Outcome and consequences according to the type of transient loss of consciousness: 1-year follow-up study among primary health care patients.

UNLABELLED: The prognosis of transient loss of consciousness (LOC) was studied in a one-year follow-up survey. Included were adult patients referred by primary health care physicians for a non-acute specialist consultation during the 2-year period from 01.10.1999 to 30.9.2001. The main outcome measures were recurrence of LOCs during the follow-up, fear of recurrence, injuries, and employment. Altogether, 109 consecutive patients were followed and 39 (36%) suffered a recurrence during the one-year follow-up: 17 (30%) with syncope, 16 (43%) with seizure and six (38%) with uncertain type of LOC. The first ever seizure recurred in 5/9 (56%) during the first year, but only 1 of 17 (6%) first syncope attacks. There was no difference in the recurrence rate if the patient had had previous attacks prior to the index LOC. Injuries, mainly minor, were associated with LOCs in 56% of patients. The risk of injury was highest (83%) with alcohol-related seizures. The unemployment rate was especially high in the seizure group. Fear of recurrence was more common at the beginning than at the end of the follow-up. CONCLUSIONS: Seizures recur relatively often, but also recurrent syncope needs more attention--both may cause fear and lead to injuries.

Working capacity and cervical dystonia.

The objective of this questionnaire study was to assess the effect of cervical dystonia on patients' working capacity. Of the 303 working-aged members of the Finnish Dystonia Association (N = 433) who participated in the study 247 (82%) had cervical dystonia. Their median age was 50 years, the median duration of CD symptoms was 12.3 years. Most (78%) subjects were on botulinum toxin treatment. Ninety-seven (39%) had retired because of CD at a median age of 48 years; 96 (39%) of the subjects were working: 87 full-time and 9 part-time. The remaining participants were on sick leave, unemployed, studying or retired of other reasons. Retirement occurred more than ten years earlier compared with the general Finnish population. All possibilities to help CD patients to continue longer in work should be considered early.

Geographical variation of medicated parkinsonism in Finland during 1995 to 2000.

We performed a nation-wide study on geographical variation in the incidence and prevalence of medicated parkinsonism among the Finns aged > or =30 years using Bayesian spatial conditional autoregressive models. Registry of reimbursed medication for parkinsonism and a prescription database of purchase of these drugs were used to identify the study subjects. They were located by the map coordinates of the place of residence and aggregated into regular 100 km(2) grid cells. A total of 7,190 incident and 10,616 prevalent cases were found. The age-adjusted annual incidence was 32.6/100,000 (95% HDR 31.8-33.4) during the years 1995 to 2000 and prevalence was 268/100,000 (95% HDR 263-274) in 2000. The male to female ratio was 1.45 (95% HDR 1.39-1.51) in incidence and 1.54 (95% HDR 1.47-1.61) in prevalence. There was strong evidence for geographic variation in incidence and prevalence. A zone with high incidence and prevalence was identified in the eastern and central part of Finland. There was no evidence for difference in incidence and prevalence between urban and rural areas. The marked (more than two-fold) geographic variation can hardly be caused solely by practices of the registration and collection of data on diagnosis or by methodological issues, but rather suggests to geographic variation in protective and predisposing factors of Parkinsonism in Finland.

Parkinson's disease and working capacity.

The purpose of the present study was to establish how Parkinson's disease (PD) affects working capacity. Altogether, 937 (70%) of 1,343 working-aged members of the Finnish Parkinson Association participated in a questionnaire study. The ages of the subjects were between 29 and 65 years, median 59.0 years; 508 (54%) were men. The median (quartile range) duration of PD symptoms was 7.3 (4.3-11.3) years, and the median self-estimated severity of the disease on the Hoehn & Yahr scale was 2. Only 150 of 937 subjects (16%) were still working: 112 (12%) full-time and 38 (4%) part-time. Among those 343 (37%) who had retired purely because of PD at a median age of 53.4 years, the median working time was 1.7 years after established diagnosis. In part-time work, PD patients had been able to continue for a median of 4.3 years. PD often leads to early retirement; compared with the general Finnish population of similar age, PD patients had retired on the average 6 years earlier. Young age, mild symptoms, and short duration of the disease as well as adjustments enabling easier employment were associated with the possibility to continue longer in the work force.