Impact of socioeconomic position on childhood obesity in Finland based on register data from 2018

Abstract Background Obesity is a globally growing public health challenge among children. In developed countries, the risk of obesity is commonly higher among lower socioeconomic groups. Measuring socioeconomic position (SEP), especially income, is challenging in surveys as self-reported information may suffer from reporting, awareness, recall and non-response bias. Our aim is to utilize official register data on several SEP indicators and measured height and weight of children, to identify the strongest predictors of SEP of the parents on the risk of obesity among the whole 2-17-year-old child population in Finland. Methods Data for all children who had visited child health clinic or school health care in 2018 were extracted from the National Outpatient Register on Primary Health Care Services (n = 387623, coverage 40% in 2018). Obesity was defined according to the WHO criteria. SEP indicators were obtained from Statistics Finland for both parents living in the same household with a child. Boosted regression model was used to analyze the contribution of SEP to obesity using training dataset on 155479 non-related children. Results The area under the curve for the final model in training dataset was 0.736 and 0.718 in validation dataset. Mother's educational level (12.6% of the total explained variation) and household's disposable income (12.6%) were the SEP indicators that most strongly predicted childhood obesity, whereas the impact of educational level of the father was somewhat smaller (8.1%). The influence of the age of a child was even bigger (39.2%), the prevalence of obesity being highest at 11 and 9 years of age among boys and girls, respectively. Conclusions Our results based on official register data from Finland, a Nordic high-income country, endorse earlier findings on higher obesity risk among children with low socio-economic family background. Identification of the SEP related risk factors and support to families are essential in the prevention of childhood obesity. Key messages Several family socio-economic factors are reflected in the risk of childhood obesity. Utilizing objective register data offers a way to tackle many challenges related to self-reported survey data.


Background:
In the context of common surgical procedures in pediatric otorhinolaryngology (ORL) patients, providing for education to families for hospitalization, surgery, and postoperative home management has been shown to improve peri-operative outcomes.In this regard, the use of Mobile Health Applications (MHA) is increasing.However, for these tools to be needs-appropriate and effective, their development requires a user-centred approach.Methods: Our study aimed to explore the informational needs and preferences -in terms of features and functionalities -of health care providers and ORL patients' caregivers (end-users) to inform the development of an MHA supporting ORL perioperative process effectively.The study was conducted at a 136-bed maternal and child health hospital in Trieste.A usercentred participatory study design was employed, and the methodology steps were informed by the 3 cycles of the Information System Research Framework (Schnall et al., 2016).

Results:
The Relevance cycle was performed to better understand the environment as well as end users' (64 participants) informational needs and desired features for the MHA.Five critical information/education moments of the ORL perioperative period were identified.In the Rigour cycle a literature review was performed to identify further key topics relevant to understanding ORL end-users' needs and relevant features for the MHA.In the Design cycle the final contents were defined to be displayed on the MHA spread across the 5 identified moments.A randomized controlled trial will then be conducted to evaluate the effectiveness of the MHA compared to standard care.

Conclusions:
Triangulation of data sources collected by experts, ORL patients' caregivers, and healthcare professionals ensured the rigour of the methodology adopted in the study.Moreover, such a MHA user-centred developed MHA favours end-users positive health outcomes and organizational benefits of health services.

Key messages:
Contextualizing, and responding to the health informational needs and intent to use by end users is a critical foundation for the design and adoption of MHA in a maternal and child health hospital.
To implement MHA quality in the process of children ORL health management and family consumer satisfaction, usercentred design methods are needed and feasible.
Abstract citation ID: ckac130.044Impact of socioeconomic position on childhood obesity in Finland based on register data from 2018
Women who reported feeling humiliated visiting the health care system are 2.08 times more likely to PTSD (OR = 2.08,95% CI = 1.23-3.52).

Conclusions:
MRC is an important factor for maternal PTSD among postpartum women and it should be considered specifically among minority women.

Key messages:
MRC can contribute to quality care, improving birthing mothers experience and reducing negative health outcomes such as PTSD, and it should be improved for women.
The health care services need to run a program to overcome racism and reduce unrespectful care for postpartum women.

Methods:
We chose 6 European countries that differ in various criteria (e.g., health/insurance system, geographical location) to illustrate the range of possible regulations and forms of funding: Germany, Switzerland, Netherlands, United Kingdom, Norway, Italy.We conducted a comprehensive hand search and consulted experts from the 6 countries using a questionnaire.

Results:
The results are based on 11 completed expert questionnaires and 22 published sources.The heterogeneity of the provision, regulation and financing of the tests concerns in particular the choice of the first-line screening test for fetal trisomies (FTS/ CT, NIPT or the identification of risk factors), the implementation of the NIPT, the reimbursement of the tests, the uptake of the examinations, but also the professional groups responsible for antenatal care (midwives, gynaecologists).There are some similarities between countries, e.g., concerning the provision and financing of invasive tests and of the ultrasound screening for fetal anomalies in the second trimester.

Conclusions:
The results highlight the significant heterogeneity between European countries regarding prenatal screening and diagnostic testing for fetal anomalies.Due to the many ethical aspects of the topic, a broad societal discourse with the relevant interest groups and stakeholders seems to be necessary.Decision-makers should pay particular attention to highquality and non-directive counselling.

Key messages:
European countries take different approaches to offer and fund prenatal screening and diagnostic tests for fetal anomalies.
The implementation of screening strategies should focus in particular on the importance of high-quality counselling to enable informed decision-making.
6% of the total explained variation) and household's disposable income (12.6%)were the SEP indicators that most strongly predicted childhood obesity, whereas the impact of educational level of the father was somewhat smaller (8.1%).The influence of the age of a child was even bigger (39.2%), the prevalence of obesity being highest at 11 and 9 years of age among boys and girls, respectively.
1,2 1 Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland 2 Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland Contact: laura.paalanen@thl.fiBackground:Obesity is a globally growing public health challenge among children.In developed countries, the risk of obesity is commonly higher among lower socioeconomic groups.Measuring socioeconomic position (SEP), especially income, is challenging in surveys as self-reported information may suffer from reporting, awareness, recall and non-response bias.(n=387623, coverage 40% in 2018).Obesity was defined according to the WHO criteria.SEP indicators were obtained from Statistics Finland for both parents living in the same household with a child.Boosted regression model was used to analyze the contribution of SEP to obesity using training dataset on 155479 non-related children.Results:The area under the curve for the final model in training dataset was 0.736 and 0.718 in validation dataset.Mother's educational level (12.