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Community-based prevention of hypertension in North Karelia, Finland.

A model programme for hypertension control in the community has been implemented in North Karelia, Finland, since 1972. The treatment status of the patients was improved and blood pressure levels were reduced during 1972 to 1977. This improvement started to level off during 1977 to 1982, although more than 10% of the population aged 35-64 years were treated with antihypertensive drugs. Several analyses were done to find out which dietary factors contributed to the blood pressure level and to its change in the community. The study material consisted of random samples of the population aged 30-59 years in two counties in Eastern Finland, who participated in the surveys in 1972, 1977 and 1982. The analyses confirmed that high BMI, high fat intake, alcohol drinking and high Na intake were associated significantly with blood pressure and also with its change both in the general population and in hypertensive persons. The high levels of these nutritional factors were also associated with unsatisfactory outcome of drug treatment in the hypertensive patients. Thus, it is likely that nutritional changes that can reduce the levels of BMI, the intake of fat, alcohol, and Na would contribute significantly both to primary prevention and to the effective treatment of elevated blood pressure in the community. In Eastern Finland the levels of alcohol intake have increased both in men and women, BMI increased in men and decreased in women and serum cholesterol levels dropped both in men and women between 1972 to 1982. The results of a community-based programme to reduce salt intake in North Karelia from 1979 to 1982 confirmed that Na intake level is high in Finland. The North Karelia Salt Project showed that it is difficult to reduce salt intake at the community level during a three-year period. A slight reduction in Na intake was seen only in women both in North Karelia and in the reference area. In men Na intake did not decrease. In conclusion our results suggest that primary prevention of hypertension at the community level is not easy and that a well conceived programme for a relatively long time period is needed.

Adolescent↗

Comparison of dental arch dimensions in children from southern and northern Finland.

The purpose of this survey was to determine whether children in northern Finland had different dental arch dimensions from children in southern Finland. Dental casts of 9-year-old healthy children from Helsinki (southern Finland) and from Oulu and Sodankylä (northern Finland) were measured. Each group contained 41 subjects who had received no orthodontic treatment. The children from Sodankylä and Oulu had narrower dental arches and greater palatal heights than those from Helsinki. The lengths and perimeters of dental arches were significantly shorter in the children from Sodankylä than in those from Helsinki. We suggest these differences could have resulted from adaptation to different climatic conditions, affecting modes of breathing.

Cephalometry↗

Body mass and social class: a comparison of Finland and Sweden in the 1990s.

High physical weight affects public health as well as people's social relations. This study seeks to examine the distribution of physical weight across the social structure in Finland and Sweden in the early 1990s. We compare physical weight, classified by overweight and obesity, 1) between men and women, 2) between different age groups, and 3) between social classes in these two countries. Comparable interview surveys were conducted in Finland 1994 (N = 8,650, response rate 73%) and in Sweden 1991 (N = 5,306, response rate 79%). Physical weight, overweight and obesity of populations are described in terms of body mass index (BMI = weight (kg)/height (m2)). The average BMI is higher in Finnish men (25.6) and women (24.6) than in their Swedish counterparts (24.6 and 23.2, respectively). In both countries, the average BMI is higher in men than in women below the age of about 55-64 years. In both countries and in both genders the average BMI is higher, the higher the age. The level of overweight as well as obesity is lower in Sweden than in Finland. Social class differences can be found in both countries. The odds ratio for overweight is higher in Finnish male and female farmers (OR = 1.57 and 1.94, respectively) as compared to upper white collars (OR = 1.0). In Sweden, high odds ratio for overweight can be found among male entrepreneurs (OR = 1.80) and female unskilled manuals (OR = 2.65). Obesity varies by social class in Swedish men and women as well as in Finnish women, but not in Finnish men. The results show that Finnish men and women are more often overweight and obese than their Swedish counterparts, but social class differences in overweight and obesity are larger in Sweden than in Finland.

Adult↗

Clonality of Vibrio anguillarum strains isolated from fish from the Scandinavian countries, Sweden, Finland and Denmark.

In order to investigate whether outbreaks of vibriosis in the Baltic region were caused by the spread of certain pathogenic clones, 291 Vibrio anguillarum isolates from Finland (n = 156), Sweden (n = 88) and Denmark (n = 47) were studied with respect to serogroup, ribotype, plasmid content, and biochemical phenotypes as expressed with the PhenePlate (PhP) typing system. For comparison, 54 V. anguillarum serogroup O1 from other countries worldwide were included. Most isolates from Finland, Sweden and Denmark belonged to serogroup O1 (255), followed by O2 (30). Four Finnish isolates cross-reacted strongly with antisera against two new serogroups VaNT2 and VaNT4, whereas two strains were non-typeable. The serogroup O1 isolates displayed ten different ribotype patterns, whereas the other strains were considerably more diverse with respect to ribotypes. Most of the O1 isolates carried the 67 kb virulence plasmid and a group of Finnish isolates, in addition, carried an 86 kb plasmid. Additional plasmids with molecular weights of 63, 76, 135 or 260-290 kb were found in single O1 isolates. With few exceptions, strains of serogroup O2 either had no plasmids or carried one or two small plasmids. PhenePlate typing revealed considerable diversity within the species, serogroup O1 being the most homogeneous. A few PhP types were dominant, whereas other types were observed only in one to four isolates. The prevalence of the different types changed significantly from one year to another but in Finland, one clonal lineage became increasingly important from 1992 (20% of isolates) to 1996 (80%). Remaining clones were mostly restricted to specific geographic areas. By cluster analysis, it was demonstrated that most of the isolates from Finland, Sweden and Denmark belonged to two clusters, and most of the strains from Southern Europe fell into two other, distinct clusters. Most isolates from the UK, North America, Chile and Tasmania grouped together in a distinct cluster. For the typing of V. anguillarum, O-serotyping should be the primary method. For isolates belonging to serogroups other than O1, plasmid profiling in combination with ribotyping gives a very good discrimination between strains, whereas for serogroup O1, another method is required. It is concluded that PhP typing is a tool that provides a good discrimination between O1 isolates.

Animals↗

Basal cell skin carcinoma and other nonmelanoma skin cancers in Finland from 1956 through 1995.

OBJECTIVE: To study trends of nonmelanoma skin cancer in Finland. DESIGN: Descriptive analysis of incidence and mortality rates for basal cell skin carcinoma (BCC) and other non-melanoma skin cancers (NMSCs) from 1966 and 1956, respectively, through 1995 in relation to sex, age, anatomical distribution, place of residence, and occupation. SETTING: Data were obtained from the nationwide Finnish Cancer Registry, to which reporting of skin cancer is compulsory. PATIENTS: Inhabitants of Finland (5.1 million in 1998). MAIN OUTCOME MEASURES: Age- and sex-specific incidence and mortality rates and overall rates adjusted for age to the world standard population; occupation-specific standardized incidence ratios, with the total Finnish population as reference. RESULTS: The age-adjusted incidence rate in 1991 through 1995 for BCC was 49 per 100,000 person-years in men and 45 in women. For NMSC it was 8.7 in men and 5.3 in women. Both cancer types showed an increasing trend in incidence rates. The proportion of tumors in the face, scalp, and neck was 59% for BCC and 67% for NMSC. The incidence rate of NMSC increased from north to south, while there was no great urban-rural or occupational variation in the occurrence of NMSC. The incidence rate for BCC was higher in urban than in rural regions. Farmers, forestry workers, and fishermen showed low incidence of BCC, whereas occupations with a high level of education or compulsory health checkups and medical care occupations appeared to have an increased incidence of BCC. The mortality rate for BCC in 1991 through 1995 was 0.08 per 100,000 person-years in men and 0.05 in women, and for NMSC, it was 0.38 in men and 0.23 in women. The mortality trend was decreasing for both cancer types. CONCLUSIONS: The incidence of NMSC is fairly low in Finland, accounting for 3.5% of all new cancer cases. Conversely, BCC is the most common cancer type. The incidence trend is increasing for both skin cancer types, but mortality remains low.

Aged↗

Autosomal, mitochondrial, and Y chromosome DNA variation in Finland: evidence for a male-specific bottleneck.

The high prevalence of rare genetic diseases in Finland has been attributed to a founder effect some 2,000 years ago. However, this hypothesis has not been supported from mtDNA sequence and autosomal microsatellite data which indicate high levels of gene diversity. Here we have identified genetic evidence for a population bottleneck by examining variable microsatellite loci on the nonrecombining portion of Y chromosomes from Finland and four populations from Europe and the Americas. Sequence data from segment I of the control region (HVS-1) of mtDNA (360 bases) and 20 autosomal dinucleotide repeat markers were also analyzed. Partitions of genetic variance within and between populations revealed significant levels of Y-chromosome differentiation between populations. Phylogenetic and diversity analyses revealed divergent Finnish Y-haplotype clades and significantly lower Y-haplotype diversity among Finns as compared to other populations. Surprisingly, Finnish Y-haplotype diversity was even lower than the Native American populations. These results provide support for the Finnish bottleneck hypothesis. Evidence for two separate founding Finnish Y-chromosome lineages was also observed from the Y-chromosome phylogeny. A limited number of closely related founding males may have contributed to the low number of paternal lineages in the Finnish population. In contrast, high levels of genetic diversity for mtDNA and autosomal STRs may be the result of sex-biased gene flow and recent immigration to urban areas from established internal isolates within Finland.

Base Sequence↗

Epidemiology of intestinal and diffuse types of gastric carcinoma. A time-trend study in Finland with comparison between studies from high- and low-risk areas.

The incidence of gastric cancer has declined markedly in Finland during the last 4 decades. To document the changes caused by that in the ratio of the intestinal type (IT) to the diffuse type (DT) of gastric carcinoma we compared the 367 cases diagnosed from southwestern Finland at the Department of Pathology, Turku University, from 1950-1959 and 1076 cases from 1980-1989. IT virtually disappeared in the male and female populations younger than 50 years, and in patients younger than 60 years, DT became more common than IT (P < 0.001). The transitional age, the time at which IT exceeds DT in frequency, shifted by 20 years to older age groups. In patients older than 60 years, IT remained the dominant type, but the ratio of IT to DT (IT:DT) decreased in men from 3.8 to 2.1 (P < 0.05) and in women from 4.4 to 2.1 (P < 0.001). No decrease in the frequency of DT could be demonstrated in the material studied. The disappearance of the male-dominant IT in the younger male population changed the male-to-female ratio of patients reported to the Finnish Cancer Registry. When the ratio IT:DT in Finland was compared with the ratios reported by the authors in data from other continents and by other investigators, regional variations in basal level of IT:DT emerged. This phenomenon seems to be based on the differing genetic susceptibility to DT of various races. The decrease of IT, seen in reports from regions with declining incidence of gastric carcinoma, seems to be connected to a diminished rate of severe chronic gastritis.

Adult↗

High summer concentrations of mercury in big perch (Perca fluviatilis L) from the Tvärminne archipelago (SW Finland) and Nåtö (Aland Islands) Baltic sea.

During high summer seasons in 1994-1999 84 big (20-42 cm total length) female perch (Perca fluviatilis L) were sampled from the waters around Tvärminne Zoological Station on the Hanko-Hangö peninsula on the SW coast of Finland for mercury analysis. Additional sampling of 13 big female perch during the same season were carried out from the waters of Nåtö Biological Station on the Aland Islands in 1997-1998. High summer is the most important season for perch fishing and consumption not only for private families during leisure time but also for professional fishery including trade and export, processing and preparations for restaurants. Fillets of big specimen of perch, s.c. "fillet perch" or "sea perch" from outer coastal waters were chosen for the study to find out the levels of mercury concentration in these desirable fish. The mean concentration of mercury in the dorsal muscle tissue (fillet) of big female "sea perch" from the coastal waters of Tvärminne Zoological Station was calculated to 0.22 (SD 0.08), range 0.08-0.43 mg/kg, f wt and for big female perch from the waters of Nåtö Biological Station to 0.18 (SD 0.07), range 0.07-0.30 mg/kg, f wt respectively. The results show a considerably lower mercury level in big "fillet perch" caught from the outer coastal waters in both Finland (and Estonia) compared with the levels recorded of big "fillet perch" from fresh water lakes and reservoirs. Thus, the common expression "sea perch" may also be used in the form "Baltic sea perch" meaning big healthy perch with low concentrations of mercury and caught from the outer coastal waters in S and SW Finland (and W Estonia) when marketing perch for human consumption.

Animals↗

Occupational exposure to carcinogens in Finland.

Finland has kept a registry on the manufacture and use of carcinogenic agents involving occupational exposure since 1979. Employers must report annually to the labor safety authorities the employees who have been exposed to carcinogens and provide information on carcinogenic agents produced, used, or formed. Out of 131 substances or groups of agents listed as carcinogenic, occupational exposure to 78 of them was reported in 1987. About half of the agents reported were used or produced in industry and half were handled on a laboratory scale. About 15,000 employees from 1,700 work departments were reported to the registry; 17% of them were women. The number of workers reported in 1987 accounted for 0.6% of the total work force. It has been estimated that at least 60,000 workers are exposed annually to carcinogens in Finland. The three most prevalent exposures--hexavalent chromium compounds, nickel and its inorganic compounds, and asbestos--accounted for over 60% of all exposed workers; only five carcinogenic chemicals were produced in Finland in 1987.

Asbestos↗

The Meckel syndrome in Finland: epidemiologic and genetic aspects.

Estimates of the incidence of the Meckel syndrome (MS) from different parts of the world vary from 1:140,000 to 1:13,250 births. In this nationwide study performed in Finland, the incidence of 1:14,400 births was found by retrospective ascertainment during the period 1970-1979, while the incidence was 1:8,500 births when prospective monitoring was performed in 1980-1981. The most probable incidence in Finland is about 1:9,000 births. Autosomal recessive inheritance of MS is confirmed in this study. The ratio of affected sibs, corrected for truncate complete ascertainment, was 0.261. No consanguinity between parents was found, as marriages between close relatives are rare in Finland and the ancestors were not traced back far enough to find remote consanguinities.

Abnormalities, Multiple↗

Health, schooling and lifestyle among young adults in Finland.

This was a longitudinal, general population study based on a Northern Finland 1966 Birth Cohort, using a structural equation approach to estimate the health production function and health input functions for four lifestyle variables (smoking, alcohol consumption, exercise and unhealthy diet) for males and females. In particular, we examined the productive and allocative effects of education on health. We used 15D, a generic measure of health-related quality of life, as a single index score measure but we also estimated models for some of its dimensions. Among the males, the important factors impacting on health were education and all the four lifestyle factors, as well as some exogenous variables at 31 years and variables describing parents' background, and health and behaviour at 14 years. An increase of five years in schooling increased the health score by 0.008, of which about 50% was due to direct effect and 50% due to indirect effects. Among the females, education does not impact on health, but health was affected by the use of alcohol, exercise and diet, but not by smoking. Our results indicate that policy options that increase education among men will increase their health indirectly via healthier lifestyles. However, since the total effect was rather modest and the direct effect insignificant, an increase of schooling is not a cost-effective way to increase health given the present high educational level of Finland. The young adults' and particularly women's internationally high educational status in Finland might be a reason why we find only a modest effect of schooling on health and the non-existence of such effects among women.

Adult↗

Cancer incidence among Sami in Northern Finland, 1979-1998.

The Sami population living in Northern Finland represents a specific genetic background and a way of life that is different from other Finns. A cohort of 2,100 Sami and 4,174 non-Sami people from the 2 northernmost municipalities of Finland on 31 December 1978 was identified from the national Population Register and followed up through the Finnish Cancer Registry for cancer incidence during 1979-1998. There were 111 cancer cases among the Sami, while the expected number based on the average cancer incidence in the Finnish population was 173. Among the non-Sami cohort members, there were 226 cases of cancer vs. 224 expected cases. The Sami had significantly decreased incidence of cancers of the prostate [standardised incidence ratio (SIR) 0.25; 95% confidence interval (CI) 0.08-0.58] and breast (SIR 0.36; 95% CI 0.14-0.73), similarly for both localised and nonlocalised tumours. Low SIRs were also observed for bladder cancer (SIR 0.28; 97% CI 0.03-0.99) basal cell carcinoma of the skin (SIR 0.12; 95% CI 0.03-0.30) and other nonmelanoma skin cancers (SIR 0; 95% CI 0-0.63). In contrast to other subcategories of the Sami, the Skolts, whose lifestyle stems from areas that now belong to Russia, showed a nonreduced overall cancer risk and a significantly elevated risk for stomach cancer (SIR 3.8; 95% CI 1.5-7.8). The low cancer incidence among the other Sami populations in Finland cannot be fully explained by their specific way of life. It seems likely that the Sami ethnicity carries a reduced cancer incidence level. Although many Sami have been exposed to radioactive fallout from the nuclear weapon tests via their reindeer-rich diet, this does not seem to affect their cancer risk.

Feeding Behavior↗

Prevalence of tick-borne encephalitis virus in Ixodes ricinus ticks in Finland.

Approximately 20 cases of tick-borne encephalitis (TBE) occur annually in Finland. The known endemic areas are situated mainly in the archipelago and coastal regions of Finland, with highest incidence in Aland islands. Ixodes ricinus panels collected in 1996-1997 from two endemic areas were screened for the presence of RNA. Two distinct RT-PCR methods were applied, and were shown to have an approximate detection limit of 10 focus forming doses (FFD)/100 microl. One out of 20 pools (a total of 139 ticks) from Helsinki Isosaari Island and one out of 48 pools (a total of 450 ticks) from Aland were positive with both methods, whereas the remaining pools were negative. The observed overall frequency (0.34%) in ticks in endemic areas of Finland, was similar to the low incidence found by virus isolation in mice in the 1960s (0.5%). Viral RNA was detectable in a diluted sample representing 0.005% of a positive pool of ten nymphs suggesting that the viral RNA load within an infected tick pool was approximately equivalent to 20,000-200,000 FFD. Sequence analysis did not show geographical clustering of the Finnish strains, suggesting an independent emergence of different TBE foci from the south. TBE virus RNA positive ticks were not found in I. ricinus panels consisting of 130 pools (726 ticks) from Helsinki city parks or 41 pools (197 ticks) from Võrmsi Island in Estonia.

Animals↗

Changes in diet in Finland from 1972 to 1992: impact on coronary heart disease risk.

BACKGROUND: Coronary heart disease mortality has declined in Finland by 55% among men and 68% among women between 1972 and 1992. About three-quarters of this decline has been explained by changes in the main coronary risk factors, the decrease in serum cholesterol being the most important one. The aim of this study was to analyze to what extent dietary changes could explain the change in serum cholesterol. METHODS: Cardiovascular risk factor surveys have been carried out in Finland from 1972 to 1992 at 5-year intervals. Dietary surveys were carried out in connection with these surveys in 1982 and 1992. An earlier, representative dietary survey carried out in 1969-1972 was used as the baseline measure for diet. RESULTS: The total fat content of the Finnish diet changed from 38% of energy to 34%, saturated fat from 21 to 16%, and polyunsaturated fat from 3 to 5% and the intake of cholesterol decreased by 16%. Based on Keys equation these changes could have decreased serum cholesterol level by 0.6 mmol/liter (23 mg/dl) in both genders. A shift from boiled to filtered coffee could have further decreased serum cholesterol by 0.3 mmol/liter (11 mg/dl). Thus, these changes together could explain the total change in serum cholesterol, which has been on average 1.0 mmol/liter (38 mg/dl). Several other changes in the diet have also been favorable. Fruit and vegetable consumption has increased two- to three-fold during this time period. Supplementation of fertilizers with selenium since 1985 has tripled the intake of selenium. CONCLUSIONS: Dietary changes seem to explain the decrease in serum cholesterol. Together with a decline in smoking among males as well as better blood pressure control they have contributed to the dramatic decline in coronary heart disease mortality in Finland.

Adult↗

Trends in self-rated health in Finland 1972-1992.

BACKGROUND: Self-rated health is a useful indicator of the population's health. Yet follow-up studies on perceived health trends are scarce. The aim of this paper is to assess perceived health trends in Finland between 1972 and 1992. METHODS: Five cross-sectional studies were done in two areas in eastern Finland every 5th year since 1972 and in a third area in southwestern Finland since 1982. The total number of respondents was 33,962. The respondents filled in a questionnaire, followed by a health examination. The subjects were categorized by age, education, and household income. RESULTS: In 1972, one-third of the population reported good health, whereas in 1992 the rates were 50 and 60% for men and women, respectively. Younger persons reported better general health than older persons. High education and high household income were undisputed indicators of good health. Among men, their importance as predictors of good health diminished during the 20 years. CONCLUSIONS: Finnish people today not only live longer but also feel healthier. In order to achieve good health for all population groups we need continual efforts to diminish the socioeconomic disparities.

Adult↗

Increasing age-adjusted incidence of hip fractures in Finland: the number and incidence of fractures in 1970-1991 and prediction for the future.

Hip fractures in the elderly are a worldwide epidemic, and aging of the populations is increasing the burden of these fractures on the health care systems. To improve the knowledge of whether the number of hip fractures is increasing even more rapidly than can be accounted for by the demographic changes only, all patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first hip fracture were selected from the National Hospital Discharge Register. There was a steady, average 7.7% annual increase in the total number of hip fractures in Finland during this period so that the number of fractures was 2239 in 1970 and 6071 in 1991. The proportion of patients aged 60 years or more increased steadily from 75% in 1970 to 91% in 1991. In 1991, 74% of the patients were women. Across the study period, the age-adjusted total incidence of hip fractures also increased in both women and men 50 years of age and over. This increase was more pronounced in men. Thus, the increasing incidence of hip fractures in Finland was not only due to the fact that the population was aging but also due to the increasing age-adjusted incidence. We conclude that the number of hip fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and this will seriously challenge the Finnish health care system in the future.

Age Factors↗

A gene in the HLA class I region contributes to susceptibility to IDDM in the Finnish population. Childhood Diabetes in Finland (DiMe) Study Group.

In Finland the haplotype A2, Cw1, B56, DR4, DQ8 is the third most common haplotype in insulin-dependent diabetic (IDDM) patients and has the highest haplotype-specific absolute risk for IDDM. Cw1, B56, DR4, DQ8 haplotypes containing HLA-A alleles other than A2 are infrequent in the population and are not associated with IDDM. Comparison of the A2 and non-A2 haplotypes at the DNA level showed that they were identical at HLA-B, -DR, and -DQ loci. Evidence that class I alleles confer susceptibility to IDDM was obtained from the two HLA-C, -B, -DR and -DQ haplotypes most frequently found in IDDM patients in Finland. A24, A3 and A2 on the Cw3, B62, DR4, DQ8 haplotype, and A28, A2 and A1 on the Cw7, B8, DR3, DQ2 were all found to be associated with IDDM. In Finland these seven haplotypes, including A2, Cw1, B56, DR4, DQ8, account for 33% of diabetic haplotypes and 10.3% of non-diabetic haplotypes (p < 0.00001). The contribution of the class I region to IDDM susceptibility was also apparent in those IDDM patients lacking the disease-predisposing class II alleles. Significantly more non-DR3/non-DR4 IDDM patients (47 of 55) possessed two of the IDDM-associated HLA-A alleles compared to non-DR3/non-DR4 control subjects (40 of 58; p = 0.038). Moreover, IDDM patients confirmed by oligotyping as unable to form a 'diabetes-susceptibility' DQ heterodimer, tended to possess two diabetes-associated HLA-A alleles (12 of 13) compared to control subjects (12 of 20; p = 0.056).

Adolescent↗

Occupational allergic rhinitis in Finland.

Between 1980 and 1987 a total of 166 patients were diagnosed as having occupational (mostly allergic) rhinitis at the Institute of Occupational Health. This is about 20% of all the diagnosed cases in Finland. The most common causes were: flour (50 cases), wood dust (30 cases), animal epithelia (19 cases), and natural fibers, mainly cotton (19 cases). Between 1981 and 1987 the number of cases of occupational rhinitis in all of Finland more than doubled (from 61 to 128 cases per year), and in 1991 a total of 319 cases were detected. This was mainly due to the increase in rhinitis caused by animal epithelium and flour dust, which were then the most common causes of occupational rhinitis in Finland. This increase, in turn, was based on changes in the Finnish legislation, which in 1982 was extended to cover farmers. Other causes of the increase were probably the increased awareness of the public and health personnel, but a true increase in occupational rhinitis cannot be excluded.

Female↗