include a clinical/environmental risk index (CERI) and polygenic scores (PGS) are able to identify individuals at increased risk of SUD in young adulthood across four longitudinal cohorts for a combined sample of N = 15,134. Our analyses included participants of European (NEUR = 12,659) and African (NAFR = 2,475) ancestries. SUD outcomes included: 1) alcohol dependence, 2) nicotine dependence; 3) drug dependence, and 4) any substance dependence. In the models containing the PGS and CERI, the CERI was associated with all three outcomes (ORs = 1.37 – 1.67). PGS for problematic alcohol use, externalizing, and smoking quantity were associated with alcohol dependence, drug dependence, and nicotine dependence, respectively (OR = 1.11 – 1.33). PGS for problematic alcohol use and externalizing were also associated with any substance dependence (ORs = 1.09 – 1.18). The full model explained 6% - 13% of the variance in SUDs. Those in the top 10% of CERI and PGS had relative risk ratios of 3.86 - 8.04 for each SUD relative to the bottom 90%. Overall, the combined measures of clinical, environmental, and genetic risk demonstrated modest ability to distinguish between affected and unaffected individuals in young adulthood. PGS were significant but added little in addition to the clinical/environmental risk index. Results from our analysis demonstrate there is still considerable work to be done before tools such as these are ready for clinical applications.

Supplemental tables (Supplementary Table 1 and 2) and Figures (Supplementary Figures 1-5) for article "Metabolomics profile of 5649 LNG-IUS users and non-users in Finland"

Study Objectives Poor sleep is one of the multiple health issues associated with heavy alcohol consumption. While acute effects of alcohol intake on sleep have been widely investigated, the longitudinal associations remain relatively underexplored. The objective of our research was to shed light on cross-sectional and longitudinal associations between alcohol use and poor sleep quality over time, and to elucidate the role of familial confounding factors in such associations. Methods Using self-report questionnaire data from the Older Finnish Twin Cohort (N = 13 851), we examined how alcohol consumption and binge drinking are associated with sleep quality during a period of 36 years. Results Cross-sectional logistic regression analyses revealed significant associations between poor sleep and alcohol misuse, including heavy and binge drinking, at all four time points (OR range = 1.61–3.37, p < .05), suggesting that higher alcohol intake is associated with poor sleep quality over the years. Longitudinal cross-lagged analyses indicated that moderate, heavy and binge drinking predict poor sleep quality (OR range = 1.25–1.76, p < .05), but not the reverse. Within-pair analyses suggested that the associations between heavy drinking and poor sleep quality were not fully explained by genetic and environmental influences shared by the co-twins. Conclusions In conclusion, our findings support previous literature in that alcohol use is associated with poor sleep quality, such that alcohol use predicts poor sleep quality later in life, but not vice versa, and that the association is not fully explained by familial factors.

Estimates from genome-wide association studies (GWAS) of unrelated individuals capture effects of inherited variation (direct effects), demography (population stratification, assortative mating) and relatives (indirect genetic effects). Family-based GWAS designs can control for demographic and indirect genetic effects, but large-scale family datasets have been lacking. We combined data from 178,086 siblings from 19 cohorts to generate population (between-family) and within-sibship (within-family) GWAS estimates for 25 phenotypes. Within-sibship GWAS estimates were smaller than population estimates for height, educational attainment, age at first birth, number of children, cognitive ability, depressive symptoms and smoking. Some differences were observed in downstream SNP heritability, genetic correlations and Mendelian randomization analyses. For example, the within-sibship genetic correlation between educational attainment and body mass index attenuated towards zero. In contrast, analyses of most molecular phenotypes (for example, low-density lipoprotein-cholesterol) were generally consistent. We also found within-sibship evidence of polygenic adaptation on taller height. Here, we illustrate the importance of family-based GWAS data for phenotypes influenced by demographic and indirect genetic effects. Within-sibship genome-wide association analyses using data from 178,076 siblings illustrate differences between population-based and within-sibship GWAS estimates for phenotypes influenced by demographic and indirect genetic effects.

BackgroundGenetically informed studies have provided mixed findings as to what extent parental substance misuse is associated with offspring substance misuse and antisocial behavior due to shared environmental and genetic factors.MethodsWe linked data from nationwide registries for a cohort of 2 476 198 offspring born in Sweden 1958–1995 and their parents. Substance misuse was defined as International Classification of Diseases diagnoses of alcohol/drug use disorders or alcohol/drug-related criminal convictions. Quantitative genetic offspring-of-siblings analyses in offspring of monozygotic and dizygotic twin, full-sibling, and half-sibling parents were conducted.ResultsBoth maternal and paternal substance misuse were robustly associated with offspring substance misuse [maternal adjusted hazard ratio (aHR) = 1.83 (95% confidence interval (CI) 1.80–1.87); paternal aHR = 1.96 (1.94–1.98)] and criminal convictions [maternal aHR = 1.56 (1.54–1.58); paternal aHR = 1.66 (1.64–1.67)]. Additive genetic effects explained 42% (95% CI 25–56%) and 46% (36–55%) of the variance in maternal and paternal substance misuse, respectively, and between 36 and 44% of the variance in substance misuse and criminality in offspring. The associations between parental substance misuse and offspring outcomes were mostly due to additive genetic effects, which explained 54–85% of the parent-offspring covariance. However, both nuclear and extended family environmental factors also contributed to the associations, especially with offspring substance misuse.ConclusionsOur findings from a large offspring-of-siblings study indicate that shared genetic influences mostly explain the associations between parental substance misuse and both offspring substance misuse and criminality, but we also found evidence for the contribution of environmental factors shared by members of nuclear and extended families.

A previously unknown haplotype of the plant pathogen ‘Candidatus Liberibacter solanacearum’ (Lso) was found in cultivated carrots and parsnips in eastern Finland. That same haplotype was found in western Finland, over 300 km away, in the family Polygonaceae, the species Fallopia convolvulus (wild buckwheat) and Persicaria lapathifolia (pale persicaria) growing as weeds within carrot and parsnip fields. The infected plants, both apiaceous and polygonaceous, showed symptoms of foliar discolouration. This is the first report of Lso bacteria in plants of the family Polygonaceae. The finding that the polygonaceous plants infected with a previously unknown haplotype of Lso were growing among the apiaceous plants infected with Lso haplotype C suggests that these two haplotypes might be transmitted by different vectors. Phylogenetic analyses showed that the new haplotype, called haplotype H, is distinct from the previously characterized haplotypes and appears to have diverged early from their common ancestor. Multi-locus sequence analysis revealed four different sequence types (strains) within the haplotype H. These findings suggest that the haplotype H is likely to be endemic in northern Europe and that the genetic diversity within the Lso species is higher than previously assumed.

This review offers an update on research conducted with FinnTwin12 (FT12), the youngest of the three Finnish Twin Cohorts. FT12 was designed as a two-stage study. In the first stage, we conducted multiwave questionnaire research enrolling all eligible twins born in Finland during 1983–1987 along with their biological parents. In stage 2, we intensively studied a subset of these twins with in-school assessments at age 12 and semistructured poly-diagnostic interviews at age 14. At baseline, parents of intensively studied twins were administered the adult version of the interview. Laboratory studies with repeat interviews, neuropsychological tests, and collection of DNA were made of intensively studied twins during follow-up in early adulthood. The basic aim of the FT12 study design was to obtain information on individual, familial and school/neighborhood risks for substance use/abuse prior to the onset of regular tobacco and alcohol use and then track trajectories of use and abuse and their consequences into adulthood. But the longitudinal assessments were not narrowly limited to this basic aim, and with multiwave, multirater assessments from ages 11 to 12, the study has created a richly informative data set for analyses of gene–environment interactions of both candidate genes and genomewide measures with measured risk-relevant environments. Because 25 years have elapsed since the start of the study, we are planning a fifth-wave follow-up assessment.

Vallan tutkijat ovat väitelleet perinteisesti siitä, miten määritellä valta, jotta sen pätevä tutkiminen olisi mahdollista. Tässä artikkelissa kysytään, miten itse politiikan toimijat – tässä veteraanikansanedustajat haastatteluissaan – puhuvat ”vallasta”, eli millainen poliittisen toiminnan väline ”valta” on. Kiinnostuksen kohteena on, ymmärtävätkö veteraaniedustajat vallan yksilölle kuuluvana määräysvaltana, yhteistyössä syntyvänä vaikutuksena vai kenties mahdollisuutena toimia. Keskeinen tulos on vallan monimerkityksellisyys, se on yhtä hyvin vastustamisen kuin oman toiminnan merkittävyyden arvioinnin väline. Artikkeli yhdistää käsitehistorian ja digitaalisen tiedonlouhinnan menetelmiä kooltaan laajan aineistokokoelman laadullisessa analyysissä. Researchers of power have traditionally debated on the definitions of power to enable further empirical studies. This article, instead, asks how political actors – namely veteran MPs in their interviews – themselves speak about “power”, and as which kind of instrument of political action “power” functions. Do veteran MPs perceive power as domination, as the power of command, as an aspect of joint action, or as possibility or creation of political space of action (Spielraum)? The key result is the ambiguity of power: it can be both a tool of resistance and a tool of characterizing one’s own action in the parliament. The article combines methods of conceptual history and digital data mining in the qualitative analysis of a considerably big corpus of data. publishedVersion

Legislation prohibiting minors from engaging in gambling is a gambling policy measure set to protect adolescents from the harmful effects of gambling. The Finnish gambling system is based on a state monopoly, regulated by the Lotteries Act. After an amendment to the Lotteries Act, the new minimum legal gambling age was raised to 18 years old between 2010 and 2011. The main purpose of this study was to discover how the amendment to the act altered adolescents’ gambling (14–16-year-olds) and to examine whether the amendment decreased socio-economic differences. Adolescents gambling was studied before (2008–2009), during (2010–2011), and after (2013–2017) the age limit of gambling was raised in Finland. The study based on five waves (2008–2009, 2010–2011, 2013, 2015, 2017) of the national repeated cross-sectional School Health Promotion Study. Cross-tabulations where gambling was studied by study year and socio-economic status (SES) were formulated, and the statistical differences were studied by using χ2-tests. Percentage change in gambling frequency was also examined by study year and SES. Study years were analyzed separately to model the weekly gambling via logistic regression models. Adolescent gambling significantly decreased over time. It appears that raising the legal gambling age had a permanent effect on under-aged gambling. However, differences in gambling by adolescents’ family’s SES increased during the study period, indicating widening inequalities in gambling among adolescents. Diminishing inequalities in adolescent gambling is likely to require both societal action and consensus on adolescent gambling being a significant social and public health concern.

Introduction In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate. Objectives To assess the association of the use of HC with the risk of AS during 2017-2019. Methods Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models. Results Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65). Conclusions A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing HC. Disclosure No significant relationships.

SummaryProbiotics have been suggested as one solution to counter detrimental health effects by SARS-CoV-2, however, data so far is scarce. We tested the effect of two probiotic consortia, OL-1 and OL-2, against SARS-CoV-2 in ferrets and assessed their effect on cytokine production and transcriptome in a human monocyte-derived macrophage (Mf) and dendritic cell (DC) model.The results showed that the consortia significantly reduced the viral load, modulated immune response, and regulated viral receptor expression in ferrets compared to placebo. In human Mf and DC model, OL-1 and OL-2 induced cytokine production and genes related to SARS-CoV-2 anti-viral immunity.The study results indicate that probiotic stimulation of the ferret immune system leads to improved anti-viral immunity against SARS-COV-2 and that critical genes and cytokines for anti-SARS-CoV-2 immunity are stimulated in human immune cellsin vitro. The effect of the consortia against SARS-CoV-2 warrants further investigations in human clinical trials.

Water content is one of the most important factors influencing the performance of earth structures. It is well known that the water content of sand has a significant effect on its shear strength and its resistance to cyclic loading. In this study, the loading resistance of four different sand materials was investigated in a cyclic load triaxial test at different water contents. Three of the four material samples were taken from the sub-ballast layer of an existing Finnish railway track. The laboratory tests confirmed that the resistance to cyclic loading decreased with an increasing saturation level for all tested materials. The weakest material in the cyclic loading triaxial test had the most uniform grain size distribution with a small median grain size. The calculation of the vertical stress increase in the sub-ballast layer revealed that even a fine-grained sand can withstand the train load well when the rolling stock is mostly passenger traffic with an axle load of 160 kN and the sub-ballast layer is not completely saturated. However, heavy freight traffic with axle loads of 225 kN and 250 kN can approach the bearing capacity of a weak sub-ballast material if the water content of the upper part of the sub-ballast layer is high. This study has shown that the top part of the sub-ballast layer should be kept below 60–70% saturation level to avoid the development of excessive permanent deformation. publishedVersion

Background and aims Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed medications for patients with anxiety/depression. These patients often have problems with substance use, but it remains unclear whether the risk of substance misuse is influenced by SSRI treatment. We aimed to determine whether SSRI treatment is associated with a decreased risk of acute substance misuse-related outcomes. Design Cohort study following individuals through Swedish nation-wide registers between July 2005 and December 2013 and comparing the risk of substance misuse outcomes during periods on- versus off-treatment within the same individual. Setting Swedish general population. Participants Individuals with a newly dispensed prescription of SSRIs between July 2006 and December 2013 and an ICD-10 diagnosis of anxiety/depressive disorder before the first treatment initiation. The cohort included 146 114 individuals (60.7% women). Measurements Substance misuse outcomes included ICD-10 diagnoses of acute intoxications (F10.0-F19.0), accidental poisonings by alcohol or drugs (X41-X42, X45-X46) and substance-related criminal offenses. Findings The absolute rate of substance misuse increased sharply before the onset of SSRI treatment and decreased after treatment initiation. Stratified Cox regression models showed an elevated risk [hazard ratio (HR) = 1.70, 95% confidence interval (CI) = 1.62-1.78] of substance misuse outcomes during a 1-month period preceding treatment initiation, compared with the reference period of more than 1 month before treatment start. The on-treatment estimates (1-30 days, HR = 1.29, 95% CI = 1.23-1.37; 31-120 days, HR = 1.30, 95% CI = 1.24-1.35; and > 120 days, HR = 1.24, 95% CI = 1.18-1.30 after treatment initiation] were consistently lower than the 1-month pre-treatment estimate, but still elevated compared with the reference period. Conclusions For people with anxiety/depression, the risk of substance misuse appears to be particularly elevated immediately before initiating selective serotonin reuptake inhibitor (SSRI) treatment, which may reflect the emergence or worsening of substance use problems concurrently with anxiety/depression. SSRI treatment appears to be associated with a lower risk of substance misuse compared with the 1-month period preceding treatment initiation, but causality remains uncertain.

Introduction Physical activity and academic performance are believed to be associated. Though both traits are partially heritable, it remains unclear whether these traits also share a genetic and/or environmental background in common. We aimed to examine to what extent leisure time physical activity and academic performance share genetic and environmental effects from early adolescence to young adulthood. Methods Participants were Finnish twins (2543-2693 individuals/study wave) who reported their leisure-time physical activity at ages 12, 14, 17, and 24 yr. Academic performance was assessed with teacher-reported grade point averages at ages 12 and 14 yr and by self-reported educational levels at ages 17 and 24 yr. Bivariate quantitative genetic modeling at each age and between different ages was performed to decompose the trait correlation between academic performance and physical activity into genetic and environmental components. Results The trait correlations between leisure-time physical activity and academic performance were positive, but modest at most (rtrait = 0.08-0.22 in males, and 0.07-0.18 in females). The genetic correlations between leisure-time physical activity and academic performance were higher than the trait correlations (rA = 0.17-0.43 in males, and 0.15-0.25 in females). Common genetic influences explained 43% to 100% of the trait correlations. Environmental influences shared by cotwins between leisure-time physical activity and academic performance were also correlated (rC = 0.27-0.54 in males, and 0.21-0.69 in females) explaining 41% to 100% of the trait correlations. Unique environmental influences were correlated only in females (rE = 0.10-0.15). Conclusions Both common genetic background and shared family environment (i.e., familial background) partially account for the associations observed between leisure-time physical activity and academic performance. However, the estimates vary in magnitude by age.