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Cities are crucially but problematically positioned to take on the climate crisis. Although local governance seems an appropriate scale for adaptation and mitigation measures, numerous barriers to implementing them effectively have been diagnosed. We argue that a focus on pinpointable barriers neglects the intrinsic organisational dynamics that often impede effective climate action. Drawing on interviews with climate specialists in Finnish municipalities, we engage with local governance practices and study how the interviewees experience and negotiate the complexities of climate work. Using Henri Lefebvre’s rhythmanalysis, we find that municipalities treat climate issues as auxiliary concerns and subsume them as separate, precarious projects. The various and conflicting rhythms that constitute the relations of organisational practices leave climate and environmental experts in a contentious state. They must not only endure constant sidelining by the core functions of their organisations but also devise strategies to keep climate issues on the agenda. We suggest that organisational practices are constituted by diverging and often conflictual rhythms. Analysing their expressions in everyday climate work, we show how a composed functioning of municipal organisations serves to persistently defer a change of pace towards achieving ambitious climate goals.

We examine why implementing climate aims has proven challenging for municipalities. Recognising that climate policy research identifies ‘barriers’ to the forward motion of environmental knowledge, we use STS tools to dismantle ‘barrier thinking’ and analyse the dynamics of climate knowledge in municipal organisations. The primary data are 21 interviews with climate change and risk management experts in Finnish municipalities. We employ the idea of ‘trials of strength’ to analyse not mere barriers but gatherings, translations, and implementations of environmental knowledge. We argue that four kinds of trials are crucial in transforming climate knowledge so it can cohere with ongoing processes: it is gathered and condensed at the organisation’s borders; climate experts embody and transmit the knowledge; meeting tables form obligatory passage points for its implementation; and road maps draw actors together to circulate it. While traveling around municipal organisations, climate knowledge is often sidetracked but can sometimes become unexpectedly effective.

Our review essay contributes to the long-standing and vibrant discussion in science and technology studies (STS) on methods, methodologies, and theory–method relationships. We aim to improve the reflexivity of research by unpacking the often implicit assumptions that imbue research conduct and by offering practical tools through which STS researchers can recognize their research designs and think through them in a new way. To achieve these aims, we analyze different compositions of theories, methods, and empirics in three different STS approaches—actor–network theory, the biography of artifacts and practices, and ethnomethodology—by employing the concept of a theory–methods package (TMP). A selection of theoretical cornerstone texts and case studies in infrastructure research from each tradition serves as our material. Our findings point, first, to differences between the TMPs of the reviewed approaches and to the internal diversity of theory–method relationships in each approach. Second, we found some intriguing similarities between the approaches and discuss potential complementarities of their theory–method fits.

Anna Lowenhaupt Tsing: Lopun aikojen sieni. Elämää kapitalismin raunioissa (The Mushroom at the End of the World: On the Possibility of Life in Capitalist Ruins). Suomentanut Anna Tuomikoski. Tutkijaliitto, Helsinki 2020. 372 s. Lopun aikojen sieni on matsutake eli tuoksuvalmuska. Kalifornian yliopiston antropologianprofessori Anna Lowenhaupt Tsing seuraa matsutakea sen matkalla ekologisista mahdollisuusehdoistaan eli rihmastoista irrotetuksi ja koriin poimituksi sieneksi, joka laivataan Japaniin luksusruoka-aineeksi. Tsingin teos on eräänlainen matsutaken reittejä seuraava matkakirja, jonka kohteet sijaitsevat Japanin lisäksi Yhdysvaltojen Oregonissa, Kiinan Yunnanissa ja Suomen Lapissa. Kööpenhaminassa haastatellaan mykologia ja tieteellisissä tapahtumissa vieraillaan eri puolilla maailmaa.

In the present study, we examine socio-cultural and practical aspects of human papillomavirus vaccination (HPVV) through a multi-sited study of framings. We ask how HPVV is framed in the daily lives of vaccination-aged Finnish girls and in school nurses' everyday work. We then mirror these framings against both each other and Finland's official vaccination campaign. Based on analysis of interviews with 24 nurses and 12 girls and the campaign materials, we argue first that the campaign frames vaccination as an individual, knowledge-based decision reflecting the informed consent principle. Second, however, the vaccination is framed in the everyday lives of eligible girls through gendered social ties and as a gendered and cohort-specific event pivoting around the needle prick. Third, HPVV is not primarily framed in the school nurses' work as preparing the girls for the vaccination decision by sharing official information but through trust-based social relationships with the girls and their parents. We conclude that, as the vaccination is not an issue of individually reflected and knowledge-based decision-making for the two interviewed key groups, the official Finnish HPVV campaign and the undergirding informed consent principle drift into problems in their practical implementation.

This article examines the institutionalization of organic agriculture in Finland's agricultural policy. Organic agriculture is one of the main alternatives for conventional food production, promoting values that go beyond the focus on productivity and profit. Yet, numerous studies have raised concerns over the changes institutionalization has produced in its transformative capacity. It has been claimed that institutionalization results in the economization of organic agriculture, whereby the goals of this alternative mode of production are displaced by market coordination and profit maximization. However, studies have also called for more detailed analyses, which would account for e.g. national variations in the development of organic agriculture. To further this discussion, we apply conventions theory to analyze how policy documents, strategy papers, and studies have justified the institutionalization of organic agriculture in official policy in Finland. Conventions theory has the benefit of examining both the moral arguments and the knowledge production related to this. From this perspective, we investigate how organic values have been shaped and how policies have attempted to resolve tensions between conflicting justifications. The results show that compromises between organic values and economic rationales have been used to promote organic agriculture, which has also promoted economization. However, the results also indicate that in addition to economization, organic values have faced other challenges. The value of organic agriculture has been questioned based on, for example, scientific measurements of organic products, and by comparisons to Finnish conventional production. Both challenges have questioned the significance of organic agriculture in terms of its health and ecological benefits. The results therefore indicate that more contextualized analytical models are needed when examining the institutionalization of organic agriculture.

Funding Information: We thank two anonymous reviewers for their valuable comments. We gratefully acknowledge funding from the Academy of Finland's Strategic Research Council Grant no. 312623, 312624, 312625, and 312626 and Academy of Finland Grant no. 338553 and 338558. Funding Information: We thank two anonymous reviewers for their valuable comments. We gratefully acknowledge funding from the Academy of Finland’s Strategic Research Council Grant no. 312623, 312624, 312625, and 312626 and Academy of Finland Grant no. 338553 and 338558. Publisher Copyright: © 2021 The Authors The magnitude and speed of change in complex human-environmental systems pose a systemic dilemma for societies. Human-induced environmental changes have pushed Earth's socio-ecological systems into an era of chronic, complex, and rapid disruptions, which call for quick intuitive decisions and effective implementation. Yet the complexity, interconnectedness and long lead times of the problems would require thoughtful and time-consuming weighing of evidence by a broad range of experts. To address the dilemma, we develop a framework, the Policy Operations Room (POR), for simultaneous practice and analysis of decision-making that prevents decisions made under time pressure from leading to unwanted socio-ecological disruptions decades ahead. The POR framework is based on earlier research on control rooms of critical infrastructures and simulation exercises of emergency response, and preliminary data from our first experiments with PORs. It immerses the policymakers in a simulated “time machine” that combines the real-time reliability management of control rooms with the long-term planning for crisis avoidance and preparedness. The POR framework can contribute significantly to novel styles of decision-making by policymakers, engineers, and corporate strategists responsible for developing urgent, forward-looking, and evidence-based policies to cope with the coming challenges of human-environmental interaction.

The evolution of computer tools has had profound impacts on many aspects of control rooms and control room studies. In this paper, we discuss some key assumptions underpinning these studies based on a new case of the electricity distribution control rooms, where the reliability of the electricity infrastructure is managed by a combination of planning and real-time maintenance. Some of these practices have changed remarkably little over the past decades – partially because they have been considered to have been ‘digitalized’ since the 1950s and have continued to amass digital solutions from different periods. Hence, the gradual transformation of control room work demands nuanced attention, both conceptual and empirical. To outline a framework for this work, we provide a conceptualization of organizational routines, habits, and reflectivity and synthesize existing CSCW and control room literature. We then present an empirical study that demonstrates our concepts and shows how they can be applied to study cooperative work. By addressing these aims the paper complements, and advances, the important topics recognized in this special theme issue and hence develops new research openings in CSCW. We address the necessity to avoid implicit determinism when analyzing new digital support tools and suggest focusing on how working habits mediate social changes, distribution, and decentralization in representing the power distribution in control rooms.

Toimijaverkostoteoreetikko Michel Callonin ajattelusta liikkeelle lähtenyt performatiivisuuden tutki-musohjelma on kahden viime vuosikymmenen aikana saavuttanut merkittävän aseman taloutta tarkastelevan yhteiskuntatieteen kentällä. Ohjelma on kohdannut viime vuosina kuitenkin myös kritiikkiä sen tavasta tarkastella taloudellisia ilmiöitä ensisijaisesti yhdestä suunnasta, talouden tiedekytkennän kautta. Osallistumme artikkelillamme tähän Callonin tutkimusohjelman päivittämisestä käytävään keskusteluun: Avaamme ensin ohjelman ydinsisältöjä ja pureudumme sille rakentuviin tapaustutkimuksiin, joiden kohteena on yksi vastuullisen liiketoiminnan uusimmista muodoista, vaikuttavuusinvestoiminen. Peilaamme tämän jälkeen tutkimusten antia ja performatiivisuuden tutkimusohjelmaan sisältyviä ohjeistuksia omaan tapaustutkimukseemme, jonka kohteena on Sitran pyrkimys kotouttaa vaikuttavuusinvestoiminen Suomeen. Osoitamme tarkastelumme pohjalta, että keskittyminen taloustieteen performatiivisuuteen jättää muut vaikuttavuusinvestoimisessa keskeiset performatiivisuuden muodot katveeseen. Luonnostelemme tältä pohjalta moniperformatiivisuudeksi kutsumaamme tutkimustapaa. Ajatus tutkimuksellisesta moniperformatiivisuudesta vastaa Callonin ohjelman päivittämistarpeeseen havainnoimalla ilmiöitä eri arvottamisen muotojen, järkeilytyylien ja perustelumallien yhdistelminä.

This article focuses on two different ways of framing and taming the uncertainties of the human papillomavirus (HPV) vaccine in the context of the Finnish welfare state: the bio‐medical rationale of population‐level cancer reduction based on epidemiological assessments, and the meaning formation of Finnish vaccination‐aged girls. Epidemiologists run analyses estimating the cost‐effectiveness and public health benefit of vaccinations, while the adolescent girls face the burdensome choice of whether to undergo vaccination. The processes of framing the complexities and actively taming them are analysed utilising a cultural‐sociological framework. Firstly, the taming work of the epidemiologists is examined by focusing on the creation of the vaccination campaign. The aetiological complexities between some HPV types and cervical cancer are tamed into a clear campaign message of vaccination as a scientifically proven protection against deadly cancer. Secondly, the girls’ own ways of framing the complexities of the HPV vaccine and taming the decision whether to undergo vaccination or not are analysed based on their comments in an Internet discussion forum. Finally, the framings and tamings of both sites are discussed together, and some interesting continuities and disjunctions between the two are revealed.

Background Healthcare professionals (HCPs) search medical information during their clinical work using Internet sources. In Finland, Physician's Databases (PD) serve as an Internet medical portal aimed at HCPs. Influenza epidemics appear seasonal outbreaks causing public health concern. Oseltamivir can be used to treat influenza. Little is known about HCPs' queries on oseltamivir and influenza from dedicated online medical portals and whether queries could be used as an additional source of information for disease surveillance when detecting influenza epidemics. Methods We compared HCPs' queries on oseltamivir and influenza from PD to influenza diagnoses from the primary healthcare register in Finland 2011-2016. The Moving Epidemic Method (MEM) calculated the starts of influenza epidemics. Laboratory reports of influenza A and influenza B were assessed. Paired differences compared queries, diagnoses, and laboratory reports by using starting weeks. Kendall's correlation test assessed the season-to-season similarity. Results We found that PD and the primary healthcare register showed visually similar patterns annually. Paired differences in the mean showed that influenza epidemics based on queries on oseltamivir started earlier than epidemics based on diagnoses by -0.80 weeks (95% CI: -1.0, 0.0) with high correlation (tau = 0.943). Queries on influenza preceded queries on oseltamivir by -0.80 weeks (95% CI: -1.2, 0.0) and diagnoses by -1.60 weeks (95% CI: -1.8, -1.0). Conclusions HCPs' queries on oseltamivir and influenza from Internet medical databases correlated with register diagnoses of influenza. Therefore, they should be considered as a supplementary source of information for disease surveillance when detecting influenza epidemics.

This research note reviews recent literature on the vulnerability of critical infrastructures caused by climate change with a focus on the Nordic countries. We integrate literature from three research areas: the role of critical infrastructures in the functioning of society, infrastructural vulnerabilities, and the long-term impacts of climate change. Focusing on climate change adaptation in the Nordic countries as a pivotal case, we discuss the mutually constitutive interrelationships between these three areas. The studies reviewed bring together social science and humanities research on infrastructure systems, their vulnerabilities, and climate change. By highlighting interdisciplinary perspectives on infrastructures, climate change, and societal security, this research note discusses a Nordic model of infrastructure provision and links the Nordic debate to a burgeoning European discussion on the role of the social sciences and humanities in addressing societal challenges related to climate change and the role of infrastructures in providing welfare.

Tarkastelemme terveyssosiologisessa artikkelissamme sitä, miten HPV-rokote kehystyy suomalaisten rokoteikäisten tyttöjen arjessa ja kouluterveydenhoitajien työssä. Tutkimusaineistomme koostuu 21 kouluterveydenhoitajan ja 12 rokoteikäisen tytön teemahaastatteluista. Taustoittavana aineistona hyödynnämme virallisen Tyttöjen juttu -rokotekampanjan materiaaleja. Analyysimme rakentuu aineistolähtöisesti. Hyödynnämme sen taustana monipaikkaisen kehystymistutkimuksen tutkimustapaa ja tutkimustavassa keskeistä kehystymisen käsitettä. Tarkastelemme terveydenhoitajien ja tyttöjen rokotekehystymisiä tiedollisella, sosiaalisella ja sukupuolen ulottuvuudella. Peilaamme kehystymisiä myös toisiaan vasten ja paikannamme niiden väliltä sekä kitkoja että jatkuvuuksia. Rinnastamme kehystymisiä edelleen virallisen rokotekampanjan tietopainotteisiin rokotekehyksiin. Tuloksina esitämme, että HPV-rokote kehystyy rokoteikäisille tytöille ensisijaisesti sukupuolittuneena, heidän omaa ikäryhmäänsä koskettavana tapahtumana, jonka keskiössä on neulalla pistäminen. Tytöillä ei ole välttämättä halua, tarvetta tai resursseja rokotekampanjassa korostuvaan tiedolliseen pohdintaan ja tietoperustaiseen päätöksentekoon. He keskustelevat rokotteesta sosiaalisissa suhteissaan, mutta varsinaisessa päätöksenteossa korostuu erityisesti äidin mielipide. Kouluterveydenhoitajille rokote kehystyy puolestaan osana käytännöllistä, kouluissa tehtävää terveystyötä. Terveydenhoitajat pohtivat lisäksi tyttöjen kypsyyttä rokotemekanismin ymmärtämiseen ja itsenäisen rokottamispäätöksen tekemiseen. Johtopäätöksenä nostamme esille kehystymisten välisen kitkan. Tyttöjen ja terveydenhoitajien rokotekehystymiset eivät asetu suoraan järkevää yksilöllistä päätöksentekoa painottavaan kampanjakehykseen, mikä haastaa terveystieteellistä lähtökohtaa tietoperustaisesta suostumuksesta. Kouluterveydenhoitajat käsittelevät kitkaa käytännön työssään. He välittävät virallisen rokotekampanjan tietopohjaista kehystä ja tyttöjen omia rokotekehystymisiä. Tiedon jakamisen sijasta keskeistä on saavuttaa rokottamisrutiini kiireisen arjen keskellä ja säilyttää luottamuksellinen suhde tyttöihin ja heidän vanhempiinsa.

Lyme borreliosis (LB) is caused by Borrelia burgdorferi sensu lato (Bb-sl) and is the most common vector-borne disease in Europe. The objectives of this study were to determine the Bb-sl seroprevalence among the general Finnish adult population and to identify risk factors associated with Bb-sl-seropositive status. Two thousand sera from a nationwide health survey from 2011 were tested by whole-cell sonicate IgG ELISA, C6 peptide ELISA, and recomBead IgG 2.0 and test results were linked to a general health questionnaire. A multivariable logistic regression model was used to identify risk factors. The median age of the study population was 56 years (range 29-97) and the Bb-sl weighted seroprevalence was 3.9% (95% confidence interval (CI) 3.03-5.08). The weighted seroprevalence was significantly higher among males than females (adjusted odds ratio 1.91, 95%CI 1.21-3.04). The seroprevalence was highest in Southern, Central, and Eastern regions. The first Bb-sl seroprevalence study in Finland showed a seroprevalence of 3.9% (regional range 0.87%-6.12%). The results of this study can be used, together with previous data on LB incidence and spatial tick distribution, to target public health communication about preventive measures.

We investigated the epidemiology of Lyme borreliosis (LB) in Finland for the period 1995–2014 by using data from 3 different healthcare registers. We reviewed data on disseminated LB cases from the National Infectious Diseases Register (21,051 cases) and the National Hospital Discharge Register (10,402 cases) and data on primary LB (erythema migrans) cases from the Register for Primary Health Care Visits (11,793 cases). Incidence of microbiologically confirmed disseminated LB cases increased from 7/100,000 population in 1995 to 31/100,000 in 2014. Incidence of primary LB cases increased from 44/100,000 in 2011 to 61/100,000 in 2014. Overall, cases occurred predominantly in women, and we observed a bimodal age distribution in all 3 registers. Our results clearly demonstrate that the geographic distribution of LB has expanded in Finland and underscore the importance of LB as an increasing public health concern in Finland and in northern Europe in general.

The social life of methods – the idea that research methods are an important topic of inquiry in and of themselves – has been receiving increasing interest in scholarship on the organisation of the economy and social life, including Science and Technology Studies (STS). In STS, especially ethnographic methods have been important for decades. This article develops an ethnographic methodology for the study of a very new case that challenges the assumptions underpinning many STS ethnographies. This case is the networked energy infrastructure, and we specifically focus on its risk management and markets. Drawing upon recent STS interest in multi-sited ethnography, the article’s research design is termed the multi-sited analysis of infrastructures (MSAI), and it develops the concepts of framing and taming to focus on meaning formation as mundane sense-making and as technicalised reasoning on different sites. We demonstrate these concepts in a multi-sited ethnography of energy infrastructure and its risk management and market activities in public regulation, special control rooms (including energy trading), and households. The article rounds up by explaining how the application of our methodology contributes to the advancement of interests in multi-sited ethnography, relating our research to the previous work in the fields of STS, infrastructure studies, and their methods.

This article discusses the reliability of electricity supply and the management of its uncertainties from a systems theoretical point of view. We begin by outlining recent Science and Technology Studies (STS) literature about energy systems, infrastructures and practices concerning their use and argue that many current discussions hold promise in two directions: one concerns the brittleness and uncertainty of the electricity system that is seen as an ongoing achievement, the other is about broader structuring factors and contexts that should also be acknowledged when researching such systems. With an aim of developing this two-part focus, the paper advances systems theoretical considerations about the electricity infrastructure and proposes an analysis tool to study the necessary reductions of complexity of the infrastructure in two emblematic settings. The sites are infrastructure control rooms on the one hand and households on the other hand. The article concludes by discussing the different reductions of complexity by electricity users and electricity experts through using the theoretical point of view presented in the article.

Consumption of milk and other dairy foods has been associated with reduced risk of stroke, although not all studies have shown this consistently.We examined the association between dairy food intake and risk of stroke subtypes within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Between 1985 and 1988, 26,556 Finnish male smokers aged 50-69 years who had no history of stroke completed a food frequency questionnaire. We used Cox proportional hazards models to estimate relative risks (RRs) and 95% confidence intervals (CIs), adjusted for potential confounders.During a mean follow-up of 13.6 years, 2702 cerebral infarctions, 383 intracerebral hemorrhages, and 196 subarachnoid hemorrhages were ascertained. We observed positive associations between whole milk intake and risk of intracerebral hemorrhage (RR = 1.41 for the highest vs. lowest quintile of intake; 95% CI = 1.02-1.96) and between yogurt intake and subarachnoid hemorrhage (RR = 1.83 for the highest vs. lowest quintile of intake; 95% CI = 1.20-2.80). Men in the highest quintile of cream intake had a moderate decreased risk of cerebral infarction (0.81; 0.72-0.92) and intracerebral hemorrhage (0.72; 0.52-1.00). There were no strong associations between intakes of total dairy, low-fat milk, sour milk, cheese, ice cream, or butter and risk of any stroke subtype.These findings suggest that intake of certain dairy foods may be associated with risk of stroke.

Background We estimated the burden of health care–associated infections (HAIs) occurring in Finnish adult acute care hospitals using national hospitalization data and estimates of HAI based on a recent national prevalence survey. Methods A total of 7531 non-HAI patients and 703 HAI patients (8.5%) identified in the prevalence survey were included in the study. Using the patients’ national identity numbers and the prevalence survey date, we obtained data on hospitalizations, including discharge diagnoses from the National Hospital Discharge Registry (NHDR), and the dates and causes of death from the National Population Information System. We converted the prevalence of HAI into incidence using the Rhame-Sudderth formula, assessed the 28-day case fatality of the HAI patients, and then extrapolated the annual estimates of HAI burden from the total number of hospitalizations in adult acute care hospitals in 2005 (n = 804,456). We also assessed the sensitivity of the NHDR diagnoses in identifying HAIs. Results The estimated incidence of HAIs was 5.7% (95% confidence interval = 5.0% to 6.5%), and the 28-day case fatality was 9.8%. Thus, >8500 hospitalizations per million population annually would result in at least 1 HAI and ~270 HAI-associated deaths within 28 days. The sensitivity of the NHDR diagnoses was 34% (range by infection type, 0% to 67%). Conclusion Our disease burden estimates can be used in health care planning and resource allocation. The NHDR was not a reliable source for case finding of HAIs.

Background and Purpose— Coffee and tea consumption could potentially reduce the risk of stroke because these beverages have antioxidant properties, and coffee may improve insulin sensitivity. We examined the associations of coffee and tea consumption with risk of stroke subtypes. Methods— We used prospective data from the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study, a cohort study of 26 556 male Finnish smokers aged 50 to 69 years without a history of stroke at baseline. Coffee and tea consumption was assessed at baseline using a validated food-frequency questionnaire. During a mean follow-up of 13.6 years, from 1985 through December 2004, 2702 cerebral infarctions, 383 intracerebral hemorrhages, and 196 subarachnoid hemorrhages were ascertained from national registries. Results— After adjustment for age and cardiovascular risk factors, both consumption of coffee and tea was statistically significantly inversely associated with the risk of cerebral infarction but not intracerebral or subarachnoid hemorrhage. The multivariate relative risk of cerebral infarction for men in the highest category of coffee consumption (≥8 cups/d) was 0.77 (95% CI, 0.66 to 0.90; P for trend P for trend=0.002). Conclusions— These results suggest that high consumption of coffee and tea may reduce the risk of cerebral infarction among men, independent of known cardiovascular risk factors.

The associations of dietary folate, vitamin B(6), vitamin B(12), and methionine intakes with risk of stroke subtypes were examined among 26,556 male Finnish smokers, aged 50-69 years, enrolled in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Dietary intake was assessed at baseline by using a validated food frequency questionnaire. During a mean follow-up of 13.6 years, from 1985 through 2004, 2,702 cerebral infarctions, 383 intracerebral hemorrhages, and 196 subarachnoid hemorrhages were identified from national registers. In analyses adjusting for age and cardiovascular risk factors, a high folate intake was associated with a statistically significant lower risk of cerebral infarction but not intracerebral or subarachnoid hemorrhages. The multivariate relative risk of cerebral infarction was 0.80 (95% confidence interval: 0.70, 0.91; p(trend) = 0.001) for men in the highest versus lowest quintile of folate intake. Vitamin B(6), vitamin B(12), and methionine intakes were not significantly associated with any subtype of stroke. These findings in men suggest that a high dietary folate intake may reduce the risk of cerebral infarction.

ObjectivesTo identify and describe dietary patterns in a cohort of pregnant women and investigate whether the dietary patterns are associated with dietary intake and sociodemographic factors.DesignMothers entering the Finnish Type 1 Diabetes Prediction and Prevention (DIPP) Nutrition Study in 1997–2002 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy. Principal components analysis was used to identify dietary patterns.SettingFinland.SubjectsSubjects were 3730 women with a newborn infant carrying increased genetic susceptibility to type 1 diabetes mellitus.ResultsSeven factors were identified and named. Energy intake correlated positively with ‘Healthy’, ‘Fast food’, ‘Traditional bread’, ‘Traditional meat’ and ‘Coffee’ patterns and inversely with the ‘Alcohol and butter’ pattern. Intake of dietary fibre correlated positively with ‘Healthy’, ‘Traditional bread’ and ‘Low-fat foods’ patterns and inversely with the ‘Alcohol and butter’ pattern. The seven dietary patterns seemed to account for relatively large proportions of the variance in energy and nutrient intakes except for the intake of vitamin D, vitamin C, carotenoids and calcium. Maternal age and higher level of education were associated with higher scores on ‘Healthy’, ‘Low-fat foods’ and ‘Alcohol and butter’ patterns.ConclusionPrincipal components analysis produced seven dietary patterns which may be useful for further research concerning maternal diet and health outcomes among both mothers and their offspring.

With the growing number of epidemiologic publications on the relation between dietary factors and cancer risk, pooled analyses that summarize results from multiple studies are becoming more common. Here, the authors describe the methods being used to summarize data on diet-cancer associations within the ongoing Pooling Project of Prospective Studies of Diet and Cancer, begun in 1991. In the Pooling Project, the primary data from prospective cohort studies meeting prespecified inclusion criteria are analyzed using standardized criteria for modeling of exposure, confounding, and outcome variables. In addition to evaluating main exposure-disease associations, analyses are also conducted to evaluate whether exposure-disease associations are modified by other dietary and nondietary factors or vary among population subgroups or particular cancer subtypes. Study-specific relative risks are calculated using the Cox proportional hazards model and then pooled using a random- or mixed-effects model. The study-specific estimates are weighted by the inverse of their variances in forming summary estimates. Most of the methods used in the Pooling Project may be adapted for examining associations with dietary and nondietary factors in pooled analyses of case-control studies or case-control and cohort studies combined.

A total of 29,133 male smokers, aged 50-69 years, were recruited into the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study in 1984-1988. The nationwide Finnish Cancer Registry (FCR) recorded 5944 incident cases of cancer in this cohort through the end of 1999. Compared with the FCR data of the entire Finnish male population of same age the standardized incidence ratio (SIR) of total cancer in the ATBC cohort was 1.55 [95% confidence interval (CI) 1.51-1.59]. There was a significant excess of established smoking-related malignancies, such as lung cancer (SIR 2.45, 95% CI 2.35-2.56), and cancers of the tongue, mouth, pharynx, larynx, oesophagus, pancreas, stomach, liver, urinary bladder and kidney. In addition to these sites, cancers of the prostate and colon were slightly more common in the ATBC cohort than in the total Finnish male population (SIR 1.10, 95% CI 1.04-1.18 and SIR 1.14, 95% CI 1.00-1.30, respectively). In conclusion, the risk of many cancers was significantly higher in the ATBC Study cohort compared with the total Finnish male population of same age. In addition to the well known smoking-related cancers, cigarette smoking may increase slightly the risk of colon and prostate cancer, too.

Background: An analysis of dietary patterns or combinations of foods may provide insight regarding the influence of diet on the risk of colon and rectal cancer. Objective: A primary aim of the Dietary Patterns and Cancer (DIETSCAN) Project was to develop and apply a common methodologic approach to study dietary patterns and cancer in 4 European cohorts: the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (Finland-ATBC), the Netherlands Cohort Study (NLCS) on Diet and Cancer, the Swedish Mammography Cohort (SMC), and the Ormoni e Dieta nella Eziologia dei Tumori (Italy-ORDET). Three cohorts (ATBC, NLCS, and SMC) provided data on colon and rectal cancer for the present study. Design: The cohorts were established between 1985 and 1992; follow-up data were obtained from national cancer registries. The participants completed validated semiquantitative food-frequency questionnaires at baseline. Results: Exploratory factor analysis, conducted within each cohort, identified 3-5 stable dietary patterns. Two dietary patterns - Vegetables and Pork, Processed Meats, Potatoes (PPP) - were common across all cohorts. After adjustment for potential confounders, PPP was associated with an increased risk of colon cancer in the SMC women (quintile4multivariate relative risk: 1.62; 95% CI: 1.12,2.34; P for trend = 0.01). PPP was also associated with an increased risk of rectal cancer in the ATBC men (quintile 4multivariate relative risk: 2.21; 95% CI: 1.07, 4.57; P for trend = 0.05). Neither pattern was associated with the risk of colon or rectal cancer in the NLCS women and men. Conclusion: Although certain dietary patterns may be consistent across European countries, associations between these dietary patterns and the risk of colon and rectal cancer are not conclusive. © 2004 American Society for Clinical Nutrition.

Common and country-specific dietary patterns in four European cohort studies.Balder HF, Virtanen M, Brants HA, Krogh V, Dixon LB, Tan F, Mannisto S, Bellocco R, Pietinen P, Wolk A, Berrino F, Van den Brandt PA, Hartman AM, Goldbohm RA.Department of Nutritional Epidemiology, TNO Nutrition and Food Research, Zeist, The Netherlands. balder@voeding.tno.nlThe association between diet and cancer, predominantly investigated univariately, has often been inconsistent, possibly because of the large number of candidate risk factors and their high intercorrelations. Analysis of dietary patterns is expected to give more insight than analysis of single nutrients or foods. This study aimed to develop and apply a common methodological approach to determine dietary patterns in four cohort studies originating in Finland, the Netherlands, Sweden and Italy. Food items on each of the food frequency questionnaires were aggregated into 51 food groups, defined on the basis of their position in the diet pattern and possible relevance to cancer etiology. Exploratory factor analysis was used to analyze dietary patterns. Using a standardized approach, 3-5 stable dietary patterns were identified, explaining 20-29% of total variance in consumption of the food groups. Two dietary patterns, which explained most of the variance, were consistent across the studies. The first pattern was characterized by high consumption of (salad) vegetables, the second by high consumption of pork, processed meat and potatoes. In addition, a few specifically national food patterns were identified. Sensitivity analyses showed that the identified patterns were robust for number of factors extracted, distribution of input variables and energy adjustment. Our findings suggest that some important eating patterns are shared by the four populations under study, whereas other eating patterns are population specific.

Objective: To study the association between dietary and serum antioxidant vitamins and carotenoids and risk for colorectal cancer in male smokers. Design: A prospective cohort study within a randomised, double-blind, placebo-controlled trial testing supplementation with α-tocopherol (50 mg/day), β-carotene (20 mg/day) or both in preventing cancer. Subjects and methods: Participants of the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study with complete dietary data and serum samples available from baseline. These included 26 951 middle-aged male smokers among whom 184 colorectal cancer cases were diagnosed during 8 y of follow-up. Relative risks were calculated with Cox proportional hazards models adjusting for trial supplementation, age, body mass index, serum cholesterol, cigarettes smoked per day and physical activity. Results: There was no significant association between dietary vitamin C or E, α-or γ-tocopherol, retinol, α- or β-carotene, lycopene or lutein+zeaxanthin and risk for colorectal cancer. Serum α-tocopherol, β-carotene or retinol was also not associated with the risk, neither did the season when baseline blood was drawn modify the relationship between serum β-carotene and colorectal cancer risk. Conclusions: Our data support the results from previous studies in which no association between dietary antioxidant vitamins and carotenoids and risk for colorectal cancer has been observed. Likewise, no association between baseline serum antioxidant concentrations and colorectal cancer risk was evident. Sponsorship: The Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study was supported by a contract with the US National Cancer Institute (N01-CN-45165).

Background: The objective of this investigation was to evaluate the association between toenail selenium concentration and lung cancer risk in male smokers. Methods: We conducted a nested case–control study within the Alpha–Tocopherol Beta–Carotene Cancer Prevention Study cohort. This substudy included 250 randomly selected incident lung cancer cases and 250 controls matched on age (up to ± 5 years), intervention group assignment, and date or randomization (±15 days). Odds ratios (ORs) and 95% confidence intervals (CIs) were determined using conditional logistic regression methods. Finland began fortification of argricultural fertilizers in the fall of 1984, increasing the dietary intake, plasma, and toenail selenium concentrations for the population. The present analyses were based on the calculated residual of toenail selenium after regressing it on date of randomization. The selenium residual and the interaction of the residual with date of randomization were included in models with smoking status and body mass index as covariates. Results: We observed a suggestion of a protective association for higher selenium status among men who entered the trial early (when the range of selenium values included very low levels). The OR for men with adjusted toenail selenium concentrations at the 75th percentile compared to those with the lowest selenium concentrations ranged between 0.20 (0.09–0.44) for men randomized earliest in the trail and 0.61 (0.27–1.41) for men randomized in the fifth year. Conclusions: These results suggest that low selenium status may be associated with increased risk for lung cancer.

Objectives: This study investigated the effects of alpha-tocopherol and beta-carotene supplementation on the incidence of gastric cancer. Methods: A total of 29,133 male smokers, aged 50–69 years, participated in a placebo-controlled prevention trial, the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study in southwestern Finland between 1985 and 1993. The men were randomly assigned to receive alpha-tocopherol (50 mg/day) or beta-carotene (20 mg/day) supplementation in a 2 × 2 factorial design. We identified 126 gastric cancer cases during the median follow-up of six years. Of these, 122 were adenocarcinomas: 75 of intestinal type, 30 of diffuse type, and 17 of mixed type. Results: There was no significant effect for either supplementation on the overall incidence of gastric cancer: relative risk (RR) 1.21, 95% confidence interval (CI) 0.85–1.74 for alpha-tocopherol, and RR 1.26, 95% CI 0.88–1.80 for beta-carotene. Subgroup analyses by histologic type suggested an increased risk for beta-carotene on intestinal type cancers, RR 1.59, 95% CI 0.99–2.56. There were no differences across anatomic locations (cardia/noncardia) in the effects of alpha-tocopherol or beta-carotene supplementation. Conclusions: Our study found no overall preventive effect of long-term supplementation with alpha-tocopherol or beta-carotene on gastric cancer in middle-aged male smokers.

An extensive drinking water-associated gastroenteritis outbreak took place in the town of Nokia in Southern Finland in 2007. 53% of the exposed came down with gastroenteritis and 7% had arthritis-like symptoms (joint swelling, redness, warmth or pain in movement) according to a population-based questionnaire study at 8 weeks after the incident. Campylobacter and norovirus were the main pathogens. A follow-up questionnaire study was carried out 15 months after the outbreak to evaluate the duration of gastrointestinal and joint symptoms. 323 residents of the original contaminated area were included. The response rate was 53%. Participants were inquired about having gastroenteritis during the outbreak and the duration of symptoms. Of those with gastroenteritis, 43% reported loose stools and abdominal pain or distension after the acute disease. The prevalence of symptoms declined promptly during the first 3 months but at 15 months, 11% reported continuing symptoms. 32% of the respondents with gastroenteritis reported subsequent arthritis-like symptoms. The disappearance of arthritis-like symptoms was more gradual and they levelled off only after 5 months. 19% showed symptoms at 15 months. Prolonged gastrointestinal symptoms correlated to prolonged arthritis-like symptoms. High proportion of respondents continued to have arthritis-like symptoms at 15 months after the epidemic. The gastrointestinal symptoms, instead, had declined to a low level. Public Library of Science open access

This essay discusses three highly interconnected themes from a systems theoretical point of view: the evidence-based turn in biomedicine, the role and relevance of ethics in this current trend, and the practices of ethics organizations in the field of medicine. First, the origins and contours of evidence-based medicine (EBM) are outlined and put against the backdrop of their societal context. Then, the question of ethics and its contents in current EBM-informed medical practices are examined by asking what kind of problems are eventually labeled as ethical and why? In the latest section, the sites of ethical reasoning, medical ethics committees and commissions, are taken up for observation. The argumentation is based on an on-going empirical case study of a national ethics organization in Finland, the Advisory Board on Social Welfare and Healthcare (ETENE). The essay concludes by discussing the function of problem-based ethics organizations in polycentric society of the presents.

ObjectiveTo study the association between lifetime alcohol consumption and the risk of breast cancer.Design and settingA case–control study carried out in eastern Finland. Information about alcohol consumption was obtained by two methods: a self-administered food frequency questionnaire (FFQ) including alcohol consumption during the previous 12 months, and a lifetime alcohol consumption questionnaire (AQ) which was administered by the study nurse.SubjectsThe study consisted of 301 breast cancer cases (25–75 years old) and 443 population controls.ResultsThe subjects reported higher current alcohol consumption in the AQ compared to the FFQ. According to the AQ, premenopausal cases consumed on average 28 g and controls 24 g alcohol week−1; in postmenopausal women the values were 15 and 14 g, respectively. About 30% of premenopausal and 60% of postmenopausal women were classified as non-drinkers. The correlation for current alcohol consumption between the FFQ and the AQ was 0.80 in premenopausal women but only 0.40 in postmenopausal women. Current alcohol consumption seemed to influence the reporting of total lifetime alcohol consumption. Current alcohol consumption was not associated with the risk of breast cancer either in premenopausal or postmenopausal women; neither were associations found between alcohol consumption at age of first use, use before the age of 30, or total lifetime alcohol consumption and the risk of breast cancer.ConclusionsOn average, one to three drinks per week did not increase the risk of breast cancer in this study. Consumption levels were, however, too low to exclude increased risk with high regular consumption. Further research is necessary on lifetime alcohol consumption.

Objectives: Epidemiological studies have suggested a protective effect of vegetables and fruits on urinary tract cancer but the possible protective nutrients are unknown. We studied the effect of alpha-tocopherol (a form of vitamin E) and beta-carotene supplementation on urinary tract cancer in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. Methods: A total of 29,133 male smokers aged 50–69 years from southwestern Finland were randomly assigned to receive alpha-tocopherol (50 mg), beta-carotene (20 mg), both agents, or a placebo daily for 5–8 years (median 6.1 years). Incident urothelial cancers (bladder, ureter, and renal pelvis; n = 169) and renal cell cancers (n = 102) were identified through the nationwide cancer registry. The diagnoses were centrally confirmed by review of medical records and pathology specimens. The supplementation effects were estimated using a proportional hazards model. Results: Neither alpha-tocopherol nor beta-carotene affected the incidence of urothelial cancer, relative risk 1.1 (95% confidence interval (CI) 0.8–1.5) and 1.0 (95% CI 0.7–1.3), respectively, or the incidence of renal cell cancer, relative risk 1.1 (95% CI 0.7–1.6) and 0.8 (95% CI 0.6–1.3), respectively. Conclusion: Long-term supplementation with alpha-tocopherol and beta-carotene has no preventive effect on urinary tract cancers in middle-aged male smokers.

Background:Calcium, phosphorus, fructose, and animal protein are hypothesized to be associated with prostate cancer risk, potentially via their influence on 1,25-dihydroxyvitamin D3. We examined these nutrients and overall diet and prostate cancer risk in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (ATBC Study). Materials and methods:The ATBC Study was a randomized 2 × 2 trial of alpha-tocopherol and beta-carotene on lung cancer incidence conducted among Finnish male smokers; 27,062 of the men completed a food-use questionnaire at baseline, and comprise the current study population. There were 184 incident clinical (stage 2–4) prostate cancer cases diagnosed between 1985 and 1993. We used Cox proportional hazards models to examine associations between dietary intakes and prostate cancer. Results:We did not observe significant independent associations for calcium and phosphorus and prostate cancer risk. However, men with lower calcium and higher phosphorus intake had a multivariate relative risk of 0.6 (95% CI 0.3–1.0) compared to men with lower intakes of both nutrients, adjusting for age, smoking, body mass index, total energy, education, and supplementation group. Of the other foods and nutrients examined, none was significantly associated with risk. Discussion:This study provides, at best, only weak evidence for the hypothesis that calcium and phosphorus are independently associated with prostate cancer risk, but suggests that there may be an interaction between these nutrients.

High intakes of calcium, potassium, and fluids have been shown to be associated with lowered risk of kidney stones. The authors studied the associations between diet and risk of kidney stones in a cohort of 27,001 Finnish male smokers aged 50-69 years who were initially free of kidney stones. All men participated in the Alpha-Tocopherol, Beta-Carotene Lung Cancer Prevention Study and completed a validated dietary questionnaire at baseline. After 5 years of follow-up (1985-1988), 329 men had been diagnosed with kidney stones. After data were controlled for possible confounders, the relative risk of kidney stones for men in the highest quartile of magnesium intake was 0.52 (95% confidence interval (CI) 0.32-0.85) as compared with men in the lowest quartile. Intake of fiber was directly associated with risk (relative risk (RR) = 2.06, 95% CI 1.39-3.03). Calcium intake was not associated with the risk of kidney stones. Beer consumption was inversely associated with risk of kidney stones; each bottle of beer consumed per day was estimated to reduce risk by 40% (RR = 0.60, 95% CI 0.47-0.76). In conclusion, the authors observed that magnesium intake and beer consumption were inversely associated and fiber intake was directly associated with risk of kidney stones.

It has been suggested that recall bias may explain the discrepant results between case-control and cohort studies on diet and the risk of breast cancer. Two control groups were used for this case-control study of 25 to 75-year-old breast cancer cases (n = 310). The first group consisted of population controls drawn from the Finnish National Population Register (n = 454). The second group consisted of women who were referred to the same examinations as were the cases because of clinical suspicion of breast disease but who were later diagnosed as healthy (referral controls; n = 506). Because the diagnosis was unknown at the time of interview, it was possible to assess by comparing the two control groups whether the self-reporting of diet changed under the threat of disease. Dietary habits were examined using a validated, self-administered food-frequency questionnaire. Premenopausal women misreported their consumption of liquid milk products, tea, and sugar. Reporting bias was also associated with the intake of fat and vitamins. Postmenopausal women misreported consumption of milk products. When recall bias was taken into consideration, milk was associated with increased risk of premenopausal breast cancer, whereas high consumption of poultry or high intake of monounsaturated fatty acids, n-3 fatty acids, n-6 fatty acids, and vitamin E were related to lower risk. The study suggested that oil, milk, cheese, coffee and beta-carotene may act as protective factors in postmenopausal women, whereas butter and cream may be risk factors for breast cancer. In summary, it is possible that some food items may be overreported or underreported under the threat of disease in health-conscious population. However, most of the results in this study were not modified by recall bias.

Objectives: Based on previous epidemiological studies, high fat and meat consumption may increase and fiber, calcium, and vegetable consumption may decrease the risk of colorectal cancer. We sought to address these hypotheses in a male Finnish cohort.

The association between coffee and black tea consumption and the subsequent risk of colon and rectal cancer was investigated within a Finnish clinical trial cohort. One hundred eleven cases of colon cancer and 83 cases of rectal cancer were diagnosed over a median of 9.0 years of follow-up. Proportional hazards regression models were used to derive adjusted relative risk (RR) and 95% confidence intervals (CI) for the association between coffee and tea consumption and cancer incidence. After controlling for confounders, coffee was not significantly associated with colon or rectal cancer. A positive association was seen for increased consumption of tea drinking and colon cancer. Compared with persons who did not drink tea, those who consumed1 cup/day had an RR of 1.40 (95% CI = 0.84 - 2.33) and those who consumedor = 1 cup/day had an RR of 2.09 (95% CI = 1.34-3.26, p for trend = 0.001). In contrast, tea consumption had little effect on rectal cancer incidence. This study does not support the hypothesis that coffee and tea protect against colorectal cancer risk. However, given the strength of the tea-colon cancer association and the significant gradient of risk we observed across level of intake, further epidemiologic research of this relationship in other populations seems warranted.

Dietary factors are widely studied as risk factors for colorectal cancer, with much information from case-control studies. We evaluated the validity of dietary data from a retrospective case-control study of diet and colorectal cancer. As part of the alpha-Tocopherol, beta-Carotene Cancer Prevention Study, diet was assessed at baseline and after diagnosis for colorectal cancer cases and at baseline and regularly during the trial for a random control group. The dietary assessment referred to the previous 12 months (in cases before diagnosis). In the two dietary assessments, the cases reported a greater increase in consumption of fruits and dairy products and a decrease in consumption of potatoes. Accordingly, relative risks for colorectal cancer by baseline dietary data differed markedly from odds ratios from case-control data; e.g., relative risk for a 652-mg increase in calcium intake was 0.79 (95% confidence interval = 0.48-1.30) in case-cohort analysis vs. an odds ratio of 1.57 (95% confidence interval = 1.06-2.33) for case-control analysis. The most likely explanation is the influence of current diet on recall of prediagnosis diet and effects of occult cancer on diet in the year before cancer diagnosis, which have implications for interpretation of case-control studies in evaluating associations between diet and colorectal cancer.

A 110-item food frequency questionnaire was tested among 152 community controls of the Kuopio Breast Cancer Study. They completed the questionnaire twice and kept two 7-day diet records at 3-month intervals. The intraclass correlations for nutrients varied from 0.49 (thiamine with supplements) to 0.81 (lactose), and for foods from 0.52 (poultry) to 0.84 (alcoholic drinks). The Pearson correlations between the first food frequency questionnaire and the 14-day diet records, after adjustment for energy, varied for nutrients from 0.18 (thiamine without supplements) to 0.80 (alcohol), and for foods from 0.30 (inner organs) to 0.90 (coffee). Comparison of quintile classification between the two methods is reasonably accurate when observed restrictions concerning some nutrients and foods are taken into account. A low association (r = 0.12) was observed between toenail selenium and dietary selenium intake, indicating the difficulty of estimating selenium intake in the Finnish diet.

BACKGROUND: In recent decades, increasing rates of Chlamydia cases have contrasted with decreasing Chlamydia trachomatis seroprevalence rates and decreasing Chlamydia-associated complication rates. We elucidated the conflicting trends by studying incidence of repeated Chlamydia infections over time. METHODS: Chlamydia cases reported during 1995 to 2009 were identified in the Finnish National Infectious Diseases Registry. Trends of single and repeated diagnoses of Chlamydia infection were analyzed. RESULTS: Our study population comprised 147,148 individuals with a total of 177,138 genital chlamydial infections. The proportion of annual repeated diagnoses of genital infections increased among female and males from 4.9% to 7.3% and from 3.8% to 5.3%, respectively. In 2009, 24.8% of the females and 20.3% of the males had had an earlier Chlamydia infection ever during the follow-up time. Of all the repeated diagnoses, 34.1% occurred within 12 months. The highest rates of repeated infection diagnoses occurred in 25-year-old women (37.0%) and in 29-year-old men (30.9%) in a cohort of individuals born in 1979. CONCLUSIONS: A gradual increase of repeated Chlamydia infections resulted in 43% increase in annual infections between 1996 and 2009. The result is supportive of the existing seroprevalence data suggesting that Chlamydia infection burden is not increasing in the whole population. The increasing infection rates in males, in particular, justify development of effective strategy in preventing reinfections and onward transmission.