Summary
Background
Atopic allergy has been more common among schoolchildren in Finland, as compared to Russian Karelia. These adjacent regions show one of the most contrasting socio‐economical ...differences in the world.
Objective
We explored changes in allergy from school age to young adulthood from 2003 to 2010/2012 in these two areas. The skin and nasal microbiota were also compared.
Methods
Randomly selected children from Finnish (n = 98) and Russian Karelia (n = 82) were examined in 2003, when the children were 7–11 years of age, and again in 2010 (Finnish Karelia) and 2012 (Russian Karelia). We analysed self‐reported allergy symptoms and sensitization to common allergens by serum sIgE values. The skin (volar forearm) and nasal mucosa microbiota, collected in 2012 (aged 15–20 years), identified from DNA samples, were compared with multivariate methods.
Results
Asthma, hay fever, atopic eczema, self‐reported rhinitis, as well as atopic sensitization, were threefold to 10‐fold more common in Finland, as compared to Russian Karelia. Hay fever and peanut sensitization were almost non‐existent in Russia. These patterns remained throughout the 10‐year follow‐up. Skin microbiota, as well as bacterial and fungal communities in nasal mucosa, was contrastingly different between the populations, best characterized by the diversity and abundance of genus Acinetobacter; more abundant and diverse in Russia. Overall, diversity was significantly higher among Russian subjects (Pskin < 0.0001, Pnasal‐bacteria < 0.0001 and Pnasal‐fungi < 0.01). Allergic diseases were not associated with microbial diversity in Finnish subjects.
Conclusions and Clinical Relevance
Differences in allergic phenotype, developed in early life, remain between populations. A parallel difference in the composition of skin and nasal microbiota suggests a potential underlying mechanism. Our results also suggest that high abundance and diversity of Acinetobacter might contribute to the low allergy prevalence in Russia. Implications of early‐life exposure to Acinetobacter should be further investigated.
Background
Obesity is a globally growing public health challenge among children. In developed countries, the risk of obesity is commonly higher among lower socioeconomic groups. Measuring ...socioeconomic position (SEP), especially income, is challenging in surveys as self-reported information may suffer from reporting, awareness, recall and non-response bias. Our aim is to utilize official register data on several SEP indicators and measured height and weight of children, to identify the strongest predictors of SEP of the parents on the risk of obesity among the whole 2-17-year-old child population in Finland.
Methods
Data for all children who had visited child health clinic or school health care in 2018 were extracted from the National Outpatient Register on Primary Health Care Services (n = 387623, coverage 40% in 2018). Obesity was defined according to the WHO criteria. SEP indicators were obtained from Statistics Finland for both parents living in the same household with a child. Boosted regression model was used to analyze the contribution of SEP to obesity using training dataset on 155479 non-related children.
Results
The area under the curve for the final model in training dataset was 0.736 and 0.718 in validation dataset. Mother's educational level (12.6% of the total explained variation) and household's disposable income (12.6%) were the SEP indicators that most strongly predicted childhood obesity, whereas the impact of educational level of the father was somewhat smaller (8.1%). The influence of the age of a child was even bigger (39.2%), the prevalence of obesity being highest at 11 and 9 years of age among boys and girls, respectively.
Conclusions
Our results based on official register data from Finland, a Nordic high-income country, endorse earlier findings on higher obesity risk among children with low socio-economic family background. Identification of the SEP related risk factors and support to families are essential in the prevention of childhood obesity.
Key messages
Several family socio-economic factors are reflected in the risk of childhood obesity.
Utilizing objective register data offers a way to tackle many challenges related to self-reported survey data.
Background
Ischemic heart disease (IHD) caused every fourth death in the European region in 2017. Furthermore, it accounted for about 12% of total disease burden estimated with disability adjusted ...life years (DALYs). DALYs summarize premature mortality (years of life lost, YLL) and morbidity (years lived with disease, YLD) in a specific cause. These disease burden estimates are customarily used to examine time trends or differences between countries or regions. However, they have seldom been calculated by socio-economic position (SEP), especially using individual-level SEP indicators.
Methods
We calculated DALYs for the Finnish 30+ year-old population in 2017. For YLL, we used Statistics Finland database for total population. For YLD, we used individual level data from the cross-sectional health examination FinHealth 2017 survey (n = 6538), which was linked with administrative register data. Population attributable fractions (PAFs) for selected IHD risk factors (smoking, blood pressure, total cholesterol and body mass index, BMI) were also calculated. Methodology published by the Global Burden of Disease study, such as disability weights for YLD and relative risks for PAFs, was applied where applicable.
Results
DALYs for IHD per 1000 population were 61.1 for men and 31.0 for women. Premature mortality (YLL) caused over 80% of DALYs. Burden of IHD morbidity (YLD) was higher in low education groups. In the total population, PAFs for IHD risk factors for men and women, respectively, were as follows: 17% and 8% for smoking, 56% and 58% for elevated systolic blood pressure, 25% and 28% for high cholesterol, and 27% and 24% for high BMI.
Conclusions
IHD morbidity was higher among low education groups. A large part of IHD burden was attributable to major cardiovascular risk factors, most markedly to elevated systolic blood pressure. In the future, the burden of disease could be increasingly assessed also by SEP.
Key messages
The burden of IHD in Finland was especially high among men, and majority of the burden was due to premature mortality. Over 50% of the IHD burden was attributed to elevated systolic blood pressure.
Assessing the burden of diseases by socio-economic position provides a new perspective for examining socio-economic differences in health.
Background
In allergic patients, clinical symptoms caused by pollen remind of symptoms triggered by viral respiratory infections, which are also the main cause of asthmatic exacerbations. In patients ...sensitized to birch pollen, Bet v 1 is the major symptom‐causing allergen. Immune mechanisms driving Bet v 1‐related responses of human blood cells have not been fully characterized.
Objective
To characterize the immune response to Bet v 1 in peripheral blood in patients allergic to birch pollen.
Methods
The peripheral blood mononuclear cells of birch‐allergic (n = 24) and non‐allergic (n = 47) adolescents were stimulated ex‐vivo followed by transcriptomic profiling. Systems‐biology approaches were employed to decipher disease‐relevant gene networks and deconvolution of associated cell populations.
Results
Solely in birch‐allergic patients, co‐expression analysis revealed activation of networks of innate immunity and antiviral signalling as the immediate response to Bet v 1 stimulation. Toll‐like receptors and signal transducer transcription were the main drivers of gene expression patterns. Macrophages and dendritic cells were the main cell subsets responding to Bet v 1.
Conclusions and clinical relevance
In birch‐pollen‐allergic patients, the activated innate immune networks seem to be, in part, the same as those activated during viral infections. This tendency of the immune system to read pollens as viruses may provide new insight to allergy prevention and treatment.
Systems immunology study to characterize the impact of bet v 1 stimulation of peripheral blood mononuclear cells (PBMC) of birch‐allergic and non‐birch allergic children and adolescent. Utilizing transcriptomics and FACS analysis, co‐expression networks revealed innate and antiviral immune networks as well as associated immune cells in birch‐allergic patients. bet v 1 – major birch allergen; PBMC – peripheral blood mononuclear cells, FACS – fluorescence activated cell sorting
Abstract
Background
Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease (CVD) risk factors is crucial for planning public health policy and future prevention ...strategies. We aimed at examining 1) the co-occurrence of smoking, hypertension, elevated cholesterol and obesity by education, and 2) the trends in educational differences in the co-occurrence of these risk factors in Finland.
Methods
We used cross-sectional health examination surveys carried out every five years among the general adult population: for 1997-2012 the National FINRISK Study and for 2017 the FinHealth 2017 Survey. Respondents aged 25-64 years were included in the analyses (n = 25,036). Current smoking, obesity (BMI≥30 kg/m2), hypertension (≥140/≥90 mmHg or medication) and elevated serum total cholesterol (≥5.0 mmol/l or medication) were used for the risk factor accumulation score with categories 1) zero, 2) one, 3) two, and 4) three or four elevated risk factors. Multinomial logistic regression was used to estimate predicted probabilities for each category.
Results
Overall, the risk factor score was more favourable among women than men, and among high education groups than low education groups in both sexes. The lowest risk factor score class became more prevalent in all education groups in both sexes over time. The change in educational differences was not significant. However, the intermediate education group approached the highest education group over time.
Conclusions
Our data indicate an overall transition towards a more favourable risk factor score in Finland, in 1997-2017. The score among the intermediate education group approached that among the highest education group. The tendency of risk factor accumulation among those with least education remained during the study period, which raises a need to develop and implement interventions and public health policies that would be effective in decreasing the risk factor burden particularly in this group.
Key messages
Overall, a favourable trend of diminishing risk factor prevalence was seen.
The tendency of accumulation of major CVD risk factors among the least educated subjects remained from 1997 to 2017.
Background
After the Second World War, the population living in the Karelian region was strictly divided by the “iron curtain” between Finland and Russia. This resulted in different lifestyle, ...standard of living, and exposure to the environment. Allergic manifestations and sensitization to common allergens have been much more common on the Finnish compared to the Russian side.
Objective
The remarkable allergy disparity in the Finnish and Russian Karelia calls for immunological explanations.
Methods
Young people, aged 15‐20 years, in the Finnish (n = 69) and Russian (n = 75) Karelia were studied. The impact of genetic variation on the phenotype was studied by a genome‐wide association analysis. Differences in gene expression (transcriptome) were explored from the blood mononuclear cells (PBMC) and related to skin and nasal epithelium microbiota and sensitization.
Results
The genotype differences between the Finnish and Russian populations did not explain the allergy gap. The network of gene expression and skin and nasal microbiota was richer and more diverse in the Russian subjects. When the function of 261 differentially expressed genes was explored, innate immunity pathways were suppressed among Russians compared to Finns. Differences in the gene expression paralleled the microbiota disparity. High Acinetobacter abundance in Russians correlated with suppression of innate immune response. High‐total IgE was associated with enhanced anti‐viral response in the Finnish but not in the Russian subjects.
Conclusions and clinical relevance
Young populations living in the Finnish and Russian Karelia show marked differences in genome‐wide gene expression and host contrasting skin and nasal epithelium microbiota. The rich gene‐microbe network in Russians seems to result in a better‐balanced innate immunity and associates with low allergy prevalence.
Background
Metabolic syndrome (MetS) is an increasing population health threat in Europe. Several MetS definitions are available. Our aim was to compare four different MetS definitions among Finnish ...adults, to assess their agreement and to evaluate the impact of the choice of the definition on the prevalence of MetS.
Methods
Data from FinHealth 2017, a cross-sectional population health survey, focusing on adults over 25 years were applied in the analysis (n = 5667). Measured data on anthropometrics, blood pressure, biomarkers and questionnaire data were used to classify the participants according to the definitions. The definitions chosen for the comparison were those by the World Health Organization (1998), National Cholesterol Education Program Adult Treatment Panel III (2004), International Diabetes Federation (2005) and Joint Interim Statement (2009).
Results
The four MetS definitions resulted in substantially different MetS prevalences among the Finnish adult population: 18% by WHO, 32% by NCEP-ATP III, 43% by IDF and 46% by JIS. Among all participants, only 13.5% were identified to have MetS according to all four definitions. The component of the definitions with highest prevalence was elevated blood pressure among men and central obesity among women. Prevalence of Mets increased with age; especially steeply among the youngest age groups. Due to varying cut-off points the prevalence of different components varied between the definitions. The agreement, estimated with kappa coefficients, ranged from 0.38 (WHO vs. IDF and WHO vs. JIS) to 0.95 (IDF vs. JIS).
Conclusions
The differences between observed MetS prevalences using the four different definitions were large. For cross-country comparisons as well as for trend analyses within a country, it is essential to use the same definition of MetS to avoid possible bias due to differences in used definitions as well as to use standardized measurement protocols in measuring different components of MetS.
Key messages
It is important to use standardized measurement protocols during data collection to achieve comparable data.
For cross-country comparisons as well as for trend analyses within countries, it is essential to use identical MetS definitions to avoid possible biases.
Background: Women's diets are healthier than men's. Finnish women eat more fruits and vegetables but less meat than men. Gender differences may be larger in the Baltic countries, which represent ...Eastern European transition societies than in Finland, a society characterized by the Scandinavian welfare ideology and a high degree of gender equality. Methods: The data are based on questionnaires to random samples of adults in Finland, Estonia, Latvia and Lithuania. The data provide a way of addressing gender differences at the turn of the century in the economically and culturally different countries. The purpose is to explore whether the consumption of foods classified as masculine or feminine—meat, fruits and vegetables—follow a similar gender pattern in Finland and the Baltic countries. Results: Men ate meat more often while women ate fruits and vegetables. A high educational level was associated with frequent consumption of fruits and vegetables. Educational differences in the consumption of meat were few and inconsistent. The consumption of fruits and vegetables was more common in urban areas except in Finland. Gender differences were similar in all countries throughout age and educational groups and in rural and urban areas. Conclusion: The consistent association of gender and food and the similarity of gender patterning in population subgroups point to the stability of masculine versus feminine food habits. The similarity suggests that food habits contribute equally to the gender gap in health in the Baltic countries as they do in Finland.
Contact with natural environments enriches the human microbiome, promotes immune balance and protects against allergies and inflammatory disorders. In Finland, the allergy & asthma epidemic became ...slowly visible in mid 1960s. After the World War II, Karelia was split into Finnish and Soviet Union (now Russia) territories. This led to more marked environmental and lifestyle changes in the Finnish compared with Russian Karelia.
showed that allergic conditions were much more common on the Finnish side. The Russians had richer gene-microbe network and interaction than the Finns, which associated with better balanced immune regulatory circuits and lower allergy prevalence. In the Finnish adolescents, a biodiverse natural environment around the homes associated with lower occurrence of allergies. Overall, the plausible explanation of the allergy disparity was the prominent change in environment and lifestyle in the Finnish Karelia from 1940s to 1980s. The nationwide
implemented the biodiversity hypothesis into practice by endorsing immune tolerance, nature contacts, and allergy health with favorable results. A regional health and environment programme,
, has been initiated in the City of Lahti, EU Green Capital 2021. The programme integrates prevention of chronic diseases (asthma, diabetes, obesity, depression), nature loss, and climate crisis in the spirit of
. Allergic diseases exemplify inappropriate immunological responses to natural environment. Successful management of the epidemics of allergy and other non-communicable diseases may pave the way to improve human and environmental health.
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