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  • E. 
    Aho, Lauri E. (1930)
  • E. 
    Lohikoski, Virpi (1998)
  • Lindqvist, Ulla (2008)
    The purpose of this study is to describe and evaluate the work of early intervention and family support in Family Centres of Helsinki City Social Services Department. The subject matter in this study is approached by using community social work perspective. The research data consists of descriptions of early intervention and family support working models. Descriptions have been gathered from the workers of play parks, social and family work, families with children home service, family houses and groups and projects in two phases: first by a questionnaire and thereafter worker joint development process. This study is a part of the development process of early intervention and family support in Family Centres. The data was analysed by applying theory engaged examination and content analysis. Evaluation method is description and the purpose is to create an overview the work of early intervention and family support and its development needs. The approach to research is development evaluation. The workers described in the questionnaire 393 different working models. Based on analysis working methods of direct client work were defined as follows: family work, group work, community work, multicultural work and information about the services. Working methods of indirect client work were defined as multiprofessional network and strengthening of the working methods of early intervention and family support. Based on the questionnaire workers saw supporting parenthood and strengthening of social networks needs for the work. Experienced results of the working methods were positive and their achievements were experienced in family and group work. Based on workers experience working methods close to basic work were considered to be effective. Workers evaluate that the working methods brought a change to client's life situation (medium 8,31 on scale 1-10). The descriptions prepared in the development process examine early intervention and family support in three levels: community, department and worker/working place. Local co-operation and group work were described by all functions. This study investigates also the descriptions of the workers from play parks from the community and community social work perspective. Parks are described as spaces of community, where participation and empowerment is made possible. The work of early intervention and family support is not a uniform collection of working methods which would be similar to all functions. All functions do it by taking into account the basic work and its specific features. Based on the analysis of descriptions I suggest looking at the early intervention and family support from developmental, social and operational point of view. Operational viewpoint is intervention and support on individual and community level. Through these elements both universal and selective needs of children and their families is visible in early intervention and family support. The changes in working environment have an impact on the development of the work. In this study four development strategies have been created from community social work basis. In these strategies the aim, elements and methods of work have been combined. Strategies are proactive and preventive work, services close to community, work centred on the social network and shared responsibility of practitioners and citizens.
  • Rosengård-Bärlund, Milla (Helsingin yliopisto, 2014)
    Diabetic autonomic neuropathy is a serious complication, associated with increased risk of morbidity and mortality, but it is perhaps the least understood of the diabetic complications. The challenge lies in the early diagnosis of this often subclinical condition, in the time window when it would still be treatable. Notably, when detected with the current diagnostic tools, diabetic autonomic neuropathy has been considered as the result of irreversible nerve damage. Reduced baroreflex sensitivity (BRS) is a sensitive marker of autonomic dysfunction, and importantly, also a prognostic marker in cardiovascular medicine. In addition to diabetes, abnormalities in the BRS also occur in conditions characterized by functional autonomic abnormalities such as myocardial infarction, heart failure, and hypertension. Accordingly, we hypothesized that early autonomic dysfunction in type 1 diabetes, as demonstrated by reduced BRS, is functional. The aim of this thesis was to elucidate the early markers of autonomic dysfunction in patients with type 1 diabetes of various durations. We reasoned that if BRS in patients with type 1 diabetes responds to slow, deep breathing, a manoeuvre shown to reduce sympathetic activity, or responds to oxygen administration, such a finding would support a functional aetiology. We also studied whether autonomic dysfunction, as established by reduced BRS, progresses alongside increasing diabetes duration to a stage where it is no longer improved by a functional manoeuvre. Moreover, we aimed to elucidate the role of BRS as a predictor of increased blood pressure (BP) level during a 5-year follow-up. We studied 117 patients with short (8.9±0.1 yrs) and 37 patients with long duration (33.7±0.5 yrs) type 1 diabetes, and a total of 73 age- and gender-matched, healthy control participants. Twelve heart-transplanted patients served as a model of cardiac denervation. An autonomic score was calculated from autonomic function tests. Spectral analysis of heart rate variability (HRV), blood pressure variability (BPV), and BRS came from recordings during normal (15/min) and slow, deep (6/min) controlled breathing. Of those with short-duration type 1 diabetes, 96 subjects were studied during a prospective visit by similar autonomic assessment as at baseline but in addition, with BRS assessed during inhalation of oxygen. In a total of 80 patients, we compared autonomic indices and ambulatory BP at baseline and follow-up. BRS was already reduced in patients with short-duration type 1 diabetes, but even more reduced in those with long duration or with increasing autonomic involvement. Slow breathing elevated the BRS to the level of control subjects at a normal breathing rate (15/min) in all patients except in those with an abnormal autonomic score. BRS also increased with oxygen during spontaneous breathing in diabetic but not in control participants, and with oxygen the difference in BRS was no longer significant. Slow breathing in normoxia restored the BRS to a similar extent as did oxygen. In the follow-up study, spontaneous BRS declined over time, but the change was not significant when adjusted for time of follow-up. Low BRS at baseline did not advance to cardiovascular autonomic neuropathy (CAN) but predicted an increase in night-time systolic BP. Furthermore, the BRS response to deep breathing at baseline predicted the increase found in 24-hour ambulatory BP. The results of this thesis indicate that even after long-duration diabetes, any abnormal BRS is at least in part of functional origin. The increased baroreflex response to oxygen supports the hypothesis of a functional reduction in parasympathetic activity occurring in patients with type 1 diabetes. The follow-up study showed that the decline in spontaneous BRS over time in patients with type 1 diabetes seems to be mainly due to normal ageing. Although early autonomic dysfunction seems functional and does not necessarily develop into autonomic neuropathy during a 5-year follow-up, the BRS and the response to deep breathing at baseline are associated with a future increase in BP. More research and a longer follow-up time will be required to fully clarify the prognostic significance of BRS in type 1 diabetes.
  • Mohebbi, Simin Z. (Helsingfors universitet, 2008)
    The present study assessed the prevalence of and risk factors for Early Childhood Caries (ECC) in children 12- to 36- month-old and evaluated the impacts of an educational intervention on ECC prevention in the 12- to 15-month-old cohort. The target population included 12- to 36-month-olds (n = 504) and their mothers attending the vaccination offices of 18 randomly selected public health centers of Tehran city. The mother was first interviewed by a structured questionnaire covering background factors, feeding habits, daytime sugar intake, mother’s and child’s oral cleaning habits, and mother’s perception toward her ability to maintain the child’s oral hygiene; then the child’s clinical dental examination was carried out covering caries experience and dental plaque status. In addition, the 12- to 15-month-olds (n = 242) were assigned to a six-month interventional study. The 18 health centers were randomly allocated into two groups for intervention and one for control. The mothers in the intervention groups received education on caries prevention from the vaccination staff with extra motivation as reminder phone calls in one of the intervention groups. The outcome was measured as differences in increments of enamel and dentinal caries. The results showed that the prevalence of ECC was rather high (3%-26%) in the three age groups, and almost all dmft was due to untreated caries. The majority of the children showed visible plaque on central upper incisors. Oral cleaning on a daily basis was reported for just 68% of mothers and 39% of children. The frequency of oral cleaning and good oral hygiene of the child were directly proportional to the mother’s own toothbrushing frequency. Of the children, 98% were solely or partly breastfed. ECC was more likely to occur among those for whom the burden of milk-bottle feeding at night existed (OR = 4.9), while breastfeeding per se, its duration, and its nighttime burden were not related to ECC. The indicator of daytime sugar intake also did not show a clear relationship with ECC. The educational intervention applying a pamphlet with some extra motivation and implemented by non-dental staff of public health centers appeared to be successful in preventing caries increments. To improve oral health status among the young children in countries with a developing oral health system, community-based oral health educational programs should be established by involving non-dental staff of health settings who are more frequently in contact with these children. Parents should be encouraged to realize that they play the dominant role in the oral health care of their children. Parents’ own oral health behaviors should be emphasized in dental and general health settings.
  • Toljamo, Tuula (Helsingin yliopisto, 2012)
    Chronic obstructive pulmonary disease (COPD) is an under-diagnosed and life-threatening progressive disease. Early symptoms of COPD include excessive sputum production and chronic cough. The primary risk factor of this disease in the western world is smoking. COPD is confirmed by spirometry, which does not totally reveal reversible airway obstruction. This study, conducted mainly in the Northern Finland, aimed to assess 1) smoking habits and smoking cessation in healthy middle-aged and young adults, 2) the prevalence of COPD and role of spirometry and prolonged respiratory symptoms in the diagnosis of COPD of smoking middle-aged adults, 3) the association of symptoms of chronic bronchitis with smoking habits in young adult males, and 4) to seek and to identify new potential biomarkers related to early COPD using non-hypothesis driven non-biased proteomics. A two-year prospective study included two visits to evaluate symptoms in healthy cigarette smokers, to screen new COPD cases and to assess the success of smoking cessation using motivational counselling and pharmacological therapies. In addition, a quantitative cross-sectional questionnaire survey was conducted in 1163 male conscripts during their military service in Northern Finland. A lung tissue proteomic approach was used to identify new COPD biomarkers. Spirometry revealed COPD by GOLD criteria in 11,0% and by national criteria in 15.3 % of originally asymptomatic chronic smokers. Further, chronic cough or sputum production was detected in 62.0% of the participants. After two years, 23.3% of adults had succeeded in quitting smoking. In young adults, 46.5% were daily smokers. The prevalence of self-reported chronic cough and sputum production was high in daily smokers (40.7%). The majority (60.2%) of the daily young smokers had made quit attempts and 46.9% of them had used nicotine replacement therapy (NRT). Based on the lung tissue proteomics, surfactant protein A (SP-A) was one of the most highly elevated spots in the COPD lung. The plasma SP-A concentration was higher both in chronic smokers and in COPD as compared to the non-smokers, and declined significantly during 2-year follow-up in those who succeeded to quit smoking compared to those who continued to smoke. To conclude there is remarkable burden of chronic bronchitis and COPD in the groups of chronic smokers who considered themselves as healthy. Motivational counselling seems to be successful, since over 23% of the adult smokers succeeded in stopping smoking. SP-A is a potential new biomarker for COPD although it needs further evaluation.
  • Gao, Weiguo (Helsingin yliopisto, 2010)
    Objectives of this study were to determine secular trends of diabetes prevalence in China and develop simple risk assessment algorithms for screening individuals with high-risk for diabetes or with undiagnosed diabetes in Chinese and Indian adults. Two consecutive population based surveys in Chinese and a prospective study in Mauritian Indians were involved in this study. The Chinese surveys were conducted in randomly selected populations aged 20-74 years in 2001-2002 (n=14 592) and 35-74 years in 2006 (n=4416). A two-step screening strategy using fasting capillary plasma glucose (FCG) as first-line screening test followed by standard 2-hour 75g oral glucose tolerance tests (OGTTs) was applied to 12 436 individuals in 2001, while OGTTs were administrated to all participants together with FCG in 2006 and to 2156 subjects in 2002. In Mauritius, two consecutive population based surveys were conducted in Mauritian Indians aged 20-65 years in 1987 and 1992; 3094 Indians (1141 men), who were not diagnosed as diabetes at baseline, were reexamined with OGTTs in 1992 and/or 1998. Diabetes and pre-diabetes was defined following 2006 World Health Organization/ International Diabetes Federation Criteria. Age-standardized, as well as age- and sex-specific, prevalence of diabetes and pre-diabetes in adult Chinese was significantly increased from 12.2% and 15.4% in 2001 to 16.0% and 21.2% in 2006, respectively. A simple Chinese diabetes risk score was developed based on the data of Chinese survey 2001-2002 and validated in the population of survey 2006. The risk scores based on β coefficients derived from the final Logistic regression model ranged from 3 – 32. When the score was applied to the population of survey 2006, the area under operating characteristic curve (AUC) of the score for screening undiagnosed diabetes was 0.67 (95% CI, 0.65-0.70), which was lower than the AUC of FCG (0.76 [0.74-0.79]), but similar to that of HbA1c (0.68 [0.65-0.71]). At a cut-off point of 14, the sensitivity and specificity of the risk score in screening undiagnosed diabetes was 0.84 (0.81-0.88) and 0.40 (0.38-0.41). In Mauritian Indian, body mass index (BMI), waist girth, family history of diabetes (FH), and glucose was confirmed to be independent risk predictors for developing diabetes. Predicted probabilities for developing diabetes derived from a simple Cox regression model fitted with sex, FH, BMI and waist girth ranged from 0.05 to 0.64 in men and 0.03 to 0.49 in women. To predict the onset of diabetes, the AUC of the predicted probabilities was 0.62 (95% CI, 0.56-0.68) in men and 0.64(0.59-0.69) in women. At a cut-off point of 0.12, the sensitivity and specificity was 0.72(0.71-0.74) and 0.47(0.45-0.49) in men; and 0.77(0.75-0.78) and 0.50(0.48-0.52) in women, respectively. In conclusion, there was a rapid increase in prevalence of diabetes in Chinese adults from 2001 to 2006. The simple risk assessment algorithms based on age, obesity and family history of diabetes showed a moderate discrimination of diabetes from non-diabetes, which may be used as first line screening tool for diabetes and pre-diabetes, and for health promotion purpose in Chinese and Indians.
  • Hukkinen, Katja (Helsingin yliopisto, 2007)
    The greatest effect on reducing mortality in breast cancer comes from the detection and treatment of invasive cancer when it is as small as possible. Although mammography screening is known to be effective, observer errors are frequent and false-negative cancers can be found in retrospective studies of prior mammograms. In the year 2001, 67 women with 69 surgically proven cancers detected at screening in the Mammography Centre of Helsinki University Hospital had previous mammograms as well. These mammograms were analyzed by an experienced screening radiologist, who found that 36 lesions were already visible in previous screening rounds. CAD (Second Look v. 4.01) detected 23 of these missed lesions. Eight readers with different kinds of experience with mammography screening read the films of 200 women with and without CAD. These films included 35 of those missed lesions and 16 screen-detected cancers. CAD sensitivity was 70.6% and specificity 15.8%. Use of CAD lengthened the mean time spent for readings but did not significantly affect readers sensitivities or specificities. Therefore the use of applied version of CAD (Second Look v. 4.01) is questionable. Because none of those eight readers found exactly same cancers, two reading methods were compared: summarized independent reading (at least a single cancer-positive opinion within the group considered decisive) and conference consensus reading (the cancer-positive opinion of the reader majority was considered decisive). The greatest sensitivity of 74.5% was achieved when the independent readings of 4 best-performing readers were summarized. Overall the summarized independent readings were more sensitive than conference consensus readings (64.7% vs. 43.1%) while there was far less difference in mean specificities (92.4% vs. 97.7%). After detecting suspicious lesion, the radiologist has to decide what is the most accurate, fast, and cost-effective means of further work-up. The feasibility of FNAC and CNB in the diagnosis of breast lesions was compared in non-randomised, retrospective study of 580 (503 malignant) breast lesions of 572 patients. The absolute sensitivity for CNB was better than for FNAC, 96% (206/214) vs. 67% (194/289) (p < 0.0001). An additional needle biopsy or surgical biopsy was performed for 93 and 62 patients with FNAC, but for only 2 and 33 patients with CNB. The frequent need of supplement biopsies and unnecessary axillary operations due to false-positive findings made FNAC (294 ) more expensive than CNB (223 ), and because the advantage of quick analysis vanishes during the overall diagnostic and referral process, it is recommendable to use CNB as initial biopsy method.
  • Ylihärsilä, Hilkka (Helsingin yliopisto, 2008)
    Theory of developmental origins of adult health and disease proposes that experiences during critical periods of early development may have consequences on health throughout a lifespan. Thesis studies aimed to characterize associations between early growth and some components of the metabolic syndrome cluster. Participants belong to two epidemiological cohorts with data on birth measurements and, for the younger cohort, on serial recordings of weight and height during childhood. They were born as singletons between 1924-33 and 1934-44 in the Helsinki University Central Hospital, and 500 and 2003 of them, respectively, attended clinical studies at the age of 65-75 and 56-70 years, respectively. In the 65-75 year old men and women, the well-known inverse relationship between birth weight and systolic blood pressure (SBP) was confined to people who had established hypertension. Among them a 1-kg increase in birth weight was associated with a 6.4-mmHg (95% CI: 1.0 to 11.9) decrease in SBP. This relationship was further confined to people with the prevailing Pro12Pro polymorphism of the peroxisome proliferator-activated receptor-γ2 (PPARγ2) gene. People with low birth weight were more likely to receive angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (ACEI/ARB, p=0.03), and, again, this relationship was confined to the carriers of the Pro12Pro (p=0.01 for interaction). These results suggest that the inverse association between birth weight and systolic BP becomes focused in hypertensive people because pathological features of BP regulation, associated with slow fetal growth, become self-perpetuating in adult life. Insulin resistance of the Pro12Pro carriers with low birth weight may interact with the renin-angiotensin system leading to raised BP levels. Habitual physical activity protected men and women who were small at birth, and thus at increased risk for the development of type 2 diabetes, against glucose intolerance more strongly. Among subjects with birth weight ≤3000 g, the odds ratio (OR) for glucose intolerance was 5.2 (95% CI: 2.1 to 13) in those who exercised less than 3 times per week compared to regular exercisers; in those who scored their exercise light compared with moderate exercisers (defined as comparable to brisk walking) the OR was 3.5 (1.5 to 8.2). In the 56-70 year old men a 1 kg increase in birth weight corresponded to a 4.1 kg (95% CI: 3.1 to 5.1) and in women to a 2.9 kg (2.1 to 3.6) increase in adult lean mass. Rapid gain in body mass index (BMI), i.e. crossing from an original BMI percentile to a higher one, before the age of 2 years increased adult lean mass index (LMI, lean mass/height squared) without excess fat accumulation whereas rapid gain in BMI during later childhood, despite the concurrent rise in LMI, resulted in a relatively higher increase in adult body fat mass. These findings illustrate how genes, the environment and their interactions, early growth patterns, and adult lifestyle modify adult health risks which originate from early life.
  • Sandboge, Samuel (Helsingin yliopisto, 2015)
    Background. A small birth size, an indicator of a suboptimal intrauterine environment, is a risk factor for several non-communicable diseases (NCDs), a risk that in many cases is modified by childhood growth patterns. Regional variation in NCD prevalence could partly have its origin in early development. Lifestyle factors further influence NCD prevalence. Aims. We aimed to explore the associations between early growth and adult resting metabolic rate (RMR), body composition, non-alcoholic fatty liver disease (NAFLD), and hypertension. We also studied the associations between fructose intake and NAFLD, and differences in birth size between Helsinki and the Åland Islands. Subjects and methods. The Helsinki Birth Cohort Study consists of 13345 individuals born in Helsinki in 1934‒44. Detailed records are available for all participants including information on maternal and birth characteristics and measurements of childhood body size. 2003 individuals participated in a clinical study in 2001‒04 and 1083 of these additionally participated in a follow-up study in 2006‒08. The Åland records include 1697 births for the years 1937‒44. Results. The association between birth weight and RMR was inverse among women and quadratic among men. A higher attained adult weight than expected, based on weight and height measurements before age 11 years and adult height, was associated with higher adult body fat content. The odds ratio (OR) for NAFLD was 18.5 (95% CI 10.1; 33.6) among those who belonged to the lowest BMI tertile at age 2 years and subsequently were obese as adults, compared to those who were still lean or normal weight as adults. NAFLD was most common among individuals with the lowest dietary fructose intake. Systolic blood pressure (SBP) and the presence of hypertension were inversely associated with linear (height) growth between ages 2 and 11 years. Relative weight gain after age 11 years was positively associated with SBP. Ålandic babies born 1937‒44 were 87 grams (95% CI 61; 111) heavier and 0.4 cm (95% CI 0.3; 0.5) longer than their Helsinki peers. Conclusions. A more pronounced increase in relative weight after age 11 years than would be expected from previous body size, was positively associated with body fat content, NAFLD, and hypertension. Conversely, several growth measurements before age 11 years were negatively associated with the outcomes studied. None of the studied individuals were obese in childhood. Instead, a larger relative childhood body size in this group most likely represents a more beneficial childhood environment. Contrary to previous findings, we found that individuals with the highest fructose intake were least likely to suffer from NAFLD. We found a small but significant difference in birth size between the Åland Islands and Helsinki for the years 1937‒44.
  • Perälä, Mia-Maria (Helsingin yliopisto, 2014)
    Epidemiological studies have shown that low birth weight and slow growth during infancy predict an increased risk of metabolic diseases, including type 2 diabetes and cardiovascular disease, in adult life. Unhealthy dietary habits are also closely linked with these diseases. However, few results are available on whether dietary habits play a role in the association between birth size and disease risk in later life. The aim of this thesis was to determine whether body size at birth is associated with food and nutrient intake later in life and whether birth weight modifies the relationship between salt intake and blood pressure. In addition, the impact of early growth on postprandial metabolism was examined. These studies included 2003 men and women born in Helsinki between 1934 and 1944 with detailed information of their birth weight and childhood growth. They participated in a clinical examination between 2001 and 2004. In the clinic, their weight, height and blood pressure were measured and they filled a validated food-frequency questionnaire. Of those who attended the clinical study, 12 obese individuals with a slow increase in body mass index (BMI) during the first year of life and 12 BMI- and age-matched controls were recruited to participate in the postprandial studies. Each participant consumed six different test meals in random order. Body size at birth was positively associated with consumption of fruits and berries and intake of carbohydrates, sugars and fibre, and inversely associated with intake of fat. Salt intake was related to systolic blood pressure among low birth weight participants (birth weight ≤ 3050 g) but not among participants whose birth weight was > 3050 g. Salt intake was not significantly associated with diastolic blood pressure, either in the low birth weight or high birth weight groups. Early growth affected the postprandial responses, and insulin and triglyceride responses were significantly higher in the group that grew slowly during early life than in the controls. Individuals with slow early growth also showed higher appetite regulatory hormone peptide YY responses than did the controls. This study showed that individuals born with small body size may be programmed towards unhealthy dietary habits. In addition, they are sensitive to the blood pressure-raising effect of salt and therefore, may especially benefit from a reduction in salt intake. Slow growth during early life adversely affects postprandial insulin and triglyceride responses. Unhealthy dietary habits and elevated postprandial responses may be one underlying mechanism explaining the increased risk of metabolic diseases associated with nonoptimal early growth. Early growth may also alter appetite regulatory hormone secretion, which could be one explanation why individuals born small or who grow slowly during infancy are unlikely to become obese in later life.
  • Salonen, Minna (Helsingin yliopisto, 2011)
    The Developmental Origins of Health and Disease Hypothesis proposes that adverse health outcomes in adult life are in part programmed during fetal life and infancy. This means that e.g. restricted nutrition during pregnancy programmes the offspring to store fat more effectively, to develop faster and to reach puberty earlier. These adaptations are beneficial in terms of short term survival. However, in developed countries these adaptations often lead to an increased risk of obesity and metabolic disturbances in later life, due to a mismatch between the prenatal and postnatal environment. This thesis aimed to study the role of early growth in people who are obese as adults, but metabolically healthy as well as in those who are normal in weight but metabolically obese. Other study aims were to assess whether physical activity and cardiorespiratory fitness are programmed early in life. The role of socioeconomic status in the development of obesity from a life course setting was also studied. These studies included 2003 men and women born in Helsinki between 1934 and 1944 with detailed information of their prenatal and childhood growth as well as living conditions. They participated in the detailed clinical examination during the years 2001-2004. A sub-group of the subjects participated in the UKK Institute 2-kilometre walk test. Metabolic syndrome was defined according to the 2005 criteria of the International Diabetes Federation. Among the obese men and women 20 % were metabolically healthy. Those with metabolic syndrome did not differ in birth size compared to the healthy ones, but by two years of age, they were lighter and thinner, and remained so up to 11 years. The period when changes in BMIs were predictive of the metabolic syndrome was from birth to 7 years. Of the normal weight individuals 17 % were metabolically obese. Again, there were no differences in birth size. However, by the age 7 years, those men who later developed metabolic syndrome were thinner. Gains in BMI during the first two years of life were protective of the syndrome. Children who were heavier, and especially taller, were more physically active, exercised with higher intensity and had higher cardiorespiratory fitness in their adult life than those who were shorter and thinner as children. Lower educational attainment and lower adult social class were associated with obesity in both men and women. Childhood social class was inversely associated with body mass index only in men while lower household income was associated with higher BMI in women. These results support the role of early life factors in the development of metabolic syndrome and adult life style. Early detection of risk factors predisposing to these conditions is highly relevant from a public health point of view.
  • Pesonen, Maria (Helsingin yliopisto, 2008)
    Atopy-related allergic diseases, i.e. allergic rhinoconjunctivitis, atopic dermatitis and asthma, have increased in frequency in the industrialized countries. In order to reverse this trend, effective preventive strategies need to be developed. This requires a better understanding of the early-life events leading to the expression of the atopic phenotype. The present study has aimed at defining early-life factors and markers associated with the subsequent development of allergic diseases in a cohort of 200 healthy, unselected Finnish newborns prospectively followed up from birth to age 20 years. Their mothers were encouraged to start and maintain exclusive breastfeeding as long as it was nutritionally sufficient for the infant. Consequently, all the infants received some duration of exclusive breastfeeding, 58% of the infants were on exclusive breastfeeding for the first 6 months of life, and 18% received this feeding at least for the first 9 months. Of the infants, 42% had a family history of allergy. After the first year of follow-up, the children were re-assessed at ages 5, 11 and 20 years with clinical examination, skin prick testing, and parental and personal interviews. Exclusive breastfeeding for over 9 months was associated with atopic dermatitis and symptoms of food hypersensitivity at age 5 years, and with symptoms of food hypersensitivity at age 11 years in the children with a familial allergy. Subjects with allergic symptoms or a positive skin prick test in childhood or adolescence had lower retinol concentrations during their infancy and childhood than others. An elevated cord serum immunoglobulin E concentration predicted subsequent atopic manifestations though with modest sensitivity. Children and adolescents with allergic symptoms, skin prick test positivity and an elevated IgE had lower total cholesterol levels in infancy and childhood than the nonatopic subjects. In conclusion, prolonging strictly exclusive breastfeeding for over 9 months of age was not of help in prevention of allergic symptoms; instead, it was associated with increased atopic dermatitis and food hypersensitivity symptoms in childhood. Due to the modest sensitivity, cord serum IgE is not an effective screening method for atopic predisposition in the general population. Retinol and cholesterol concentrations in infancy were inversely associated with the subsequent development of allergic symptoms. Based on these findings, it is proposed that there may be differences in the inborn regulation of retinol and cholesterol levels in children with and without a genetic susceptibility to atopy, and these may play a role in the development of atopic sensitization and allergic diseases.
  • Lahti, Marius (Helsingin yliopisto, 2012)
    Previous studies suggest that a suboptimal early life environment may predict an increased risk of adult personality disorders. However, most of this evidence is based on studies with retrospective accounts of early adversity. This retrospective design may induce a bias and hinder interpretation of the direction of causality. This thesis examines, in a longitudinal study setting, the developmental origins of personality disorders severe enough to justify hospitalisation. The focus is on pre- and postnatal growth and on parental separation in childhood due to temporary evacuations from Finland during World War II in the etiology of both any and dramatic personality disorders requiring hospitalisation. The study cohort is the Helsinki Birth Cohort Study, which comprises 13,345 individuals born 1934-1944. Data on early life growth, on childhood evacuations, and on the diagnoses of personality disorders were drawn from birth- and child welfare records and national registers. These objective record- and register-based data enabled the longitudinal design of the studies. In the current study cohort, there were 1,781 individuals who had been separated from their parents in childhood. There were 202 subjects who had been hospitalised for personality disorders, and 77 individuals with dramatic personality disorders. The results showed that a small head circumference and a small head-to-length ratio at birth predicted an increased risk of any severe personality disorder among men and a small placental surface area at birth predicted dramatic personality disorders among women. Slower gain in BMI between birth and six months of age, faster gains in weight and in BMI between six months and one year, and slower gains in weight and in BMI between seven and 11 years of age also predicted personality disorders among men. Slower height growth between two and seven years of age predicted an increased risk of personality disorders among women. The associations between infancy and childhood growth and severe personality disorders among men were especially characteristic of dramatic personality disorders, and were independent of comorbid mood disorders. Temporary separation from parents, particularly in the first five years of life, predicted an increased risk of severe personality disorders, and among men, of dramatic personality disorders. The effects of early parental separation were specific to personality disorders, since they emerged in comparisons to both healthy control participants and to individuals with other mental disorders. These longitudinal study findings strongly support an etiological role for early life, both pre- and postnatal, environmental adversity in the development of severe personality disorders, especially dramatic personality disorders. Vulnerability to severe personality disorders is developmentally programmed in early life.
  • Alastalo, Hanna (Helsingin yliopisto, 2013)
    Experienced stress in childhood might have been so severe that it has effects throughout the life course. It has been suggested that early life stress may extend consequences on psychological and physical well-being. Previous findings focusing upon consequences of early life stress are however limited and mostly based upon retrospective studies. Still little is known about the consequences of early life stress, such as war separation on physical health from a longitudinal aspect. This thesis aimed to study cardiovascular mortality and morbidity in late adulthood among people who experienced separation without their parents to temporary foster care during World War II (WWII). Other study aims were to examine cardiovascular health, blood pressure levels and physical and psychosocial functioning in the separated participants. People who were not separated served as controls. Participants in this study belong to the Helsinki Birth Cohort Study (HBCS) which includes 13,345 people born in Helsinki between 1934 and 1944 and visited child welfare clinics in the city. Of these 13.5% had experienced evacuation abroad. Data on parental separation was obtained from National Archives, and information on use of medication or events on coronary heart disease (CHD), hypertension, stroke and cardiovascular deaths are obtained from national registers during a follow-up period from 1971-2002. Clinical study cohort included 2003 men and women who participated in the detailed clinical examination during the years 2001-2004. All these participants are included the cardiovascular health sub-study and of them 16.0% were separated participants. The blood pressure sub-study consist of 1361 non-obese subjects whose body mass index (BMI) were <30 kg/m2, of whom 14.1% had experienced evacuation abroad. The sub-study of physical and psychosocial functioning included 1803 people and of these separated participants were 14.8%. In all sub-studies the participants who did not experience war separation in childhood served as controls. Among the separated participants over one-third were separated in toddlerhood and approximately duration of separation was two years. The separated group were older and they have lower socioeconomic status in childhood and adulthood than among the non-separated controls. War separation was associated with higher CHD morbidity, the prevalence of cardiovascular disease (CVD) and diabetes. The separation in early childhood and the duration of separation were associated with higher CHD morbidity. Duration of separation over three years showed higher prevalence of CVD in later life. Despite this the evidence of higher hospitalizations and mortality was not found. In addition war separation predicted higher blood pressure levels in late adulthood and moreover increases in the risk of impaired physical functioning. The separation in early childhood was associated with higher blood pressure levels likewise duration in less than a year and over three years. The separation in school age and duration for over two years were associated with the later life lower physical functioning. The effects of separation in overall health were more pronounced among the separated men than women. These studies suggest that early life stress experience such as temporary parental separation may have consequences on cardiovascular health and general well-being through the lifespan. The war separation and its timing and duration are stressors, which could have long-term influence on critical development phases and thereby increases the risk of chronic non-communicable diseases in later life.