[show abstract][hide abstract] ABSTRACT: Background and Purpose Stroke registers were established as part of the international collaborative World Health Organization Monitoring of Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project in 17 centers in 10 countries. The aim of the present analyses was to estimate and compare temporal stroke trends across the MONICA populations.
Methods All stroke events in defined populations were ascertained and validated according to a common protocol and uniform criteria. Almost 25 000 stroke events in more than 15 million person-years were analyzed. Age-standardized rates for fatal stroke and for all stroke events were calculated for whole calendar years for each of the populations. Temporal stroke trends were estimated using annual rates for 5 to 6 years.
Results Annual stroke attack rates decreased among men in 13 populations and among women in 15 of the 17 MONICA populations. Stroke mortality rates declined among men in 11 populations and among women in 14 of the populations studied. The estimated trends reached the level of statistical significance at the 5% level in only a small number of populations. The trends in official cerebrovascular death rates were in agreement with those estimated on the basis of MONICA data in the majority of the populations studied.
Conclusions Decreasing stroke mortality and attack rates in a large proportion of populations studied can be interpreted as an indication of declining stroke rates in most of the populations studied. The numbers of populations with statistically significant trends were small, and it is therefore not possible to determine with certainty in which of the populations were the changes real.
[show abstract][hide abstract] ABSTRACT: To determine if there is a worldwide seasonal pattern in the clinical onset of Type 1 diabetes.
Analysis of the seasonality in diagnosis of Type 1 diabetes was based on the incidence data in 0- to 14-year-old children collected by the World Health Organization Diabetes Mondiale (WHO DiaMond) Project over the period 1990-1999. One hundred and five centres from 53 countries worldwide provided enough data for the seasonality analysis. The incidence seasonality patterns were also determined for age- and sex-specific groups.
Forty-two out of 105 centres exhibited significant seasonality in the incidence of Type 1 diabetes (P < 0.05). The existence of significant seasonal patterns correlated with higher level of incidence and of the average yearly counts. The correlation disappeared after adjustment for latitude. Twenty-eight of those centres had peaks in October to January and 33 had troughs in June to August. Two out of the four centres with significant seasonality in the southern hemisphere demonstrated a different pattern with a peak in July to September and a trough in January to March.
The seasonality of the incidence of Type 1 diabetes mellitus in children under 15 years of age is a real phenomenon, as was reported previously and as is now demonstrated by this large standardized study. The seasonality pattern appears to be dependent on the geographical position, at least as far as the northern/southern hemisphere dichotomy is concerned. However, more data are needed on the populations living below the 30th parallel north in order to complete the picture.
Diabetic Medicine 08/2009; 26(7):673-8. · 3.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this study was to examine the effects of childhood BMI growth dynamics on the risk of developing young adult-onset type 1 and type 2 diabetes.
Finnish national healthcare registers were used to identify individuals with diabetes diagnosed between 1992 and 1996 at 15-39 years of age. Non-diabetic control participants were chosen from the National Population Registry. Anthropometric measurements were obtained from the original child welfare clinic records. Only the case-control pairs with sufficient growth data recorded were included in the analyses (218/1,388 for type 1 diabetes [16%] and 64/1,121 for type 2 diabetes [6%]). Two developmental stages in BMI growth (the points of infancy maximum BMI and the BMI rebound) were examined, and conditional logistic regression was applied to the variables of interest.
The risk for type 1 diabetes increased 1.19-fold per 1 kg/m(2) rise in the infancy maximum BMI (p = 0.02). In addition, there was a 1.77-fold increase in the risk for type 2 diabetes per 1 kg/m(2) rise in the level of BMI at the BMI rebound (p = 0.04). Higher values of BMI at these points corresponded to a larger BMI gain from birth to that developmental stage. Age at the infancy maximum BMI or age at the BMI rebound did not affect the risk for either type of diabetes.
The BMI gain in infancy among individuals who subsequently developed young adult-onset type 1 diabetes was faster than that of those who remained healthy. The excess BMI gain in individuals who developed young adult-onset type 2 diabetes could already be seen during early childhood.
[show abstract][hide abstract] ABSTRACT: The protective role of water hardness and Mg in cardiovascular illness has been suggested in several epidemiological studies. In the present ecological study, the association of Ca, Mg, Al, Cu, F, Fe, Zn and NO3 in local ground water and spatial variation of acute myocardial infarction (AMI) incidence among men and women 35–74 years of age in rural Finland in 1991–2003 were examined. Data on AMI cases, 67,755 men and 25,450 women, were obtained from the Finnish Cardiovascular Disease Register. The statistical analysis was carried out using Bayesian modeling. 10 × 10 km grid cells were used instead of administrative boundaries to partition the study area. On average, 1 mg/L increment in Mg level in local ground water was associated with 2% (95% HDR −0.0391, −0.0028) decrease in incidence of AMI in the rural population. In conclusion, high AMI incidence in eastern Finland is associated with soft ground water, low in Mg.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to examine the effects of birth order and parental age on the risk of type 1 and type 2 diabetes among Finnish individuals aged 15-39 years.
Data on all cases of type 1 diabetes (n = 1,345) and type 2 diabetes (n = 1,072), diagnosed between 1992 and 1996, were collected from four sources: standardised national reports from diabetes nurses, the National Hospital Discharge Register, the Drug Prescription Register and the Drug Reimbursement Register. Information on matched controls and the family members of all study subjects were obtained from the National Population Registry. The odds ratios (ORs) for both types of diabetes were estimated using a conditional logistic regression model.
There was a U-shaped relationship between maternal age and the risk of type 2 diabetes in the offspring: the risk was higher in children born to young and old mothers compared with children born to mothers aged around 30 years. The children born second (OR 0.76, 95% CI 0.62-0.94), third (OR 0.73, 95% CI 0.55-0.95), or fourth (OR 0.66, 95% CI 0.47-0.94) had a lower risk of type 2 diabetes than the first-born children. Maternal age, paternal age, and birth order did not have an effect on the risk of type 1 diabetes in the individuals aged 15-39 years at the time of diagnosis.
Maternal age and birth order are both associated with the risk of early-onset type 2 diabetes. However, part of these associations may be due to low birthweight. In this study neither parental age nor birth order showed a significant association with the risk of type 1 diabetes diagnosed after 15 years of age.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to examine the incidence and trends of type 1 and type 2 diabetes in the 15-39 year-old population between 1992 and 1996 in Finland.
Data on the nationwide incidence of diabetes were obtained from four data sources: standardised reports from diabetes nurses, the Finnish National Hospital Discharge Register, the Drug Reimbursement Register and the Drug Prescription Register. The inclusion criterion was consistency in the diagnosis of diabetes across at least two data sources. The sex- and age-specific incidence was calculated for 5-year age groups, both for type 1 and type 2 diabetes. The effects of age, sex and year of diagnosis were assessed by fitting the linear regression model to the incidence data.
Between 1992 and 1996 the age-adjusted incidence of type 1 diabetes among 15-39 year olds was 15.9 per 100,000/year. The incidence was highest among the 15-19 year olds and decreased with age. Conversely, the incidence of type 2 diabetes was very low among 15-19 year olds and increased with age. The total age-adjusted incidence of type 2 diabetes among 15-39 year olds was 11.8 per 100,000/year. The average annual increase in the incidence of type 2 diabetes was 7.9% (95% CI 3.7-12.2%).
The age at which the Finnish population is at risk of type 1 diabetes extends into young adulthood. The rapid increase in the incidence of type 2 diabetes in the young adult population is a current public health problem.
[show abstract][hide abstract] ABSTRACT: Childhood diabetes is one of the major non-communicable diseases in children under 15 years of age. It requires a life-long insulin treatment and may lead to serious complications. Along with the worldwide increase in the incidence several countries have recently reported a decreasing trend in the age of onset of the disease. The aim of this study is to analyse long-term data on the incidence of the childhood diabetes in Finland from the birth cohorts perspective. The annual incidence data were available for the period 1965--1996 which translates into 1951--1996 birth cohorts. Hence the data consist of completely and partially observed cohorts. Bayesian modelling was employed in the analysis. Several different priors and cohort combinations were tried in order to determine the sensitivity of the results. The cumulative birth cohort incidence of diabetes was determined to have an increasing average annual trend of 2.5 per cent. Although the average birth cohort-specific age of onset was estimated to have decreased slightly over the years of observation, the trend could be a result of random variation.
Statistics in Medicine 11/2005; 24(19):2989-3004. · 2.04 Impact Factor
[show abstract][hide abstract] ABSTRACT: In Finland, the risk of childhood Type 1 diabetes varies geographically. Therefore we investigated the association between spatial variation of Type 1 diabetes and its putative environmental risk factors, zinc and nitrates.
The association was evaluated using Bayesian modelling and the geo-referenced data on diabetes cases and population.
Neither zinc nor nitrate nor the urban/rural status of the area had a significant effect on the variation in incidence of childhood Type 1 diabetes.
The results showed that although there was no significant difference in incidence between rural and urban areas, there was a tendency to increasing risk of Type 1 diabetes with the increasing concentration of NO3 in drinking water. The fact that no significant effect was found may stem from the aggregated data being too crude to detect it.
Diabetic Medicine 04/2004; 21(3):256-61. · 3.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the association of spatial variation in acute myocardial infarction (AMI) incidence and its putative environmental determinants in ground water such as total water hardness, the concentration of calcium, magnesium, fluoride, iron, copper, zinc, nitrate, and aluminium.
Small area study using Bayesian modelling and the geo-referenced data aggregated into 10 km x 10 km cells.
The population data were obtained from Statistics Finland, AMI case data from the National Death Register and the Hospital Discharge Register, and the geochemical data from hydrogeochemical database of Geological Survey of Finland.
A total of 18 946 men aged 35-74 years with the first AMI attack in the years 1983, 1988, and 1993.
One unit (in German degree degrees dH) increment in water hardness decreased the risk of AMI by 1%. Geochemical elements in ground water included in this study did not show a statistically significant effect on the incidence and spatial variation of AMI, even though suggestive findings were detected for fluoride (protective), iron and copper (increasing).
The results of this study with more specific Bayesian statistical analysis confirm findings from earlier observations of the inverse relation between water hardness and coronary heart disease. The role of environmental geochemistry in the geographical variation of the AMI incidence should be studied further in more detail incorporating the individual intake of both food borne and water borne nutrients. Geochemical-spatial analysis provides a basis for the selection of areas suitable for such research.
Journal of Epidemiology & Community Health 03/2004; 58(2):136-9. · 3.39 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of the study was to investigate the incidence of type 1 diabetes among children aged 14 years or under according to the level of urbanization of the place of residence of children at the time of diagnosis in Finland during 1987 to 1996. The analysis was carried out using a Bayesian approach and GIS. The incidence was the highest in the rural heartland areas while the increase in incidence was sharpest in urban areas. The level of urbanization seems to explain only a part of the spatial variation in the incidence in Finland. It is possible that some environmental risk factors for type 1 diabetes have been more prevalent in rural heartland areas than in the rest of the country. These factors might have increased in urban environments in Finland particularly during the first half of 1990s.
Health & Place 01/2004; 9(4):315-25. · 2.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: To provide age-gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged < or = 14 years.
Data were prospectively collected over a period of 6 years (1992-1997) according to the DiaMond Project protocol using the capture-recapture method of ascertainment.
Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100,000 children 0-14 years (95% confidence interval (CI) 18.0-22.1); age-standardized incidence rate 20.9 (95% CI 18.8-23.0). The incidence rate among boys, 21.1 per 100,000 (95% CI 18.1-24.1) was slightly higher than that among girls, 19.0 per 100,000 (95% CI 16.1-21.8). The age-standardized incidence rate was 21.9 (95% CI 18.9-24.8) in boys, and 19.9 (95 CI 17.1-22.8) in girls. Incidence rates increased with age in both sexes (boys chi(2) for linear trend = 13.5, P < 0.001; and for girls chi(2) = 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6-year period (chi(2) = 6.210, P = 0.013), and in age group 5-9 (chi(2) = 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001).
The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.
Diabetic Medicine 06/2002; 19(6):522-5. · 3.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: In this paper, the spatial distribution of the first event of acute myocardial infarction among 35- to 74-year-old men in Finland was examined for the cross-section years 1983, 1988 and 1993. The analysis was performed using a Bayesian hierarchical spatial approach to the geographically referenced data. The population data and case data received from nationwide registries were aggregated into 10 × 10 km cells. The estimated maps show that along with the overall decreasing incidence, the high-risk area withdrew deeper into the northeast, with an incidence 7–12% higher in rural than in urban areas. It could be concluded that eastern Finland is likely to remain a high-risk area in the future due to the concentration of certain risk factors.
[show abstract][hide abstract] ABSTRACT: We aimed to study the incidence of Type I diabetes in 4 countries, Estonia, Latvia, Lithuania and Finland, during 1983-1998, focusing on the two separate periods of 1983-1990 and 1991-1998.
Population-based incidence data from nationwide diabetes registries were used. Crude and age-standardized incidence rates using the proportions of 39%, 32% and 29% for 5-year age groups (0-4, 5-9 and 10-14 years) were calculated. Yearly incidence was evaluated and the means between the two periods compared.
Between 1983-1990 and 1991-1998 there was a statistically significant incidence increase in all 4 countries of Estonia, Lativia, Lithuania and Finland (relative risk 1.15, 95%-Confidence interval 1.10-1.19) and as well as in the 3 Baltic states of Estonia, Latvia, Lithuania (relative risk 1.13, 95%. Confidence interval 1.04-1.22). The crude incidence increased in Estonia from 10.1 (95%-Confidence interval 8.9-11.4) to 12.3 (11.0-13.8), in Latvia from 6.6 (5.8-7.3) to 7.4 (6.6-8.2) and in Lithuania from 6.8 (6.2-7.5) to 7.8 (7.1-8.5). In Finland the incidence rose from 34.6 (33.3-36.0) in 1983-1990 to 40.8 (39.4-42.2) in 1991-1998. In children under 5 years of a age a statistically important increase was seen in Estonia and Finland. The highest incidence for a single year was recorded for all participating countries in the late 1990 s. The highest annual incidence rate of childhood onset Type I diabetes in the world ever known was recorded in Finland in 1998 with 48.5 cases per 100 000 person-years. CONCLUSION/HYPOTHESIS: The incidence of Type I diabetes has increased since 1983 in the three Baltic states as well as in Finland. Long-term monitoring is needed for a better detection in changes in incidence.
[show abstract][hide abstract] ABSTRACT: In Finland, the incidence of Type I (insulin-dependent) diabetes mellitus among children aged 14 years or under is the highest in the world. The increase in incidence is approximately 3% per year. A marked geographical variation in incidence was reported in Finland during the late 1980s. Our aim was to explore the most recent regional pattern in incidence of Type I diabetes in Finland.
Data on the nationwide incidence of childhood diabetes in Finland was obtained from the Prospective Childhood Diabetes Registry for the periods 1987-1991 and 1992-1996. Population data was obtained from the National Population Registry. The geographical pattern of incidence was studied applying a Bayesian hierarchical approach and Geographical Information Systems. The inferences from the data was based on the estimated geographical intensity of diabetes.
There was a clear evidence of geographic variation for the risk of childhood diabetes during the entire 10-year period. The high-risk areas were found in the wide belt crossing the central part of Finland. Comparison of the estimated intensity of diabetes between the two 5-year periods showed that the geographical pattern of diabetes risk has changed over time. Our analyses also confirmed the existence of a few persistent high-risk and low-risk areas in Finland.
The finding of high-risk areas of childhood Type I diabetes suggests that specific genetic or environmental risk factors have become greater in certain geographic locations in Finland.
[show abstract][hide abstract] ABSTRACT: To characterize the factors that influence the frequency of tonsillectomy and adenoidectomy operations.
Nationwide questionnaire. Analysis of patients undergoing tonsillectomy or adenoidectomy at Helsinki University Central Hospital, Helsinki, Finland.
Four hundred eighty-three of 819 individuals randomly selected from the Finnish National Public Registry. Two thousand two hundred thirty-one individuals younger than 30 years who underwent tonsillectomy (888 patients), adenotonsillectomy (294 patients), or adenoidectomy (1049 patients) at Helsinki University Central Hospital from January 1, 1997, through December 31, 1998.
Age of the individual at the time of operation. Indication for the operation.
The frequency of adenoidectomies was 24% (116 persons) and that of tonsillectomies 8% (39 persons) among the 483 individuals who returned the questionnaire. The frequency of tonsillectomy operations by age was multimodal; the frequency of tonsillectomies increased in preschool-aged children, declined thereafter, and increased again in teenagers. Tonsillar hyperplasia was the most frequent among children younger than 10 years, peritonsillar abscesses among teenagers, and chronic tonsillitis among individuals older than 20 years. The proportion of females was higher than males among teenaged patients. However, the cause and sex distribution could not explain the multimodality in the age-specific frequency. The age-specific frequency of tonsillectomies performed because of peritonsillar abscesses still followed a multimodal distribution.
Factors relating to respiratory tract infections, maturation of the immune system, and the onset of puberty contribute to the cause of tonsillar disease. Distinct indications for tonsillectomy should be defined for preschool-aged children, teenagers, and individuals older than 20 years.
Archives of Otolaryngology - Head and Neck Surgery 02/2001; 127(1):37-44. · 1.78 Impact Factor