Hunt for the origin of allergy - comparing the Finnish and Russian Karelia.

The Finnish and Russian Karelia are adjacent areas in northern Europe, socio-economically distinct but geoclimatically similar. The Karelia Allergy Study was commenced in 1998 to characterize the allergy profiles in the two areas. Allergy prevalence had increased in Finland since the early 1960s, but the situation in Russia was unknown. The key finding was that allergic symptoms and diseases were systematically more common in Finnish children and adults than in their Russian counterparts. For example, in the early 2000s, hay fever in school children was almost non-existent in Russian Karelia, and only 2% were sensitized to birch pollen compared with 27% in Finnish Karelia. Adult birth cohorts showed that among those born in the 1940s, the sensitization to pollens and pets was at the same low level in both countries, but among younger generation born in the late 1970s, the difference was already manifold. Seropositivity to some pathogens, microbial content in house dust and drinking water seemed to confer allergy protection in Russia. In subsequent studies, it became apparent that on the Finnish side, healthy children had a more biodiverse living environment as well as greater diversity of certain bacterial classes on their skin than atopic children. Abundance of skin commensals, especially Acinetobacter (gammaproteobacteria), associated with anti-inflammatory gene expression in blood leucocytes. In vivo experiments with the mouse model demonstrated that intradermally applied Acinetobacter protected against atopic sensitization and lung inflammation. These observations support the notion that the epidemic of allergy and asthma results from reduced exposure to natural environments with rich microbiota, changed diet and sedentary lifestyle. Genetic studies have confirmed strong influence of lifestyle and environment. With our results from the Karelia study, a 10-year National Allergy Programme was started in 2008 to combat the epidemic in Finland.

Do health behaviour and psychosocial risk factors explain the European east-west gap in health status?

BACKGROUND: Mortality rates are much more favourable in Western European countries than in those of Eastern Europe. Health behaviour and psychosocial factors have been suggested to be important contributors to East-West differences in mortality and health status. METHODS: To compare reported health status as well as health behaviours and psychosocial factors which may be related to unequal health status in different parts of Europe, standardised postal surveys of representative populations samples were conducted in six Eastern and Western European areas. RESULTS: Higher mortality in the eastern populations was associated with more reported morbidity and generally more negative health ratings. Health behaviours and psychosocial factors were also more negative in the East. Multivariate analyses suggested that the East-West difference in health status may be partly explained by differences in health behaviours and psychosocial factors. CONCLUSION: Efforts to promote health in Eastern Europe should concentrate both on the promotion of healthier lifestyles and on improvement of social and economic conditions.

Self-reported health in the Republic of Karelia, Russia and in north Karelia, Finland in 1992.

BACKGROUND: Major differences in mortality, cardiovascular disease risk factors and health behaviour are known to exist between the populations of eastern Finland and the Republic of Karelia, Russia. Little is known, however, whether similar differences exist in subjective health. METHODS: In spring 1992 a population survey was conducted in North Karelia, Finland and in the area of Pitkäranta, Republic of Karelia, Russia. Random population samples (n = 2,000 in North Karelia and n = 1,000 in Pitkäranta) stratified for age and sex were taken from the population registers. The subjects completed questionnaires and were examined at local health centres. RESULTS: In North Karelia 50% of men reported their health as being quite good or very good, compared to 34% in Pitkäranta (p < 0.0001 for area difference). Among women the corresponding percentages were 58% in North Karelia and 22% in Pitkäranta (p < 0.0001). High household income and education were associated with good self-rated health among both sexes in North Karelia and among women but not men in Pitkäranta. Self-reported physical condition was better in North Karelia than in Pitkäranta (p < 0.0001). Psychosomatic symptoms (p = 0.0002 among men and p < 0.0001 among women) and many somatic symptoms were more prevalent in Pitkäranta than in North Karelia. CONCLUSION: In general, people in North Karelia, Finland feel healthier than people in the neighbouring Republic of Karelia, Russia. Socioeconomic differences in subjective health are less prominent in the Republic of Karelia.

East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.

BACKGROUND: Differences have been reported in life expectancy and mortality between Eastern and Western European countries. Also, disparities have been found among different European countries or populations concerning the implementation of preventive practices by health professionals. This study analysed the patterns of reported preventive practices in three Eastern European areas and three Western ones. METHODS: Health surveys were carried out in particular geographical area of six countries participating in the project (three Eastern European countries; Russia, Poland and Hungary and three Western European countries; Finland, Germany and Spain). All of them are partners in the WHO-CINDI (Countrywide Integration Non-communicable Diseases Intervention) Programme. Three preventive practices are analysed: reported blood pressure and blood cholesterol measurements and reported antismoking counseling during the last year. Data are presented separately for the general population and for people reporting specific chronic conditions (cardiovascular disease, respiratory disease and/or diabetes mellitus). RESULTS: Blood pressure measurement and antismoking counseling are more frequently reported to be carried out by primary health care physicians in the Eastern European areas while blood cholesterol measurement is more frequently reported in Western European countries. All these preventive activities are more frequently reported to be done among people with chronic conditions than in the population as a whole. CONCLUSIONS: Major differences have been found in reported preventive practices between Eastern and Western European countries. Great potential exists for chronic disease prevention among them.

Plasma ascorbic acid concentrations in the Republic of Karelia, Russia and in North Karelia, Finland.

OBJECTIVES: To determine the plasma ascorbic acid concentrations among men in North Karelia (Finland) and in Pitkäranta (Republic of Karelia) and to test how a short intervention would affect the plasma concentrations. DESIGN: The baseline survey was done as a cross-sectional population survey. A subsample was selected to the intervention study and randomised to treatment and control groups. SETTING: North Karelia province in Finland and the Pitkäranta area in the Republic of Karelia. SUBJECTS: In the cross-section population survey the stratified random sample of men between 25 and 64 years of age was 1000 in North Karelia and 500 in Pitkäranta. Participation rates were 68% and 77%, respectively. Plasma ascorbic acid measurements were made in one-third of the sample. In Pitkäranta 60 men, having very low plasma ascorbic acid concentrations, were invited to the intervention study. INTERVENTIONS: A controlled intervention study was made with blackcurrant-strawberry nectar in which vitamin C content was approximately 70 mg/100 g. The treatment group drank two times daily 200 ml nectar for 4-5 weeks. After intervention plasma ascorbic acid concentration was measured from both treatment and control groups. RESULTS: Plasma ascorbic acid concentrations were very different in the two areas. In Pitkäranta 93% of the men and in North Karelia only 2% of the men had plasma levels suggesting severe vitamin C deficiency. After intervention 46% of the men in the experimental group compared with 5% in the control group had plasma ascorbic acid concentrations exceeding 23 mumol/l (4.0 mg/l). CONCLUSIONS: In addition to a high smoking prevalence the very low ascorbic acid concentration among men in the Republic Karelia can have an effect on the high cardiovascular disease mortality.

Health-related behaviors in the Republic of Karelia, Russia, and North Karelia, Finland.

Risk factors and health behaviors related to chronic diseases were studied in a population survey in Pitkäranta District in the Republic of Karelia, Russia, and in North Karelia, Finland, in Spring 1992 (Puska, Matilainen et al., 1993). The random sample of the population (25 to 64 years) was 1,000 in Pitkäranta and 2,000 in North Karelia. Among men there were more current smokers in Pitkäranta than in North Karelia (65% vs. 31%) whereas among women the respective rates were 11% and 16%. Self-reported alcohol consumption was higher in North Karelia. Leisure time physical activity was much less frequent in Pitkäranta both among men and women. Use of vegetables and berries was very infrequent in Pitkäranta. The differences in health behavior can at least partly explain the differences in risk factors and in mortality of chronic diseases.

Cardiovascular risk factors in the Republic of Karelia, Russia, and in North Karelia, Finland.

Cardiovascular disease risk factors were measured in a population survey in Pitkäranta District in the Republic of Karelia and in North Karelia in Finland in spring 1992. According to official statistics the cardiovascular mortality in the Republic of Karelia is somewhat higher, and total mortality and cancer mortality considerably higher than in North Karelia. A random sample of the population, aged 25-64 years, was taken in Pitkäranta (n = 1000) and in North Karelia (n = 2000). The participation rates were 84% and 74% respectively. The mean total serum cholesterol among men was 5.2 mmol/l in Pitkäranta and 5.8 mmol/l in North Karelia (P < 0.001) and among women 5.3 mmol/l and 5.6 mmol/l (P < 0.001), respectively. The mean high density lipoprotein (HDL) cholesterol levels among men were 1.4 mmol/l and 1.3 mmol/l (P < 0.001), and among women 1.4 mmol/l and 1.5 mmol/l (P < 0.001), respectively. There were no significant differences in blood pressure among men, but women in Pitkäranta had higher blood pressure than women in North Karelia. The mean body mass index in Pitkäranta was higher among women, 28.0 versus 26.5 (P < 0.001) and lower among men, 25.2 versus 27.0 (P < 0.001) than in North Karelia. Smoking was much more common among men (65% versus 31%) but less common among women (10% versus 16%) in Pitkäranta than in North Karelia. The general level of the risk factors, and especially the higher prevalence of smoking among men could explain the high mortality rates in Pitkäranta, and in particular the high cancer mortality.