Markku Sumanen

Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease

Background Studies suggest that childhood adversities are important determinants of various types of later illnesses as well as poor health behaviour. However, few large-scale prospective studies have examined the associations between childhood adversities and cardiovascular disease. Objective To investigate whether childhood adversities are associated with increased risk of incident cardiovascular disease Design and setting Participants were 23 916 men and women in four age groups (20–24, 30–34, 40–44, and 50–54 years) from the Health and Social Support study, a longitudinal study on a random sample representative of the Finnish population. Data from national health registers on coronary heart disease and cerebrovascular disease during a mean follow-up of 6.9 years were linked to survey responses on childhood adversities. Cox proportional hazard models were adjusted for age group and potential mediators (education, health risk behaviours, diabetes and depression). Results There was a significant linear trend between the number of childhood adversities and disease end points in women. The risk of incident cardiovascular disease was threefold among women exposed concurrently to three types of childhood adversities (financial difficulties, interpersonal conflicts and longstanding illness of a family member). Among men, increased risk was observed only among those with longstanding illness of a family member (HR=1.44; 95% CI 1.06 to 1.96). Conclusions In this prospective population-based sample, childhood adversities were associated with a significantly increased risk of objectively verified cardiovascular disease, especially among women but to a lesser extent among men. More studies with prospective settings are needed to confirm the association and possible mechanisms.

Childhood adversities, adulthood life events and depression

BACKGROUND The role of childhood adversities in predicting adulthood depression has been suggested to be complex and in need of additional comprehensive studies. AIMS This investigation set out to examine whether increased exposure to life events (LEs) in adulthood mediates the association between childhood adversities and adulthood depression. METHODS This study is based on a random health survey sample from the Finnish working-aged population (n=16,877) with a follow-up of up to 7 years. Depression was identified by Beck Depression Inventory, records of antidepressant prescriptions and hospitalization due to depression obtained from national health registers. RESULTS Childhood adversities were associated with an increased likelihood of experiencing a high number of LEs in adulthood and their perceived burdensomeness. The mean number of new LEs correlated significantly (P<0.001) in a dose-response relationship with the number of childhood adversities. Reporting childhood adversities was associated with a 1.28-2.70-fold increase in the odds of depression as indicated by BDI score, a 1.29-1.94-fold increase in the rate of antidepressant prescriptions and a 1.17-4.04-fold increase in the risk of hospitalization due to depression. Adjustment for new LE attenuated these associations by 21-24%, but did not render them insignificant. CONCLUSIONS Increased exposure to adult negative life events proximal to adult depression may partially explain the association between childhood adversities and adult depression.

Non-response in a nationwide follow-up postal survey in Finland: a register-based mortality analysis of respondents and non-respondents of the Health and Social Support (HeSSup) Study

Objective To examine difference in mortality between postal survey non-respondents and respondents. Design A prospective cohort study with baseline survey in 1998 and comprehensive linkage to national mortality registers until 2005, the Health and Social Support study. Setting A population-based postal survey of the working-aged population in Finland in 1998. Participants The original random sample comprised 64 797 working-aged individuals in Finland (20–24, 30–34, 40–44, 50–54 years of age; 32 059 women and 32 716 men), yielding 25 898 (40.0%) responses in the baseline postal survey in 1998. Primary outcome measure Registry-based primary causes of death encoded with the International Classification of Diseases (ICD-10). Results In women, HR for total mortality was 1.75 (95% CI 1.40 to 2.19) times higher among the non-respondents compared with the respondents. In men, non-response was associated with a 1.41-fold (1.21–1.65) excess risk of total mortality. Non-response associated in certain age groups with deaths due to diseases in women and with deaths due to external causes in men. The most prominent excess mortality was seen for total mortality for both genders and for mortality due to external causes among men. Conclusions Postal surveys result in slight underestimation of illness prevalence.

Good pregnancy outcome despite intrahepatic cholestasis.

Abstract Objective. Pregnant women complaining of itching are screened for intrahepatic cholestasis (ICP) by laboratory tests in primary healthcare. Cases of ICP are referred to specialist care. In Finland, ICP occurs in 1% of pregnancies. The aim was to study the outcome of deliveries. Design. Retrospective study of ICP pregnancies. Data were collected from the hospital discharge register, patient records, and the labour register. Setting. The region of Tampere University Hospital in Finland. Subjects. Altogether 687 ICP cases from 1969 to 1988 and two controls for each. Main outcome measures. ICP patients were compared with controls in terms of mothers age, pregnancy multiplicity, weeks of gestation at delivery, frequency of induction and Caesarean section, length of ward period, childs weight, Apgar scores, and stillbirth. Results. For ICP patients, the risk for hospital stay of 10 days or more was eightfold (OR 8.41), for gestational weeks less than 37 at delivery sevenfold (OR 7.02), for induction threefold (OR 3.26), for babys low weight at birth almost twofold (OR 1.86), and for Caesarean section one and a half fold (OR 1.47). The possibility of the incidence of multiple pregnancy was two and a half fold (OR 2.49, 95%). ICP was not associated with mothers age, the babys risk of stillbirth, or low Apgar scores. Conclusion. ICP mothers are found and taken care of appropriately, and thus ICP is only a minor risk for mothers and their children.

Health history after intrahepatic cholestasis of pregnancy

Objective. To establish whether intrahepatic cholestasis of pregnancy (ICP) is associated with other diseases during a womans lifetime. Design. Prospective controlled cohort study. Setting. University Hospital in Finland. Population. A total of 575 women with ICP and 1374 control women, all having delivered in 1969–1988. Questionnaires were sent to 544 ICP patients and 1235 control women. Responses were received from 1178 (66.4%). Methods. Questionnaire survey in autumn 2010. Main outcome measures. Perceived health, symptoms and complaints, diseases diagnosed by a doctor and use of medicines. Results. No statistically significant differences were detected in perceived health. Differences in recent symptoms and complaints were small. Diagnoses made by a doctor showed higher frequencies in the ICP group than in control women for other hepatobiliary diseases, breast cancer and hypothyreosis. Diagnosed hypertension and high cholesterol requiring medication as well as cardiac arrhythmia were less frequent in the ICP group. Women in this group used antacid medicines more often than control women. Conclusions. There were few differences between the ICP patients and control women except for a higher frequency of later hepatobiliary disease, breast cancer and hypothyreosis. Women with a history of ICP should be screened for hypothyreosis more readily than those without. The higher frequency of breast cancer warrants further research.

Occurrence of symptoms and depressive mood among working-aged coronary heart disease patients

BackgroundThe typical symptoms of coronary heart disease (CHD), chest pain and breathlessness, are well-known. They are considered quite dramatic, and can thus be fairly reliably mapped by a survey. However, people might have other clearly unpleasant symptoms impairing quality of life. The aim of this study is to evaluate the appearance of these complaints of working-aged people with self-reported CHD.MethodsThe study consists of a postal questionnaire of randomly selected Finns in age groups 30–34, 40–44 and 50–54, a response rate of 39% (N = 15,477). The subjects were asked whether or not a doctor had told them that they had angina pectoris or had had myocardial infarction. Four randomly selected age and sex matched controls were chosen for every patient. The occurrence of self-reported dyspnoea, chest pain during anger or other kind of emotion, palpitation and perspiration without physical exercise, irregular heartbeats, flushing, trembling of hands and voice, jerking of muscles, depression and day-time sleepiness were examined. Odds ratios (OR) with 95% confidence intervals (CI), between occurrence of symptoms and CHD with and without heart infarction, were computed by multivariate logistic regression analysis.ResultsThe sample eventually comprised 319 CHD patients. Dyspnoea, chest pain during anger or other kind of emotion, palpitation, perspiration without physical exercise, irregular heartbeats daily or almost daily, trembling of hands and voice, and jerking of muscles occurred statistically significantly more frequently among CHD patients than among controls. The CHD patients also reported more depressive mood according to Becks inventory scores and poorer sleep and more frequent day-time sleepiness than controls. In the multivariate logistic regression analysis chest pain during anger or other kind of emotion (ORs 4.12 and 3.61) and dyspnoea (ORs 2.33 and 3.81) were the symptoms most associated with CHD.ConclusionsWorking-aged people with self-reported coronary heart disease evince a number of symptoms limiting the quality of their every day life. This aspect should be paid attention to when evaluating functional capacity of these patients.

Prescription patterns in preventive and abortive migraine medication

Background: Migraine is considered a common but under-diagnosed and untreated condition. Treatment patterns have pointed at frequent over-the-counter medication use and low use of preventive therapies. Studies exploring migraine prescription practice among doctors are few. Methods: A population-based study was carried out to examine the prescription practice in the use of acute and preventive migraine medications. The data covered 4864 working-age people reporting they have been diagnosed with migraine. Data on reimbursed prescription medicines from 1 January 1998 to 31 December 2006 were drawn from the registers of the Social Insurance Institute of Finland and compared with age- and sex-matched controls. Results: Anti-inflammatory analgesics were prescribed for 71% of female and 62% of male migraine patients vs. 56% and 50% of controls. Triptans were prescribed for 21% of female and 10% of male patients. Combinations of analgesics and muscle relaxants were offered to 37% of female and 29% of male patients vs. 26% and 21% of controls, and antidepressants to 19% of women and 14% of men vs. 13% and 9% of controls. Conclusion: Although use of preventive medication among migraineurs was high, the prescription patterns in acute treatments showed that NSAIDS were used more often than triptans. Assimilation of national guidelines to treat migraine published in 2002 in Finland was not reflected in the prescription patterns up to 2006.

Cancer in working-age is not associated with childhood adversities

Abstract Background. Early life events are studied as potential causes of cancer. The objective here was to study childhood adversities in the etiology of cancer. Methods. The material comprised a population based random sample of 25 898 individuals among the Finnish working-aged population. In 1998 they were requested through six questions in a postal questionnaire to recall their childhood adversities. The cases consisted of people with cancer diagnosed 2000–2006 and registered in the Finnish Cancer Registry (n = 384). The rest of the sample consisted of cancer-free controls. Results. The most common adversities were prolonged financial difficulties, serious conflicts in the family and someone in the family having been seriously or chronically ill. The cancer patients reported more prolonged financial difficulties and someone seriously or chronically ill in the family. They reported less parental divorce than the controls. The associations were not statistically significant after adjusting for age, sex, education, and health behaviour. Nor was there a significant difference in the total number of childhood adversities between the study group and the controls. Conclusion. On the whole, these cancer patients had not experienced more childhood adversities than the controls. According to our findings, there is no cause to attribute development of cancer in working age to childhood adversities. This information may also give relief to other family members.

Gender differences in sex life issues – A population-based study of migraine sufferers

BackgroundMigraine is considered to have a negative influence on sex life. The present study was to analyse the perceptions of importance of and satisfaction with sex life as well as the expression of interest in sex among people having migraines in a prospective follow-up mail survey in 1998 and 2003.MethodsThe random sample was stratified according to gender and age in four age groups (20–24, 30–34, 40–44, and 50–54 years). Altogether 25 898 individuals responded to the baseline and 19 626 to the follow-up questionnaire (75.8% response rate). We examined as to how the perceptions of sex life of those suffering from migraine changed during a 5-year follow-up. Conditional logistic regression was used to analyse the data of the responses on self-reported migraine in the baseline and follow-up surveys (N = 2 977, 79.2% women). Each person with migraine was assigned a gender- and age-matched control in the analysis.ResultsAll three outcome variables tended to decrease in value. Importance of sex life was higher among men with migraine than among their controls. Among women migraine lessened interest in sex life.ConclusionOur findings suggested that migraine has a different impact on sex life among women from that among men.

Exercise treadmill test may predict clinical outcome among working-aged patients suspected of coronary heart disease in general practice

Objective To specify the diagnostic value of treadmill tests conducted in primary health care by trained GPs for working-aged patients. Design A two-year follow-up study. Setting Kangasala Health Centre, Finland. Subjects All patients under the age of 60 (n=348) examined by exercise treadmill test carried out by trained GPs during a period of three years. Main outcome measures The number of patients having a diagnosis of coronary heart disease at the end of two years’ follow-up. Predictive values of the exercise test. Results During the two years’ follow-up period CHD was diagnosed in six of the patients who did not yield a positive finding in the test. A negative finding in the test was very reliable; coronary heart disease manifested in only 2% of these cases. Almost half of the patients yielding a positive finding ended up having coronary angiography and 1 in 10 underwent coronary bypass surgery. Conclusion Among working-aged patients suspected of coronary heart disease an exercise treadmill test may predict clinical outcome in general practice.