Cancer incidence of 20 529 hypertensive patients included in the community-based hypertension register of the North Karelia Project was determined. A total of 2511 incident cancer cases were obtained among the patients in record linkage with the nationwide Finnish Cancer Registry during the mean follow-up time of 16 years. The age-adjusted incidence rates per 100 000 person-years were 248.4 for men and 171.7 for women, which correspond to that of the general population in the area. The Cox regression model was used to analyze the effect of hypertension-related variables on cancer incidence. In men, the diastolic blood pressure was associated with an increased cancer risk but only in those who smoked >10 cigarettes per day. The functional diagnosis of hypertension (stage I, hypertension with no end-organ damage; stage II, hypertension with left cardiac hypertrophy; and stage III, hypertension with extracardiac organ damage) was associated with the increased risk significantly in men who used antihypertensive drugs at baseline. In women, the diastolic blood pressure was associated with an increased cancer risk in those who did not use antihypertensive drugs at baseline. The functional diagnosis of hypertension was associated with an increased risk only in those who smoked >10 cigarettes per day, but the number of women and cancer cases in this group was small. These results indicate a complex pattern of diastolic blood pressure, functional diagnosis, use of antihypertensive drugs, smoking, and gender in the cancer risk of hypertensive patients.
The oldest old are prone to develop delirium. Studies into risk factors for delirium have been carried out predominantly in younger age groups. The aim of this population-based follow-up study was to investigate the risk factors for delirium requiring medical attention and subsequent prognosis in the non-demented general population aged > or = 85 years.
The study included the non-demented subjects in the population-based Vantaa 85+ study. After the 3-year observation period, 199 subjects (91% of those surviving) were re-examined and their medical records were evaluated for episodes of delirium. The subjects were followed up with respect to mortality for another 2 years.
During the 3-year observational period, 20 subjects (10%) had been diagnosed as having had an episode of delirium. A Mini-Mental State Examination score of or = 85 years. The study also highlights the significant association between delirium and a new dementia diagnosis in this age group.
To determine whether community care of demented patients can be prolonged by means of a 2-year support program based on nurse case management.
Randomized controlled intervention study with 2-year follow-up.
Demented patients entitled to payments from the Social Insurance Institution for community care, in five municipalities in eastern Finland.
One hundred demented patients, age 65 and older, living at home with the primary support of informal caregivers, allocated at random to the intervention (n = 53) or control group (n = 47).
Intervention patients and their caregivers were provided with a 2-year intervention program of systematic, comprehensive support by a dementia family care coordinator.
Time to institutionalization (period in community care) from enrollment of patients in the study to their placement in long-term institutional care.
During the first months, the rate of institutionalization was significantly lower in the intervention group than in the control group (P = .042), but the benefit of the intervention decreased with time (P = .028). Estimated probability of staying in community care up to 6, 12, and 24 months was 0.98, 0.92, and 0.63 in the intervention group and 0.91, 0.81, and 0.68 in the control group, respectively. Results also suggest that the intervention used in the study might be especially beneficial to patients with severe dementia and those with problems threatening the continuity of community care.
The placement of demented patients in long-term institutional care can be deferred with the support of a dementia family care coordinator. However, by the end of the 2-year intervention, the number of patients institutionalized was similar in the intervention and control group. It seems to be beneficial to direct this type of intensive support at severely demented patients and their caregivers. On the basis of our experiences, we suggest that intervention by a dementia family care coordinator should be targeted especially at patients with problems threatening the continuity of community care.
Blood pressure (BP) levels in the Finnish population are amongst the highest in the world, despite favourable changes at the national level in the past two decades. The study evaluates the familial aggregation of BP and the association of some environmental factors to the familial aggregation of BP as a primary epidemiological approach of the genetics of hypertension in a sample of families with young offspring from eastern Finland. Offspring aged 15 years were examined between 1996 and 1997 and their biological parents were examined between 1993 and 1994. A total of 224 children were invited, 184 families participated, from which 144 were included in the analysis with complete data. Systolic (SBP), diastolic (DBP) and mean (MAP) arterial BPs were the main outcome measurements. After the offspring's gender and body mass index (BMI) and the parent's age and BMI were controlled for, the mother/offspring correlation of SBP and the father/offspring correlation of MAP were statistically significant (r = 0.18, P = 0.039, n = 134 and r = 0.20, P = 0.048, n = 99, respectively). The additional adjustment for the parent's education and family history of acute myocardial infarction did not change these results. There was a higher proportion of offspring in the highest quartile of SBP and MAP when the mother had a history of hypertension (OR = 3.4, 95% CI = 1.4-8.5, n = 139, and OR = 2.6, 95% CI = 1.0-6.5, n = 139, respectively). The study confirmed the familial aggregation of BP. The consistent BP association between the mother and the offspring may indicate the key role of the mother in the primary prevention of hypertension.
In this study, we investigated the familial aggregation of body mass index (BMI) in a sample of families with young offspring from eastern Finland. 15-year-olds were examined from 1996 to 1997, and their biological parents were examined from 1993 to 1994. 224 children were invited; 184 families participated, and 144 were included in the analysis with complete data. Significant positive correlations were found for mother-offspring pairs (correlation [r] = 0.31, p
The Finnish population has a high risk of coronary heart disease, which is associated to a high population level of serum total cholesterol (CHOL) already evident at early ages. The study investigated the familial aggregation of CHOL in a sample of families with young offspring from eastern Finland.
Fifteen-year-old offspring were examined during 1996-1997 and their biological parents were examined during 1993-1994. A total of 224 children were invited and 184 families participated, of which 123 were included in the analysis with complete data. The main outcome measure was the CHOL (millimoles per liter).
Significant positive familial correlations of CHOL were found for the pairs of mother/offspring (r = 0.35, P or =5 mmol/L (OR = 3.26, 95% CI = 1.2-8.9, n = 111).
The study confirmed the familial aggregation of CHOL. The consistent CHOL association between the mother and the offspring may indicate the key role of the mother for the primary prevention of hypercholesterolemia.
The aims of this prospective cohort study were to monitor childhood blood pressure (BP) and cholesterol and link them to fetal and childhood growth. Of the 215 children recruited after delivery in a rural county of eastern Finland during 1981 and 1982, 180 (83.7%) stayed in the study until the age of seven. The measurements assessed were BP, serum cholesterol and anthropometry. Of the children originally in the highest BP quartile at the age of 6 months, 58% (systolic BP (SBP)) and 68% (diastolic BP (DBP)), respectively, remained in the same quartile until the age of 7 years; 53% (SBP) and 60% (DBP), respectively, remained in the same lowest quartile. Consequently, BP at 6 months correlated strongly with SBP (r=0.69, P
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.
To examine the relationship between hyperinsulinemia and clusters of cardiovascular risk factors in middle-aged hypertensive patients.
A population-based study.
Pieksämäki District Health Center, and the Community health Center of the city of Tampere, in central Finland.
Hypertensive men and women aged 36, 41, 46, and 51 years (n = 18) in the town of Pieksämäki, and a normotensive control population of 177 subjects aged 40 and 45 years in the city of Tampere.
Clusters of obesity (body mass index > 30.0 kg/m2), abdominal adiposity (waist:hip ratio > 1.00 for men and > 0.88 for women), hypertriglyceridemia (> 1.70 mmol/l), a low level of high-density lipoprotein cholesterol (
Cerebral amyloid angiopathy (CAA) is frequent in patients with Alzheimer's disease while its prevalence in different populations is variable. We investigated the prevalence and severity of CAA in a very elderly Finnish population.
Neuropathological investigation was performed on 306 subjects from the population-based Vantaa 85+ Study (253 women, 53 men, mean age at death 92.3 years). The presence of CAA was analysed in six brain regions by using Congo red and immunohistochemistry with an antibody against amyloid beta peptide. The severity of CAA was assessed by counting the percentage of the CAA-positive blood vessels.
In total, 69.6% of the participants (170 women, 43 men) had CAA, with median severity of 1.0%, inter-quartile range (IQR) 0-5.4% and range 0-72.7%. CAA was more prevalent (81.1% vs. 67.2%; P = 0.046) and severe (median 2.7%, IQR 0.4-7.5%, range 0-72.7%) in the men than in the women (median 1.0%, IQR 0-4.6%, range 0-52.8%; P = 0.004). Parietal lobe showed the highest prevalence (57.8%) whereas the severity was highest (median 1.0%, IQR 0-6.0%, range 0-77%) in the frontal lobe. Prevalence of CAA in the six regions was variable, but the severity indices between those regions correlated highly (P