UKK Institute for Health Promotion

Tampere, Finland

UKK Institute for Health Promotion

Tampere, Finland
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Makinen J.,University of Tampere | Rainesalo S.,University of Tampere | Raitanen J.,University of Tampere | Raitanen J.,UKK Institute for Health Promotion | Peltola J.,University of Tampere
Epilepsy Research | Year: 2017

Purpose To assess the impact of the new AEDs on overall outcome for patients with epilepsy. Methods In 2004, the effect of combination therapy on seizure frequency in adult patients with focal epilepsy was evaluated in a cross-sectional study in our center. We repeated this analysis ten years and eight new antiepileptic drugs (AED) later. Results In 2014, a higher percentage of patients with polytherapy (117 out of 396; 30%) were seizure-free compared with the original analysis (22%) (p = 0.042). Eighty three out of 218 (38%) subjects on duo-therapy were seizure-free (27% in 2004) (p = 0.040); in the 151 receiving triple therapy there were 30 (20%) seizure-free subjects (10% in 2004). Four out of 27 subjects (15%) with four AEDs were seizure-free (0% in 2004). The most common pairing of 52 different combinations for duo-therapy was levetiracetam-oxcarbazepine. Eighty different AEDs regimens were being used in the patients administered three AEDs. Conclusion Our combined data from these two studies indicate that some patients with focal epilepsy might benefit from newer AEDs as an adjunctive therapy in the hope they could acquire seizure freedom. © 2017 Elsevier B.V.


Luoto R.,UKK Institute for Health Promotion | Luoto R.,Finnish National Institute for Health and Welfare | Mannisto S.,Finnish National Institute for Health and Welfare | Raitanen J.,UKK Institute for Health Promotion
Gender Medicine | Year: 2011

Overweight or weight development related to pregnancy has been associated with number of deliveries (ie, parity). This study evaluates 10-year changes in associations between obesity and parity. The data were from the National FINRISK Study on women 2564 years of age. The study included a questionnaire and anthropometric measurements in 1997 (N = 4193) and 2007 (N = 3578). Women whose body mass index (BMI) was <30 kg/m 2 were considered obese, and women whose waist circumference was ≥88 cm were considered viscerally obese. Women with no pregnancies were categorized as nulliparous, those with 12 deliveries as parous, and those with ≥3 deliveries as multiparous. Logistic regression models were used to estimate separately the odd ratios (ORs) and 95% CIs for BMI and waist circumference. Linear regression models were used to evaluate the main effect of parity on obesity and visceral obesity. Women with 1 or 2 children were less often obese (OR = 0.75; 95% CI, 0.640.88) or viscerally obese (OR = 0.98; 95% CI, 0.85-1.14) than nulliparous or multiparous women. Multiparous women had more visceral obesity in 2007 (OR = 1.36; 95% CI, 1.16-1.60) than other parity groups. Multiparous women had the highest BMI or waist circumference even after adjusting for age, study year, and education. The year 2007 was significantly associated with visceral obesity (OR = 2.07; 95% CI, 1.87-2.30) and obesity (OR = 1.13; 95% CI, 1.01-1.28) when compared with 1997. Parity is an important determinant of visceral obesity, which is more prevalent in younger age groups than a decade ago. Women with ≥3 deliveries were more often obese or viscerally obese than other women. © 2011 Elsevier HS Journals, Inc. All rights reserved.


Moilanen J.,University of Tampere | Aalto A.-M.,Finnish National Institute for Health and Welfare | Hemminki E.,Finnish National Institute for Health and Welfare | Aro A.R.,University of Southern Denmark | And 4 more authors.
Maturitas | Year: 2010

Background and aim of the study: The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle (smoking, use of alcohol, physical activity) and body mass index (BMI). Material and methods: Health 2000 is a nationally representative population-based study of Finnish adults. Data were collected by home interview, three self-administered questionnaires and a clinical examination by a physician. This study included women aged 45-64 years (n = 1427). All symptoms included menopause-specific symptoms. Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group. Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors (age, education, smoking, alcohol use, physical activity, BMI, use of hormonal replacement therapy (HRT) and chronic disease status). Results: Over one-third (38%) of the premenopausal, half of the perimenopausal, and 54% of both postmenopausal and hysterectomized women reported bothersome symptoms. The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes. Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle. Smoking was not related to vasomotor symptoms. Conclusion: Bothersome symptoms are common in midlife, regardless of menopausal status. Inverse association between physical activity and menopausal symptoms needs to be confirmed in randomized trials. © 2010 Elsevier Ireland Ltd. All rights reserved.


Moilanen J.M.,University of Tampere | Aalto A.-M.,Finnish National Institute for Health and Welfare | Raitanen J.,University of Tampere | Raitanen J.,UKK Institute for Health Promotion | And 4 more authors.
Health and Quality of Life Outcomes | Year: 2012

Background and objectives: The aim of this study was to study the role of menopausal status and physical activity on quality of life.Methods: A total of 1,165 Finnish women aged 45-64 years from a national representative population-based study were followed up for 8 years. Study participants completed the Health 2000 study questionnaire and follow-up questionnaire in 2008. Ordinal logistic regression analysis was used to measure the effect of menopausal status on global quality of life (QoL). Other variables included in the analyses were age, education, change of physical activity as assessed with metabolic equivalents, change of weight and hormone therapy (HRT) use.Results: Peri- and postmenopausal women increased their physical activity (28% and 27%) during the eight-year follow up period slightly more often than premenopausal (18%) women (p = 0.070). Menopausal status was not significantly correlated with change of QoL. QoL of the most highly educated women was more likely to improve than among the less educated (e b= 1.28, 95%CI 1.08 to 1.51 p = 0.002). Women whose physical activity increased or remained stable had greater chances for improved QoL than women whose physical activity decreased (e b= 1.49, 95%CI 1.23 p < 0.001 to 1.80, e b= 1.46, 95%CI 1.24 to 1.73 p < 0.001 respectively). Women whose weight remained stable during follow-up also improved their QoL compared to women who gained weight (e b= 1.26, 95%CI 1.07 to 1.50 p > 0.01). Women who had never used HRT had 1.26 greater odds for improved QoL (95%CI 1.02 to 1.56 p = < 0.05).Conclusion: Improvement of global QoL is correlated with stable or increased physical activity, stable weight and high education, but not with change in menopausal status. © 2012 Moilanen et al; licensee BioMed Central Ltd.


Mustila T.,Seinajoki Central Hospital | Raitanen J.,UKK Institute for Health Promotion | Raitanen J.,University of Tampere | Keskinen P.,University of Tampere | And 4 more authors.
BMC Pediatrics | Year: 2013

Background: According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes.Methods: The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10-17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26-28 weeks' gestation, the mother's gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models.Results: Intervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother's GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups.Conclusion: Since the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring's weight gain may manifest only later in childhood.Trial registration: Clinical Trials gov: NCT00970710. © 2013 Mustila et al.; licensee BioMed Central Ltd.


Nevalainen O.,University of Tampere | Raitanen J.,University of Tampere | Raitanen J.,UKK Institute for Health Promotion | Ansakorpi H.,University of Oulu | And 4 more authors.
European Journal of Epidemiology | Year: 2013

To estimate long-term mortality by cause of death in a nationwide, register-based cohort of newly diagnosed patients with epilepsy (PWE). All noninstitutionalized Finnish PWE aged 10-74 years (n = 10,818) eligible for reimbursement for antiepileptic medication for the first time between 1990 and 1994 were identified in the database of Social Insurance Institution of Finland. Mortality was compared against a population-based reference cohort (n = 43,894). Hazard ratios (HR) and their 95 % confidence intervals (95 % CI) during a follow-up of 18 years were estimated using proportional hazards modeling. Potential years of life lost (PYLL) and excess fraction of causes of death attributable to epilepsy were estimated. PWE contributed 137,610 person-years of observation and there were 3,558 deaths. Mortality remained elevated up to 18 years post-diagnosis (HR 3.21, 95 % CI 3.07-3.35). Ischemic heart disease mortality in PWE was two-fold (HR 2.31, 95 % CI 2.09-2.54), and remained constantly elevated during entire follow-up in both men and women. Most premature mortality in terms of PYLL was attributable to brain cancer (17 %), other cancers (15 %), ischemic heart disease (11 %), as well as cerebrovascular diseases (10 %). The percentage of deaths in PWE statistically attributable to epilepsy was 3.9 % for accidents, 3.4 % for alcohol-related diseases, and 1.6 % for suicides. PWE had substantial excess mortality from non-communicable diseases, which did not disappear by 18 years. Diseases of the circulatory system and cancers, especially brain cancer, were the most important causes of death almost regardless of the mortality indicator. © 2013 Springer Science+Business Media Dordrecht.


Lamberg S.,University of Tampere | Raitanen J.,UKK Institute for Health Promotion | Rissanen P.,University of Tampere | Luoto R.,UKK Institute for Health Promotion | Luoto R.,Finnish National Institute for Health and Welfare
European Journal of Public Health | Year: 2012

Background: The prevalence of gestational diabetes (GDM) is constantly increasing all around the world. Aim of this study is to report prevalence and regional differences of GDM, oral glucose tolerance tests (OGTT) and register-based GDM risk factors [age and body mass index (BMI)] among Finnish women. Methods: Data from the Finnish Medical Birth Register including all deliveries in Finland during 2004-06 (N=174634) were used. The criteria for GDM were abnormal results in OGTT, GDM diagnosis based on ICD-10 classification or use of insulin treatment during pregnancy. Pregnant women with type I diabetes were excluded, but women with pregestational diabetes (type II) were included since they also can receive GDM diagnosis. Results: The prevalence of GDM was 10-11% and OGTTs 22-28% between the period 2004 until 2006. Regional differences were 2-fold both in prevalence of GDM (8-15%) and OGTTs (19-34%). Proportions of obese women varied between 28% and 35% and women aged >40 years between 3% and 4%. The regional differences in GDM prevalence were not attenuated when risk factors were taken into account. Overweight and age ≥years explained only a fourth of the variation in GDM prevalence. Conclusion: Proportion of women undergoing OGTT increased but the prevalence of GDM did not during the study period. Two-fold regional differences in OGTT prevalence explained higher proportion of variation in prevalence of GDM than risk factors available from birth registry, age and BMI. © The Author 2011. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.


Nevalainen O.,University of Tampere | Auvinen A.,University of Tampere | Ansakorpi H.,University of Oulu | Artama M.,Finnish National Institute for Health and Welfare | And 4 more authors.
Epilepsia | Year: 2012

The authors evaluated the contribution of various clinical characteristics to mortality risk and underlying causes of death among all adult patients with epilepsy seen at the Department of Neurology, Oulu University Hospital in Finland during 1996 and 1997. Hazard ratios (HRs) for mortality in 1998-2006 relative to a population-based reference cohort were estimated using Cox modeling, with adjustment for age and gender. The HR for total mortality was 2.66 (95% confidence interval [CI] 2.09-3.39). Infectious etiology of epilepsy (HR 5.77, 95% CI 2.52-13.2) and a seizure frequency of ≥1 per month (HR 4.42, 95% CI 3.00-6.52) related to high risks of death. Cancer (21%), ischemic heart disease (15%), and accidents (12%) caused most of the potential years of life lost. Despite recent advances in treatment of epilepsy and improved seizure control, chronic epilepsy still carries a substantially increased risk of death. © 2012 International League Against Epilepsy.


Pakarainen T.,University of Tampere | Raitanen J.,University of Tampere | Raitanen J.,UKK Institute for Health Promotion | Talala K.,Finnish Cancer Registry | And 4 more authors.
European Urology | Year: 2016

Background: The multicenter European Randomized Study of Screening for Prostate Cancer has shown a 21% reduction in prostate cancer (PC) mortality by prostate-specific antigen-based screening, with substantial overdiagnosis. In the present study, we analyzed the incidence of PC after screening in relation to the number of screening rounds attended in the Finnish section of the trial. Objective: To evaluate the possible reduction in PC incidence following completed screening cycles in relation to the number of screening rounds attended. Design, setting, and participants: The participants in the screening arm of the Finnish screening trial (29 298 men) were divided into subgroups of men who had participated at one, two, or three screening rounds. A reference group was formed of the 43 151 men in the control arm by selecting age-matched controls for each subgroup of the screening participants. PC cases diagnosed after screening were identified from the Finnish Cancer Registry until the end of 2011. Follow-up of the screened men started 12 mo (365 d) after the last screening attendance and a similar date was assigned to the men in the control arm. Results and limitations: A total of 1514 new PCs cases (cumulative incidence 5.2%) were diagnosed among the screened men after the last screening attendance. In the reference group formed from the control arm, 2683 cases (6.2%) occurred. The hazard ratio (HR) for PC among nonparticipants in the screening arm was 0.89 (95% confidence interval [CI] 0.79-0.99) compared with their controls. Among participants, the HR in those who participated once was 1.39 (95% CI 1.22-1.57), among men who participated twice the HR was 0.97 (95% CI 0.86-1.10), and among men screened three times the HR was 0.57 (95% CI 0.49-0.68). A limitation of the study was that the comparison by attendance is not based on randomization. Conclusions: The postscreening PC incidence is reduced after attending three screening rounds, but not after only one or two rounds. Thus, the increased cancer detection at screening is compensated by a subsequent risk reduction only after repeated screening cycles. Patient summary: The results of the study indicate that at least three prostate-specific antigen-based screening cycles are needed to reduce subsequent prostate cancer incidence. The present study showed that for a reduction of prostate cancer incidence, one screening round is not sufficient. At least three screening cycles are needed to achieve a compensatory decrease in prostate cancer risk after termination of screening. © 2016 European Association of Urology.


Nevalainen O.,University of Tampere | Ansakorpi H.,University of Oulu | Simola M.,University of Oulu | Raitanen J.,University of Tampere | And 5 more authors.
Neurology | Year: 2014

Objective: We systematically synthesized the epidemiologic literature on mortality in patients with epilepsy (PWE) by epilepsy-related clinical characteristics with an aggregate data metaanalysis. Methods: We systematically searched 15 electronic databases, browsed reference lists of pertinent publications, and contacted authors in the field. We were interested in cohort studies that reported the relative risk of death in representative epilepsy populations relative to the general population, with exclusion of highly selected subpopulations of PWE, such as patients with intellectual disabilities or epilepsy surgery series. Search, data abstraction, and study quality assessment with the Newcastle-Ottawa Scale were all performed in duplicate. Results: Pooled mortality was threefold (relative risk 3.33, 95% confidence interval 2.83-3.92) in 38 epilepsy cohorts including 165,879 patients (79.6% from Nordic countries). Among incident cases, idiopathic epilepsies did not associate with materially increased mortality (1.29, 0.75-2.20; 4 studies), whereas mortality was almost twofold in cryptogenic epilepsy (1.75, 1.20-2.54; 5 studies), and highly elevated in patients with symptomatic epilepsy (4.73, 3.27-6.83; 12 studies) and especially in epilepsies due to congenital or developmental causes (10.3, 4.03-26.2; 2 studies). Newly diagnosed patients who attained seizure freedom did not have elevated mortality (0.97, 0.73-1.30; 2 studies). Conclusion: Excess mortality was highly related to the etiology of epilepsy in all ages. In adult patients without neuroradiologic abnormalities or other identifiable cause of epilepsy, only patients with cryptogenic epilepsy exhibited excess mortality. Risk of premature death was lowest in idiopathic epilepsy and in PWE who attained seizure freedom. © 2014 American Academy of Neurology.

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