Psychological recovery and well-being of spouses of patients with prostate cancer 5 years after primary treatment in Finland: a follow-up survey.

OBJECTIVE AND SETTING: To study longitudinally cancer-related experiences of spouses of patients with prostate cancer and the predictors of their psychological recovery and quality of life (QOL) by following the participants of our previous survey at primary cancer treatment in a university hospital. DESIGN: A 5-year longitudinal cohort design. PARTICIPANTS AND PROCEDURE: A follow-up questionnaire was mailed to the female spouses/partners who participated in our previous survey (n=104). We quantitatively explored the spouses' prostate cancer-related experiences since the previous survey and measured their current psychological symptom distress and well-being/QOL. Seventy-seven (74%) of the initial participants responded. OUTCOMES: The main outcome measures were the spouses' psychological recovery (psychological symptoms at the initial survey vs currently) and well-being/QOL (depressive symptoms, domains of QOL) at 5 years. We analysed their predictors with regression analyses. RESULTS: The treatment had been prostatectomy in 70% of the patients. Psychological distress had alleviated in 76% of spouses (p<0.001) and emotional changes decreased (p=0.02), but a deteriorating impact on the partnership (from 4% to 16%) and on sex life ('strong impact' from 23% to 37%) had increased. The outcomes were inversely associated with negative depression-related psychological symptoms and emotional changes either initially or at follow-up. However, some early experiences also predicted the outcomes when other factors were controlled for. Prostate cancer-related information received by the spouses from several sources (leaflets/handouts, TV/radio, internet) predicted better recovery and well-being/QOL, whereas the patients' prostate cancer and treatment-related symptoms (pain, irritability/anger, bowel dysfunction) predicted poorer recovery and well-being/QOL in spouses. CONCLUSIONS: A major negative impact of prostate cancer was experienced by the spouses still 5 years after primary treatment. Early prostate cancer-related experiences predicted long-term psychological recovery and QOL. Responding to the early information needs of spouses and effective symptom management for the patients are likely to enhance the spouses' long-term recovery and well-being.

Does sauna bathing protect against dementia?

Repeated heat exposure like sauna bathing is suggested to beneficially affect against dementia development. The epidemiological evidence is, however, scarce. Therefore, we studied the association between heat exposure during sauna bathing (i.e., the frequency of sauna bathing, frequency of heat sessions, length of stay in heat, sauna temperature) and the subsequent risk of dementia. A prospective cohort study was conducted based on 13,994 men and women aged 30-69 and free from dementia diagnosis from the Finnish Mobile Clinic Follow-up Survey. During a follow-up of 39 years, a total of 1805 dementia patients were diagnosed. The sauna bathing data was gathered from a questionnaire. Analyses based on the Cox model included the sauna bathing variables and the potential confounding factors. Sauna bathing frequency was related to a reduced risk of dementia after adjustment for the potential sociodemographic, lifestyle, and metabolic risk factors of dementia considered. The hazard ratio of dementia between individuals sauna bathing 9-12 times per month in comparison with those not sauna bathing or sauna bathing less than four times per month was 0.47 (95% CI = 0.25-0.88) during the first 20 years of follow-up and 0.81 (95% CI = 0.69-0.97) during the whole follow-up. The results are in line with the hypothesis that sauna bathing provides protection against dementia. Further studies are required to verify the suggested benefits of sauna bathing.

Work-related risk factors for sciatica leading to hospitalization.

The aim of this study was to assess the effects of the general strenuousness of work and various physical exposures on the risk of hospitalization for sciatica. The study population consisted of Finns aged 30 to 59 who had participated in a national health examination survey in 1978-80 (N = 3891). The participants were followed up until the end of 2011 and information on work-related determinants was acquired by a questionnaire. After adjustment for confounders, sedentary work involving handling fairly heavy objects/physically light work (HR 1.57; 95% CI 1.05-2.34), lifting or carrying heavy objects (2.10; 1.35-3.26) and exposure to whole-body vibration (1.61; 0.95-2.72) predicted sciatica, whereas heavier workloads appeared to reduce its risk (0.48; 0.26-0.89). There was an interaction between body mass index and exposure to whole-body vibration for the risk of sciatica. Overweight (1.94; 0.96-3.93) and obese (3.50; 1.44-8.46) participants exposed to whole-body vibration were at an increased risk of sciatica. Individuals of normal weight who were exposed to vibration, and overweight and obese individuals who were not exposed to vibration were not at an increased risk. The risk of hospitalization for sciatica seems to be highest among obese individuals exposed to whole-body vibration and among those lifting or carrying heavy objects.

Projecting long-term trends in mobility limitations: impact of excess weight, smoking and physical inactivity.

BACKGROUND: Policy makers need disability projections for planning adequate services and measures for health promotion. The aim of this study is to provide projections on severe mobility limitations up to year 2044 and illustrate how the projected prevalence and the number of persons with severe mobility limitations are affected by potential changes in the modifiable risk factors, namely excess weight, physical inactivity and smoking. METHODS: We analysed the nationally representative, repeated measures Health 2000 and 2011 Surveys (BRIF8901) with 8615 and 6740 participants, respectively, aged 18 years and older. Severe mobility limitations were defined as major difficulties or unable to walk about half a kilometre. We applied a multistate model on repeated measures to account for both individual risk factors and their changes over time. RESULTS: The number of people with severe mobility limitations was projected to double by the year 2044 in Finland, due to the rapid ageing of the population. Eliminating half of the excess weight would reduce their number by one-fifth, while reductions in the prevalence of smoking and physical inactivity would have a minor impact. Even if excess weight, smoking and physical inactivity were completely eliminated, the number of persons with severe mobility limitations is projected to increase. CONCLUSIONS: Designing and implementing strategies to promote healthy weight are important to slow down the rapid increase in mobility limitations due to population ageing. Providing adequate health and social services for the increasing population with disabilities will nevertheless be an increasing national challenge.

Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer.

PURPOSE: The constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer. METHODS: A consecutive sample of patients with localized prostate cancer (T1-3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death. RESULTS: After controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time. CONCLUSIONS: Higher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.

Experiences and psychological distress of spouses of prostate cancer patients at time of diagnosis and primary treatment.

We studied experiences and psychological distress of partners of prostate cancer patients at the time of diagnosis and primary treatment and investigated associates of their psychological wellbeing and the emotional social support they give to and receive from the patient. Using a quantitative questionnaire we studied the spouses' experiences (psychological response and sources of information and emotional support at diagnosis; impacts of prostate cancer on partnership and sex life; impact of side effects of treatment) and the emotional support given and received, and measured their psychological symptom distress. Many spouses reported distressing experiences and all psychological symptoms. Two thirds perceived no impact of the cancer on the partnership while 29% no change in sex life. Distress was associated with a shock, fear of the man's death and impact of side effects, whereas emotional support from a doctor predicted less distress. More support given to the patient was associated with information and emotional support received from a doctor and the patient's sexual dysfunction and pain, and less with experiences of depression, no impact on the partnership and the patient's irritableness. The spouses' distress was relieved by emotional support from a doctor, which along with received information also enhanced their capability to support the patient.

Risk factors for first hospitalization due to meniscal lesions - a population-based cohort study with 30 years of follow-up.

BACKGROUND: Meniscal lesions are among the most common injuries of the knee, yet limited epidemiologic data is available on their risk factors. We investigated the association of lifestyle factors and physical strenuousness of work on knee injuries with a focus on meniscal lesions. METHODS: We examined a nationally representative sample of persons aged 30 to 59 years, who participated in a comprehensive health examination (the Mini-Finland Health Survey). Subjects without any injury or osteoarthritis in the knee joint at baseline (n = 4713) were subsequently followed via the National Hospital Discharge Register up to 30 years. RESULTS: During the follow-up, 338 knee injuries were identified of which 224 were meniscal lesions. Obesity and regular leisure time physical exercise were associated with an increased risk of first hospitalization due to meniscal lesions (hazard ratio (HR) 1.62 and 95% confidence interval (CI) 1.06-2.48 and 1.53, 95% CI 1.05-2.23, respectively). The types of sports predicting the highest risk of meniscal lesions were ballgames, gymnastics and jogging. Physical strenuousness of work did not predict meniscal lesion. The hazard of other knee injury was increased among those reporting irregular or regular physical exercise at baseline (HR 1.64, 95% CI 1.03-2.64 and 1.88 CI 1.05-2.36, respectively). Smoking or alcohol intake were not associated with knee injuries. CONCLUSIONS: Better safety measures in high-risk sports and weight control would likely improve the prevention of meniscal lesions in populations.

International Differences in the Risk of Death from Smoking and Obesity: The Case of the United States and Finland.

Despite much interest in the health risks associated with behavioral factors, little is known about whether individuals residing in different countries experience a different set of risks. International comparisons of the death risks from major behavioral factors can shed light on whether features of health systems and epidemiological histories modify the health effects of risky behaviors. We used nationally representative samples and mortality linkages spanning the 1971-2014 period from the United States and Finland to examine cross-national differences in the risks of death from cigarette smoking and obesity. We evaluated both current and former smoking and current and prior obesity. In 1990, the approximate midpoint of our study, the death risks from current smoking were about 55% higher in U.S. women compared to Finnish women, but similar for men in the two countries. Death risks from smoking significantly increased over the period for women in both countries and there was no parallel increase in risks among men. Death risks from obesity did not significantly differ in the two countries and no significant trend in the risks were detected in either country. Reasons for the relatively high and increasing risks from smoking among American women warrant further evaluation.

Patients' perceptions of the negative effects following different prostate cancer treatments and the impact on psychological well-being: a nationwide survey.

BACKGROUND: Although the prognosis of localised prostate cancer is good, the negative effects of prostate cancer treatment often impair patient quality of life. A growing number of men experience these negative effects over a longer time because of the increased incidence of and prolonged survival in prostate cancer, and the ageing of the population. Only a few studies have investigated the adverse effects of different prostate cancer treatments using large population-based samples. METHODS: We conducted a nationwide survey (n=1239) to collect detailed information regarding the negative effects (i.e., the occurrence, perceived level and perceived bother since the beginning of the treatment) of prostate cancer treatments: radical prostatectomy, external beam radiotherapy, brachytherapy, hormone therapy and surveillance. Furthermore, we measured patient satisfaction with the outcome of the treatment and their psychological well-being (i.e., psychological symptoms and satisfaction with life) 5 years after diagnosis. The negative effects between the treatments were compared, and the determinants of satisfaction and psychological well-being were investigated. RESULTS: The negative effects of all types of active prostate cancer treatments were common and persistent (33-48% reported symptoms at 5 years) and showed the known differences between the treatments. Prostatectomy and the radiotherapies caused urinary leakage; radiotherapy also caused symptoms of urinary irritation; and external radiation also caused bowel dysfunction. Most symptoms were considered highly bothersome. Most respondents (81-93%) reported that their treatment negatively affected their sex lives; 70-92% reported sexual dysfunction; and 20-58% reported that their sex lives with their spouses had ended. Urinary symptoms were especially associated with poorer psychological outcomes. The perception of symptom level and bother had a greater effect on patient satisfaction and well-being than the symptoms per se. CONCLUSION: Multiple and persistent negative effects follow active prostate cancer treatment, and these effects predict long-term patient satisfaction and psychological well-being. The harms and benefits associated with prostate cancer treatments should be considered when selecting whether and how to actively treat prostate cancer.

Income-related inequality in perceived oral health among adult Finns before and after a major dental subsidization reform.

Objectives In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. The aim of this study was to investigate income-related inequality in the perceived oral health and its determinants among adult Finns before and after the reform. Materials and methods Three identical cross-sectional nationally representative postal surveys, concerning perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2157), in 2004 (n = 1814) and in 2007 (n = 1671). Three measures of perceived oral health were used: toothache or oral discomfort during the past 12 months, current need for dental care and self-reported oral health status. Concentration index was used to analyse the income-related inequalities. Its decomposition was used to study factors related to the inequalities. Results The proportion of respondents reporting need for dental care decreased from 2001 to 2007, while no changes were seen in reports of toothache or self-reported oral health status. Income-related inequalities in reports of toothache and perceived need for care widened, while the inequality in self-reported oral health remained stable. Most of the inequalities were related to income itself, perceived general health and the time since the last visit to dental care. Conclusions It seems that the income-related inequalities in perceived oral health remained or even widened after the reform.

Inequality in oral health-related quality of life before and after a major subsidization reform.

In Finland, a dental subsidization reform, implemented in 2001-2002, abolished age restrictions on subsidized dental care. We investigated income-related inequality in oral health-related quality of life (OHRQoL) and its determinants among adult Finns before and after the reform. Three cross-sectional postal surveys, focusing on perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2,046), 2004 (n = 1,728), and 2007 (n = 1,560). Five measures, based on the Oral Health Impact Profile-14, were used as indicators of OHRQoL. Income-related inequality and associated factors were analysed using the concentration index and its decomposition. Prevalence, extent, and severity of oral health impacts were slightly lower in 2007 than in 2001. The oral health impacts were concentrated, at all study time points, among individuals with lower income. Most of the inequality was related to self-perceived general health, tooth loss, and income. Contributions of time since the last dental visit and satisfaction with the last treatment period to the inequality decreased from 2001 to 2007. However, the contributions of these factors were already small (10-20%) in 2001. In general, OHRQoL improved slightly; however, no clear or dramatic change in inequality in OHRQoL was seen after the reform.

Social, lifestyle and demographic inequalities in hypertension care.

AIMS: Recent nationwide in-depth analyses on inequalities in hypertension prevalence and care are scarce. This study assessed sociodemographic and lifestyle factors associated with the prevalence, awareness, treatment and control of hypertension in Finland. METHODS: A representative nationwide sample (participation rate 58%) of the Finnish adult population underwent a health examination and interview in 2011. After excluding participants with missing data, 4230 people were included in the analyses. Weighted regression modelling was used to explore the associations of sociodemographic and lifestyle factors with the prevalence, awareness, treatment and control of hypertension. RESULTS: The prevalence, awareness, treatment and control rates of hypertension (blood pressure ⩾140/90 mmHg or antihypertensive medication) in Finland were 47%, 57%, 51% and 48%, respectively. Older age, male sex, lower education, retirement, higher BMI, never-smoking and heavy alcohol use were associated with a higher prevalence of hypertension (p<0.05). In contrast, younger age, non-retirement, lower BMI, smoking and high physical activity were associated with lower awareness and treatment rates (p<0.05). In addition, male sex was associated with lower awareness rates (p<0.01). Hypertension control was better in younger participants (p<0.05). CONCLUSIONS: In addition to high prevalence and moderate treatment rates of hypertension, serious sociodemographic and lifestyle inequities in hypertension care exist in Finland. Hypertension is more prevalent in older people of lower socio-economic status with adverse lifestyles. However, hypertension is more often unrecognised and untreated among people with low risk of hypertension.

Income-related inequality and inequity in the use of dental services in Finland after a major subsidization reform.

OBJECTIVES: In Finland, a major oral healthcare reform (OHCR), implemented during 2001-2002, opened the public dental services (PDS) and extended subsidies for private dental services to entire adult population. Before the reform, adults born earlier than 1956 were not entitled to use PDS nor did they receive any reimbursements for their private dental costs. We aimed to examine changes in the income-related inequality and inequity in the use of dental services among the adult Finns after the reform. METHODS: Representative data from Finnish adults born in 1970 or earlier were gathered from three identical postal surveys concerning the use of dental services and subjective perceptions of oral health. Those surveys were conducted before the OHCR in 2001 (n = 1907) and after the OHCR in 2004 (n = 1629) and 2007 (n = 1509). We used concentration index and its decomposition to analyse income-related inequality and inequity in the use of dental services and factors associated with them. RESULTS: Results showed that pro-rich inequality and inequity in the overall use of dental services narrowed from 2001 to 2004. However, between 2004 and 2007, pro-rich inequality and inequity widened, so it returned to a rather similar level in 2007 as it had been in 2001. Most of the pro-rich inequality and inequity were related to regular dental visiting habit and income level. While there was pro-poor inequality and inequity in the use of PDS, there was pro-rich inequality and inequity in the use of private dental services throughout the study years. CONCLUSION: It seems that income-related inequality and inequity in the use of dental services narrowed only temporarily after the reform.

The role of behaviour in inequality in increments of dental caries among Finnish adults.

BACKGROUND: Evidence from cross-sectional studies implies that dental behaviours partially explain inequalities in oral health. OBJECTIVE: To assess whether dental behaviours completely eliminate inequality in increments of dental caries in a sample of Finnish adults. METHODS: The baseline data were collected from the Health 2000 survey, a nationally representative survey of 8,028 individuals aged 30 years or older living in mainland Finland. Four years later, 1,248 subjects were invited for oral re-examination, and 1,049 agreed to participate (84% response rate). At baseline, participants provided information on demographics, education and dental behaviours (dental attendance, tooth brushing with fluoride toothpaste, sugar consumption and daily smoking). Oral examinations at baseline and follow-up were identical. RESULTS: Adults with basic education had significantly greater increments of DMFT (incidence rate ratio 1.41, 95% CI 1.07-1.85) and DT (incidence rate ratio 2.23, 95% CI 1.27-3.90) than those with high education. Adjusting for single behaviours attenuated but did not eliminate education inequality in DMFT and DT increments, tooth brushing having the greatest impact on inequality. Simultaneous adjustment for all behaviours eliminated the significant relationship between education and caries increment. CONCLUSIONS: Accounting for important dental behaviours appears to explain all education inequality in dental caries in Finnish adults. The results should be interpreted with caution when applied to less egalitarian populations.

Concordance of genetic risk across migraine subgroups: Impact on current and future genetic association studies.

BACKGROUND: There has been intensive debate whether migraine with aura (MA) and migraine without aura (MO) should be considered distinct subtypes or part of the same disease spectrum. There is also discussion to what extent migraine cases collected in specialised headache clinics differ from cases from population cohorts, and how female cases differ from male cases with respect to their migraine. To assess the genetic overlap between these migraine subgroups, we examined genome-wide association (GWA) results from analysis of 23,285 migraine cases and 95,425 population-matched controls. METHODS: Detailed heterogeneity analysis of single-nucleotide polymorphism (SNP) effects (odds ratios) between migraine subgroups was performed for the 12 independent SNP loci significantly associated (p < 5 × 10(-8); thus surpassing the threshold for genome-wide significance) with migraine susceptibility. Overall genetic overlap was assessed using SNP effect concordance analysis (SECA) at over 23,000 independent SNPs. RESULTS: Significant heterogeneity of SNP effects (p het < 1.4 × 10(-3)) was observed between the MA and MO subgroups (for SNP rs9349379), and between the clinic- and population-based subgroups (for SNPs rs10915437, rs6790925 and rs6478241). However, for all 12 SNPs the risk-increasing allele was the same, and SECA found the majority of genome-wide SNP effects to be in the same direction across the subgroups. CONCLUSIONS: Any differences in common genetic risk across these subgroups are outweighed by the similarities. Meta-analysis of additional migraine GWA datasets, regardless of their major subgroup composition, will identify new susceptibility loci for migraine.

Patient experiences at diagnosis and psychological well-being in prostate cancer: A Finnish national survey.

PURPOSE: Most cases of prostate cancer are diagnosed at an early stage, and men live for many years after diagnosis. Thus, their well-being and quality of life are of great importance. This study investigated patient experiences and psychological well-being in a Finnish national sample of prostate cancer patients who received various types of treatment. METHOD: In a national sample (50%) of prostate cancer patients diagnosed in Finland in 2004, information was collected on the patients' experiences at diagnosis and choice of treatment (e.g. treatment selection, patient satisfaction with care and information, psychological reactions). In 2009, participants were asked about their experiences, and psychological well-being (psychological symptoms, satisfaction with life) was measured. In total, 1239 completed questionnaires (73%) were accepted for the study. Differences between treatments and predictors of psychological well-being were investigated using descriptive statistics and regression analysis. RESULTS: Half of the respondents were satisfied with the care and information they received about the cancer and side effects of treatment. Experiences and psychological well-being were most positive among patients who received brachytherapy and poorest among patients who received hormonal therapy. Patients who underwent prostatectomy or brachytherapy were most likely to have been involved in treatment selection. Negative experiences, such as learning of the diagnosis in an impersonal way and dissatisfaction with the information and care received, were predictive of poorer well-being. CONCLUSIONS: Unmet supportive care and informational needs were common. Experiences and well-being varied between treatments. Patients tended to prefer prostatectomy and brachytherapy. Unmet needs, which would probably be reduced by improvements in care, appear to have a long-lasting impact on patients' psychological well-being.

Weight histories and mortality among finnish adults: the role of duration and peak body mass index.

BACKGROUND: Many studies use information on weight histories to examine the association between body weight and mortality. A recent paper in Epidemiology (2013;25:707-710) developed a typology of the most common weight-history specifications. METHODS: We use data from a sample of Finnish adults to explore the associations of body weight and mortality, using existing specifications and also peak body mass index (BMI), a new specification. RESULTS: We confirm earlier findings that longer time in a high BMI state is predictive of mortality. Peak BMI (the highest BMI attained in life or available in the data) is also positively associated with mortality. CONCLUSIONS: The specifications of duration in a high BMI state and peak BMI are both valuable for understanding the relationship between lifetime weight dynamics and mortality. The collection of information on peak body weight may be useful when collection of more detailed weight histories is not feasible.

Dental attendance among adult Finns after a major oral health care reform.

OBJECTIVES: Between 2001 and 2002, all age limits restricting the availability of subsidized private dental care and Public Dental Services (PDS) were abolished in Finland. In addition, the reform aimed to address income- and residence-related disparities in access to subsidized oral health care services. The aim of this study was to analyse how dental attendance and factors associated with it changed after the reform. METHODS: We carried out three consecutive surveys on the use of oral health care services and perceived oral health. The surveys were conducted in 2001 (n = 2837), in 2004 (n = 2420) and in 2007 (n = 2296), and the study population comprised Finnish adults born in 1970 or earlier. Logistic regression analyses were used to examine factors associated with the use of the services. RESULTS: The percentage of respondents who attended dental care regularly or had used oral health care services over the past 12 months rose between 2001 and 2007. In particular, there was an increase in the proportion of subjects who used PDS. The average number of visits to a private dentist decreased between 2001 and 2007. In the regression analyses, the use of services was associated with older age, perceived lack of need for care, perceived toothache during the past 12 months, perceived good oral health, lower number of missing teeth and regular dental visiting habits. The use of private dental care services was associated with perceived good oral health and perceived lack of need for care, higher household income and older age in all three study years while the use of PDS was associated with younger age, perceived good oral health and perceived lack of need for care only in 2001. CONCLUSIONS: The use of oral health care services rose and age did not seem to be a barrier to the use of oral health care services after the reform, as was the aim of the reform. No change in the association of household income with the use of oral health care services was seen after the OHCR.

Sugar-sweetened beverages and dental caries in adults: a 4-year prospective study.

OBJECTIVES: To explore the association between frequency of consumption of sugar-sweetened beverages (SSB) and caries increment over 4 years in adults. A second objective was to explore whether the association between frequency of SSB consumption and caries increment varied by socio-demographic characteristics and use of fluoride toothpaste. METHODS: Data from 939 dentate adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours, including two questions on frequency of SSB consumption. The 4-year net DMFT increment was calculated using data from baseline and follow-up clinical oral examinations. The association was tested in negative binomial regression models and the moderating role of sex, age, education and use of fluoride toothpaste was examined by adding their two-way interaction with SSB consumption to the main effects model. RESULTS: A positive association was found between frequency of SBS consumption and 4-year net DMFT increment, regardless of participants' socio-demographic and behavioural characteristics. Adults drinking 1-2 and 3+ SSB daily had, respectively, 31% (Incidence Rate Ratio: 1.31; 95%CI: 1.02-1.67) and 33% (IRR: 1.33; 95%CI; 1.03-1.72) greater net DMFT increments than those not drinking any SSB. None of the four two-way interaction terms was significant (all p>0.05). CONCLUSION: There seems to be a dose-response relationship between frequency of SSB consumption and caries increment in adults. That association was consistent across socio-demographic characteristics, and more importantly, use of fluoride toothpaste. CLINICAL SIGNIFICANCE: Drinking sugar-sweetened beverages on a daily basis is related to greater caries risk in adults.

High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms.

3% of the population develops saccular intracranial aneurysms (sIAs), a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH) is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder population and bottleneck events. As the sIA-SAH incidence in Finland is >2× increased, such variants may associate with sIA in the Finnish population. We tested 9.4 million variants for association in 760 Finnish sIA patients (enriched for familial sIA), and in 2,513 matched controls with case-control status and with the number of sIAs. The most promising loci (p<5E-6) were replicated in 858 Finnish sIA patients and 4,048 controls. The frequencies and effect sizes of the replicated variants were compared to a continental European population using 717 Dutch cases and 3,004 controls. We discovered four new high-risk loci with low frequency lead variants. Three were associated with the case-control status: 2q23.3 (MAF 2.1%, OR 1.89, p 1.42×10-9); 5q31.3 (MAF 2.7%, OR 1.66, p 3.17×10-8); 6q24.2 (MAF 2.6%, OR 1.87, p 1.87×10-11) and one with the number of sIAs: 7p22.1 (MAF 3.3%, RR 1.59, p 6.08×-9). Two of the associations (5q31.3, 6q24.2) replicated in the Dutch sample. The 7p22.1 locus was strongly differentiated; the lead variant was more frequent in Finland (4.6%) than in the Netherlands (0.3%). Additionally, we replicated a previously inconclusive locus on 2q33.1 in all samples tested (OR 1.27, p 1.87×10-12). The five loci explain 2.1% of the sIA heritability in Finland, and may relate to, but not explain, the increased incidence of sIA-SAH in Finland. This study illustrates the utility of population isolates, familial enrichment, dense genotype imputation and alternate phenotyping in search for variants associated with complex diseases.