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BackgroundThe increased use of wearable sensor technology has highlighted the potential for remote telehealth services such as rehabilitation. Telehealth services incorporating wearable sensors are most likely to appeal to the older adult population in remote and rural areas, who may struggle with long commutes to clinics. However, the usability of such systems often discourages patients from adopting these services. ObjectiveThis study aimed to understand the usability factors that most influence whether an older adult will decide to continue using a wearable device. MethodsOlder adults across 4 different regions (Northern Ireland, Ireland, Sweden, and Finland) wore an activity tracker for 7 days under a free-living environment protocol. In total, 4 surveys were administered, and biometrics were measured by the researchers before the trial began. At the end of the trial period, the researchers administered 2 further surveys to gain insights into the perceived usability of the wearable device. These were the standardized System Usability Scale (SUS) and a custom usability questionnaire designed by the research team. Statistical analyses were performed to identify the key factors that affect participants’ intention to continue using the wearable device in the future. Machine learning classifiers were used to provide an early prediction of the intention to continue using the wearable device. ResultsThe study was conducted with older adult volunteers (N=65; mean age 70.52, SD 5.65 years) wearing a Xiaomi Mi Band 3 activity tracker for 7 days in a free-living environment. The results from the SUS survey showed no notable difference in perceived system usability regardless of region, sex, or age, eliminating the notion that usability perception differs based on geographical location, sex, or deviation in participants’ age. There was also no statistically significant difference in SUS score between participants who had previously owned a wearable device and those who wore 1 or 2 devices during the trial. The bespoke usability questionnaire determined that the 2 most important factors that influenced an intention to continue device use in an older adult cohort were device comfort (τ=0.34) and whether the device was fit for purpose (τ=0.34). A computational model providing an early identifier of intention to continue device use was developed using these 2 features. Random forest classifiers were shown to provide the highest predictive performance (80% accuracy). After including the top 8 ranked questions from the bespoke questionnaire as features of our model, the accuracy increased to 88%. ConclusionsThis study concludes that comfort and accuracy are the 2 main influencing factors in sustaining wearable device use. This study suggests that the reported factors influencing usability are transferable to other wearable sensor systems. Future work will aim to test this hypothesis using the same methodology on a cohort using other wearable technologies.

Background: The decline in marriage and increases in cohabiting unions during childbearing ages represent a major change in family structures and family dynamics. Yet no comprehensive description has covered period trends in the prevalence of marital and nonmarital unions or partnership entry and exit rates across educational levels. Objective: We describe period trends in the proportion of individuals in union and the flow of union formation and dissolution at ages 18-49 across educational levels for men and women in 1989-2019 in Finland. Methods: We use register data with full histories of coresidential unions regardless of marital status. We calculate the age-specific yearly prevalence of marriages, cohabitations, and all coresidential unions, and rates of union formation and separation. Results: The prevalence of marriage declined across educational groups. Increases in the prevalence of nonmarital cohabitation are slightly smaller than declines in marriage; as a result, the total union prevalence declined, especially among low-educated men and women. Union formation rates have declined since around 2010, and separation rates have increased notably, especially among the lower educated and in age groups below 35. Conclusions: The increase in nonmarital cohabitation has not fully covered the decline in the stock of marriages. The increases in union instability are notable. All observed trends and educational gradients are remarkably similar among men and women. Contribution: We provide the first comprehensive population-level estimates of trends and patterns of the union stock and the flow of marital and nonmarital unions by education for both men and women of childbearing ages.

Biomechanical analysis of gait is commonly used in physiotherapy. Ground reaction forces during phases of gait is one element of kinetic analysis. In this article, we analyze if the MoveSole® smart insole is valid and accurate equipment for measuring ground reaction forces in clinical physiotherapy. MoveSole® StepLab is a mobile measurement system for instant underfoot force measurements during gait. Unique electromagnetic film (EMFI) based sensor technology and printed electronics production technology is integrated in the MoveSole® StepLab measurement system. The MoveSole® StepLab measures plantar ground reaction force distribution over the sensors and provides an estimation of the maximum total ground reaction force. We developed a two phase validation process to extract relevant parameters and compared the results to a Kistler force plate using the BioWare® analyzing program as a reference method. Our results show that MoveSole® smart insoles reach the strong level of accuracy needed in clinical work concerning highest ground reaction forces during step (Pearson correlation .822 - .875). The correlation of the time when the maximum ground reaction force occurred was moderate, e.g. during heel strike or toe-off (Pearson correlation natural gait speed .351 - .462, maximum gait speed .430). Our conclusion is that MoveSole® smart insoles are a potential tool for analyzing and monitoring gait ground reaction forces during physiotherapy processes.

Since the 1970s, several European countries have experienced high union dissolution risk as well as high unemployment rates. The extent to which adverse economic conditions are associated with union instability is still unknown. This study explores the relationship between both individual and aggregate unemployment and union dissolution risk in five European countries before the recent economic crisis. Using rich longitudinal data from Belgium, Finland, France, Germany, and Italy, the empirical analysis, based on discrete-time event history models, shows that male unemployment consistently increases the risk of union dissolution. While a strong association is observed between male unemployment and separation at the micro level, no association is found between male unemployment and union dissolution at the macro level. The results for female unemployment are mixed, and the size of the impact of female unemployment is smaller in magnitude than that of male unemployment. In Germany and Italy, where until very recently work is less compatible with family life than in other countries, female unemployment is not significantly associated with union dissolution.

The increased use of sensor technology has been crucial in releasing the potential for remote rehabilitation. However, it is vital that human factors, that have potential to affect real-world use, are fully considered before sensors are adopted into remote rehabilitation practice. The smart sensor devices for rehabilitation and connected health (SENDoc) project assesses the human factors associated with sensors for remote rehabilitation of elders in the Northern Periphery of Europe. This article conducts a literature review of human factors and puts forward an objective scoring system to evaluate the feasibility of balance assessment technology for adaption into remote rehabilitation settings. The main factors that must be considered are: Deployment constraints, usability, comfort and accuracy. This article shows that improving accuracy, reliability and validity is the main goal of research focusing on developing novel balance assessment technology. However, other aspects of usability related to human factors such as practicality, comfort and ease of use need further consideration by researchers to help advance the technology to a state where it can be applied in remote rehabilitation settings.

Background: Divorce and separation have become common life-course events in many European countries. Previous studies show that separated individuals are likely to move from homeownership to renting and to experience a period of residential instability. However, little is known about postseparation homeownership levels in the long run. Objective: This paper investigates homeownership levels after union dissolution. We extend previous research by examining changes in homeownership levels after separation by time (since union dissolution) and across population subgroups. We study whether and how postseparation homeownership levels are associated with repartnering and gender. Methods: We use Finnish register data and logistic regression analysis. Results: Compared to partnered individuals, homeownership levels among recently separated individuals are low. With increasing time since union dissolution, homeownership levels increase. However, the levels are high only among repartnered persons and remain low among separated individuals who remain single. Homeownership levels are slightly lower among separated women than among separated men. Contribution: The study shows the short- and long-term effects of separation on individuals' housing careers. After separation many individuals move from homeownership to rental accommodation, and most previous renters continue to rent. Separated individuals who form new unions are likely to move or return to homeownership. By contrast, those who remain unpartnered following separation have a low likelihood of living in owner-occupied dwellings. This likely reflects both individuals' choices and their constrained opportunities in a country with high homeownership aspirations and levels.

Saksalainen Suomi 1918. Marjaliisa Hentilä & Seppo Hentilä. Siltala, Helsinki 2016. (432 s.)

BACKGROUND The decline in marriage and increases in cohabiting unions during childbearing ages represent a major change in family structures and family dynamics. Yet no comprehensive description has covered period trends in the prevalence of marital and nonmarital unions or partnership entry and exit rates across educational levels. OBJECTIVE We describe period trends in the proportion of individuals in union and the flow of union formation and dissolution at ages 18-49 across educational levels for men and women in 1989-2019 in Finland. METHODS We use register data with full histories of coresidential unions regardless of marital status. We calculate the age-specific yearly prevalence of marriages, cohabitations, and all coresidential unions, and rates of union formation and separation. RESULTS The prevalence of marriage declined across educational groups. Increases in the prevalence of nonmarital cohabitation are slightly smaller than declines in marriage; as a result, the total union prevalence declined, especially among low-educated men and women. Union formation rates have declined since around 2010, and separation rates have increased notably, especially among the lower educated and in age groups below 35. CONCLUSIONS The increase in nonmarital cohabitation has not fully covered the decline in the stock of marriages. The increases in union instability are notable. All observed trends and educational gradients are remarkably similar among men and women. CONTRIBUTION We provide the first comprehensive population-level estimates of trends and patterns of the union stock and the flow of marital and nonmarital unions by education for both men and women of childbearing ages. [ABSTRACT FROM AUTHOR]

BACKGROUND Previous research on fertility has focused on women, and less attention has been paid to men and couples. OBJECTIVE The aim of this study is to examine how the socioeconomic resources of cohabiting and married partners affect entry into parenthood in a relatively gender-egalitarian welfare society. METHOD The study is based on Finnish register data and uses event-history analysis to predict first births from both partners' socioeconomic characteristics. RESULTS The results show that each partner being employed (as opposed to studying) and having a higher income seems to encourage entry into parenthood. As compared to employed couples, either partner being currently unemployed or having recent spells of unemployment had very weak effects, whereas either partner being economically inactive seems to discourage childbearing. Although the resources of male partners also have an effect, the female partner's situation appears to be equally or even more influential. The effects of female partners' characteristics are almost as great when male characteristics are controlled as when they are not, and women's and men's characteristics do not interact with each other. Moreover, with regard to income and educational attainment beyond age 30, for example, the woman's resources have a stronger positive effect than the resources of the male partner. CONCLUSIONS Together with several previous studies from the Nordic countries, this study lends support to the idea that the influence of women's and men's economic resources on family formation are perhaps much more symmetrical than conventional theories suggest. COMMENTS The significance of women's own resources, net of the male partner's resources, suggests that previous studies have not overestimated their positive impact. [ABSTRACT FROM AUTHOR]

This study investigates how unemployment is associated with the transition to parenthood among men and women in times of increased instability in the labour market. We provide novel insights into how education and life stage might modify the link between unemployment and fertility. We focus on a Nordic welfare state, Finland, and apply event history models to a rich register sample covering the years 1988--2009 (N=306,413). We find that unemployment or a weaker labour market attachment tends to delay parenthood among both men and women, but the association is stronger for men. In most groups, the accumulation of unemployment periods is associated with a lower rate of entry into parenthood. However, among young, low-educated women, even long-term or recurring unemployment seems to promote first childbearing, and the generally negative association between unemployment and entry into parenthood does not apply to young, low-educated men. The effect of unemployment is largely mediated by the low income of unemployed persons. Overall, our findings suggest that in a modern, gender-egalitarian welfare society, better employment prospects promote transition to parenthood in a very similar fashion among men and women, but the effects are strongly modified by education and life course stage. [ABSTRACT FROM AUTHOR]

Various bone proteins and growth factors in specific concentrations are required for bone formation. If the body cannot produce sufficient quantities of these factors, bone trauma can be healed with an implant that includes the required factors in a carrier. This study was designed to evaluate various calcium salt candidates that can be used as carrier with reindeer bone protein extract to induce ectopic bone formation in the muscle pouch model of mouse. The bone protein extract was either impregnated into the disc form of carrier or mixed with carrier powder before implantation. The radiographic analysis indicated increased bone formation in all of the active groups containing the bone protein extract compared to the controls within 21 days follow-up. The highest bone formation was seen in the group with calcium sulfate with stearic acid where new bone and calcified cartilage were clearly visible. The greatest bone formation occurred in the groups that had bone protein extract readily available. This indicates that the bone forming factors in sufficient concentrations are required at the early stage of bone formation. The calcium sulfate with stearic acid was the most suitable and effective carrier for reindeer bone protein extract.

Objective: This paper studies postseparation fertility behavior. The aim is to investigate whether, and if so how, separation affects second birth spacing in Western European countries. Methods: This analysis makes use of rich survey data from Belgium, France, Germany, Italy, Spain, and the United Kingdom, as well as from Finnish register data. We thus cover the behavior of a large proportion of the population of Western Europe. We also use descriptive measures, such as Kaplan‒Meier survival functions and cumulative incidence curves. In the multivariate analysis, we employ event history modeling to show how education relates to postseparation fertility behavior. Results: There are large differences in postseparation fertility behavior across European countries. For Spain and Italy, we find that only a negligibly small proportion of the population have a second child after separating from the other parent of the firstborn child. The countries with the highest proportion of second children with a new partner are the United Kingdom, Germany, and Finland. In all countries, separation after first birth leads to a sharp increase in the birth interval between first and second births. Contribution: Our study is a contribution to the demographic literature that aims at understanding birth spacing patterns in Western Europe. Furthermore, we draw attention to the role of postseparation policies in explaining country differences in fertility behavior in contemporary societies.

Background: Childlessness has increased in many European countries. Partnerships and parenthood are obviously closely related, but there is relatively little knowledge on how childlessness is linked to contemporary union dynamics that involve high rates of separation and unmarried cohabitation. Objective: To situate (biological) childlessness in longitudinal dynamics of union formation and stability, we take a life-course approach to union trajectories that consist of states entered via the formation and dissolution of cohabitations and marriages. Concretely, we identify groups of similar union trajectories of individuals between the ages of 18 and 39 who are childless at age 42. Methods: We analyse register data on Finnish men and women born in 1969 and 1970 (childless N=3,241) with sequence, cluster, and multinomial logistic regression methods. Results: Four clusters of typical union trajectories were identified among the childless and assigned these labels: 1) Never Partnered (45Š), characterized by never having entered a coresidential partnership, or just having entered a cohabitation near age 40; 2) Briefly Cohabited (25Š), characterized by mostly living single after a brief cohabitation spell; 3) Cohabitors, Often Serial (19Š), marked by typically discontinuous cohabitation; and 4) Married (11Š). The Never-Partnered cluster is male-dominated. Men with a rural background and less-educated men and women are overrepresented among the Never-Partnered childless. Conclusions: For the great majority of the childless in our study cohorts, union trajectories are marked by either the (almost) complete absence of coresidential unions or fragmentary cohabitation histories. Contribution: The study contributes to the literature by showing that union histories, including never partnering as well as cohabitation instability, are key for understanding contemporary childlessness. Comments: We recommend that you read the paper on screen or print a color version.

Background: Previous studies suggest that in some countries socioeconomic differences in family formation are highly gendered, whereas gender-neutral patterns are reported in other countries. Most previous studies focus on single events and therefore it is unclear how the gender differences and neutralities in family transitions combine into variation in longer family-formation trajectories. Objective: We explore how family trajectories vary by educational attainment and gender. The research asks whether there are gender differences in family trajectories by education. We focus on the trajectories of women and men in Finland between the ages of 18 and 39, and on the 1969 and 1970 birth cohorts. The trajectories consist of states entered via the formation and dissolution of cohabitation and marriage and the birth of the first child. Methods: We give a sequence representation of Finnish register data comprising monthly histories of union dynamics and childbearing. We focus on the number and order of family states. Results: We find notable differences in family trajectories by educational attainment; however, the gender differences in the trajectories within educational groups are negligible. For instance, the proportion of never-partnered and childless at age 39 is largest among those with low education, regardless of gender. Further, at age 39, highly educated women and men are most likely to live in the same union in which they became first-time parents. Contribution: This study adds to previous literature by showing that in an egalitarian Nordic welfare state, longitudinal family-formation trajectories are highly stratified by education but remarkably gender-neutral.

The high and increasing incidence of divorce, with the various consequences for adults and children, has aroused interest among social scientists in understanding the contributory factors. Prominent economic and psychosocial theories suggest that the husband’s social and economic resources tend to stabilize a marriage, whereas the wife’s economic success tends to destabilize it (the gendered hypothesis). Register-based follow-up data from Statistics Finland on first marriages in Finland that were intact at the end of 1990 and divorces in 199193 (n=21,309), and Poisson regression were used to analyze the impact of the socio-economic positions of the spouses on the risk of divorce. This thesis consists of three articles published in international refereed journals, and a summary article. The aim of sub-study I was to disentangle the influences of various aspects of the spouses’ socio-economic positions on divorce risk and to reveal the causal pathways through which each socio-economic factor was related to it. Sub-study II investigated the joint effects of both spouses’ socio-economic positions. Finally, sub-study III explored the possibility that the effect of spouses’ socio-economic positions on divorce risk might vary according to the duration of the marriage. When examined individually, divorce risk was inversely associated with socio-economic status for all its various indicators (i.e. each spouse’s education, occupational class, economic activity, and income, as well as housing tenure and housing density) except the wife’s income. All of these factors had an independent effect. The independent effect was weak for both spouses’ occupational rankings and housing density, however, and it was positive for the wife’s income. The divorce risk for couples with both partners at the lowest educational level was lower than expected on the basis of its overall inverse association with each spouse’s education. Employed and homemaker women with employed husbands had comparatively stable marriages, whereas couples in which the husband, the wife, or both partners were unemployed had an elevated risk of divorce. The husband’s high income decreased the risk, and the wife’s high income increased it regardless of the level of the other spouse’s income, but the divorce-promoting effect of the wife’s high income was especially strong when the husband’s income was low. The comparatively high divorce risks for spouses with little formal education and those in manual-worker occupations were found to be specific to marriages of relatively short duration. In contrast, factors such as unemployment, the wife’s high income, and living in a rented dwelling were found to increase the risk regardless of marital duration. Overall, the socio-economic resources of the spouses, irrespective of which spouse had contributed them, decreased the risk of divorce, supporting the gender-neutral hypothesis. However, some aspects of the wife’s resources (absolute and relative to those of her husband) tended to increase the risk. The finding that the less structural socio-economic factors affected divorce risk in a very similar way in marriages of varying duration highlights their importance as factors predicting marital stability.