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Mustila T.,Seinajoki Central Hospital | Keskinen P.,University of Tampere | Luoto R.,UKK Institute for Health Promotion | Luoto R.,Finnish National Institute for Health and Welfare
BMC Pediatrics

Background: Prevention is considered effective in combating the obesity epidemic. Prenatal environment may increase offspring's risk for obesity. A child starts to adopt food preferences and other behavioral habits affecting weight gain during preschool years. We report the study protocol of a pragmatic lifestyle intervention aiming at primary prevention of childhood obesity.Methods/Design: A non-randomized controlled pragmatic trial in maternity and child health care clinics. The control group was recruited among families who visited the same clinics one year earlier. Eligibility criteria was mother at risk for gestational diabetes: body mass index ≥ 25 kg/m2, macrosomic newborn in any previous pregnancy, immediate family history of diabetes and/or age ≥ 40 years. All maternity clinics in town involved in recruitment. The gestational intervention consisted of individual counseling on diet and physical activity by a public health nurse, and of two group counseling sessions. Intervention continues until offspring's age of five years. An option to participate a group counseling at child's age 1 to 2 years was offered. The intervention includes advice on healthy diet, physical activity, sedentary behavior and sleeping pattern. The main outcome measure is offspring BMI z-score and its changes by the age of six years.Discussion: Early childhood is a critical time period for prevention of obesity. Pragmatic trials targeting this period are necessary in order to find effective obesity prevention programs feasible in normal health care practice.Trial registration: Clinical Trials gov NCT00970710. © 2012 Mustila et al.; licensee BioMed Central Ltd. Source

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

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. Source

Borodulin K.,Finnish National Institute for Health and Welfare | Karki A.,Finnish National Institute for Health and Welfare | Laatikainen T.,Finnish National Institute for Health and Welfare | Laatikainen T.,University of Eastern Finland | And 3 more authors.
Journal of Physical Activity and Health

Background: Daily sitting time may be a risk factor for incident cardiovascular disease (CVD); however, this has not yet been extensively studied. Our aim was to study the association of total sitting time with the risk of CVD. Methods: Participants (n = 4516, free of CVD at baseline) from the National FINRISK 2002 Study were followed for fatal and nonfatal CVD using national registers. Participants underwent a health examination and completed questionnaires, including total daily sitting time. Results: During a mean follow-up of 8.6 years, 183 incident CVD cases occurred. Sitting on a typical weekday, at baseline, was statistically significantly associated with fatal and nonfatal incident CVD. The hazard ratios (with 95% confidence intervals, CI) for the total amount of sitting were 1.05 (95% CI, 1.00-1.10) in the age and gender adjusted model and 1.06 (95% CI, 1.01-1.11) in the fully adjusted model, including age, gender, employment status, education, BMI, smoking status, leisure time physical activity, use of vegetables and fruit, alcohol use, blood pressure or its medication, and cholesterol or its medication. Conclusions: Our findings suggest that total amount of daily sitting is a risk factor for incident CVD. More research is needed to understand the etiology of sedentary behavior and CVD. © 2015 Human Kinetics, Inc. Source

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

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. Source

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

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. Source

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