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Aims To evaluate the effect of the pre-pregnancy body surface area (BSA) on the risk of gestational diabetes mellitus (GDM). Methods The study population consisted of all primiparous women with singleton pregnancies (n = 328,892) without previously diagnosed diabetes or chronic hypertension in Finland between 2006 and 2019. The information on GDM, oral glucose tolerance test (OGTT) results, and maternal backgrounds was derived from the Finnish Medical Birth Register. The pre-pregnancy BSA was calculated by using the Mosteller formula. Logistic regression models were used to estimate the association between BSA and GDM/ OGTT separately by the body mass index groups. Results A lower BSA predicted an increased risk for GDM and pathological OGTT among the underweight (b = − 2.69, SE = 0.25, p b = − 2.66, SE = 0.23, p b = − 0.30, SE = 0.10, p = 0.002; b = − 0.67, SE = 0.09, p b = − 0.31, SE = 0.10, p = 0.001) pregnant women. Within the obese class II or greater, a higher BSA predicted a higher risk for GDM (b = 0.74, SE = 0.12, p b = 0.79, SE = 0.13, p Conclusion This study showed that in comparison with women with a higher BSA, underweight, and normal weight pregnant women with a smaller BSA may be more susceptible to GDM and have a pathological OGTT.

Background Lower-than-normal estimated glomerular filtration rate (eGFR) is associated with the risk for all-cause mortality and adverse cardiovascular events. In this regard, the role of higher-than-normal eGFR is still controversial. Objective Investigate long-term clinical consequences across the levels of eGFR calculated by the creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation among apparently healthy cardiovascular risk subjects. Design Prospective study. Participants Participants (n=1747) of a population-based screening and intervention program for cardiovascular risk factors in Finland during the years 2005–2007. Main Measures Cardiovascular morbidity and all-cause mortality. Key Results Over the 14-year follow-up, subjects with eGFR ≥105 ml/min/1.73 m2 (n=97) had an increased risk for all-cause mortality [HR 2.15 (95% CI: 1.24–3.73)], incident peripheral artery disease [HR 2.62 (95% CI: 1.00–6.94)], and atrial fibrillation/flutter [HR 2.10 (95% CI: 1.21–3.65)] when compared to eGFR category 90–104 ml/min after adjustment for cardiovascular and lifestyle-related risk factors. The eGFR category ≥105 ml/min was also associated with a two-fold increased mortality rate compared to the Finnish general population. Conclusions Renal hyperfiltration defined as eGFR ≥105 ml/min/1.73 m2 is a frequent and important finding in patients commonly treated in primary care. These patients should be followed closely for timely interventions, such as strict BP and blood glucose regulation.

Pregnancy itself predisposes to urinary tract infections (UTI). There appears to be a higher prevalence of infections and genitourinary diseases among pregnant smokers than among non-smokers. The present study is a retrospective observational register study aiming to investigate whether maternal smoking is associated with the prevalence of UTIs during pregnancy by utilizing a pregnancy-pair analysis.Information about pregnancies and maternal smoking was obtained from the Finnish Medical Birth Register. The study sample consisted of all singleton pregnancies (n = 723 433) of women giving birth between January 2006 and December 2018 in Finland. Information on maternal smoking was collected in three categories: (1) non-smoking; (2) quit smoking during the first trimester; and (3) continued smoking throughout the pregnancy. Information about maternal UTI diagnoses during pregnancy was received from the Hospital Discharge Register and the Medical Birth Register. UTIs were categorized as lower and upper UTIs according to the International Statistical Classification of Diseases and Related Health Problems (ICD)-10 diagnosis codes. Risks were calculated as odds ratios (OR) by logistic regression with 95% confidence intervals (CI) further adjusted for maternal characteristics (aOR). Finally, pregnancy-pair analyses were performed: mothers who had changed smoking status (no smoking/any smoking) between consecutive pregnancies (n = 27 246 pregnancy-pairs) were analyzed as one cluster and compared with non-smokers.Smokers had UTIs more often compared with the non-smokers. The association was even stronger among those who continued to smoke (aOR 1.60, 95% CI 1.51-1.70) than among those who smoked only during the first trimester (aOR 1.27, 95% CI 1.18-1.37) compared with non-smokers. In pregnancy-pair analysis, smoking was associated with upper UTIs during pregnancy (OR 1.49, 95% CI 1.05-2.12) compared with non-smokers, but after the adjustments this association was attenuated (aOR 1.27, 95% CI 0.88-1.82). No association in lower UTIs was observed in the pregnancy-pair design.Maternal smoking was associated with a higher prevalence of UTIs during pregnancy in the standard comparison. The observed association was fully attenuated in the pregnancy-pair analysis, in which smoking was dichotomized. This study suggests that the association between maternal smoking during pregnancy and adverse maternal health effects might be more complex than previously thought.

The aim of this study was to evaluate if maternal height affects the link between the inverse association on smoking during pregnancy and preeclampsia.The study population consisted of all women with singleton pregnancies (n = 803 698) in Finland during the years 2004-2018, excluding women with unknown smoking and diagnosis of prepregnancy chronic hypertension. Information on smoking and background factors were derived from the Finnish Medical Birth Register. Smoking was categorized in three classes: no, quitted in the first trimester and continued throughout the pregnancy. Information on preeclampsia was derived from the Finnish Hospital Discharge Register and the Finnish Medical Birth Register. Multiple logistic regression models were used to estimate first the association between smoking and preeclampsia, and finally whether maternal height modified the association.In the standard comparison, we found evidence of an association between preeclampsia and continued smoking [adjusted odds ratio = 0.74, 95% confidence interval (95% CI) = 0.67-0.81], but no association was found between quitted smoking and preeclampsia. Thus, the interaction of continued smoking and maternal height by z-scores was estimated. Among taller mothers, continued smoking was associated with a higher risk for preeclampsia than in smoking mothers with average height (β = 0.33, SE = 0.14, P = 0.02).Our results partly challenge the smoking-preeclampsia paradox: smoking seems not to protect tall mothers against preeclampsia. We speculate the findings through a new theory about the pathophysiology of preeclampsia. It seems that tall pregnant smokers must raise their blood pressure aggressively to ensure perfusion in the dysfunctional placenta.

In this prospective follow-up study, we aimed to examine whether changes in self-reported sleep quality, sleep duration, and sleep medication use are temporally associated with changes in quality of life and work ability in municipal employees when several confounding factors are considered. The study was conducted in Finland among 637 municipal employees (88% women, mean [SD] age 48 [10] years) in 2014 and 2015. Information about the participants was collected by self-administered questionnaire and from medical history. Predicting variables were changes in self-reported sleep quality, sleep duration, and sleep medication use. Outcome variables were changes in the EUROHIS-QOL eight-item index and the Work Ability Score. Improved or unchanged sleep quality compared to worse sleep quality were associated with a preferable change in quality of life (both p 0.001). No change in sleep duration compared to a decrease and no change in sleep medication use compared to increased use were also associated with favourable changes in quality of life. Increased use of sleep medication was associated with a decline in work ability, and the change in Work Ability Score also differed significantly between improved and worsened sleep quality. In this study, changes in sleep were widely associated with changes in quality of life and work ability of municipal employees. Programmes aiming for better sleep health would probably be beneficial both from a health-oriented and an economical point of view. Special attention should be paid to employees with a need for sleep medication.

Purpose The aim of this cross-sectional, observational study was to determine the impact of self-reported headache on absenteeism and presenteeism in a female working-age population. Subjects and Methods The study population consisted of 594 Finnish female municipal employees, who answered self-administered questionnaires including sociodemographic, lifestyle, health, and work-related data. Sickness absence days were obtained from the official records of the employer. Headache recurrence was defined by asking whether headache was occasional or recurrent. Headache impact was measured by the HIT-6. Results In our study, 456 (77%) females had headache, and headache was recurrent in 178 (39%). The self-reported recurrence of headache was related to age, AUDIT-C, health-rated quality-of-life, self-rated work ability, depressive symptoms, and work stress (P for linearity

Many unexplained sex differences have been observed in blood pressure (BP) related morbidity. However, there has been little research about the most obvious difference between men and women-body size. Given that blood vessels are organs of tubular shape, we hypothesized that correction of BP for body surface area (BSA), a two-dimensional measurement of body size, would allow comparison of BP load between men and women. We assessed the relationship of 24-h ambulatory BP measurements and BSA in 534 participants (mean age 61 ± 3 years, 51% women) from the Helsinki Birth Cohort Study. The study subjects had no previous medication affecting vasculature or BP. When BP values were adjusted for age, smoking, physical activity, and body fat percentage, males had higher ambulatory daytime mean systolic BP (131 mmHg vs. 127 mmHg, p 0.001), diastolic BP (83 mmHg vs. 78 mmHg, p 0.001), and mean arterial pressure (100 mmHg vs. 96 mmHg, p 0.001) than females. However, all BP components per unit of BSA were significantly lower in males: daytime mean systolic BP (65 mmHg vs. 71 mmHg, p 0.001), diastolic BP (41 mmHg vs. 44 mmHg, p 0.001), pulse pressure (24 mmHg vs. 28 mmHg, p = 0.013), and mean arterial pressure (49 mmHg vs. 54 mmHg, p 0.001). The same phenomenon was observed in night-time BP values. BP load per BSA is higher in women than in men, which may explain many reported sex differences in cardiovascular morbidity. Relatively small-sized individuals might benefit from a more aggressive therapeutic strategy.

Although it has been evaluated that even 76% of men with chronic obstructive pulmonary disease suffer from erectile dysfunction, the association has been poorly characterised. The aim of the study was to describe the association between forced expiratory volume in first second and erectile dysfunction in apparently healthy men. All together 331 men aged 45-70 years old were randomly drawn from a cross-sectional population-based study conducted in 2005 in Finland. Decreased forced expiratory volume was defined by performing mini-spirometry and erectile dysfunction by International Index of Erectile Function short form questionnaire. After adjustment for age and depressive symptoms predicted forced expiratory volume (FEV

Aims The aim of this study is to find factors associated with metabolic syndrome in obese individuals and thus offer guidance to stay metabolically healthy if obese. Methods A cardiovascular screening programme performed in Finland during the years 2005–2007, identified 901 obese white individuals. Of them, 269 (30%) were metabolically healthy according to the Harmonization criteria of metabolic syndrome. Results In multivariate logistic regression analysis, male sex [odds ratio (OR) 1.44 (95% CI 1.01–2.07)], living alone [OR 1.77 (95% CI 1.18–2.65)], physical inactivity [OR 3.73 (95% CI 1.24–11.24)], and use of betablockers [OR 2.63 (95% CI 1.75–3.95)] were associated with metabolic syndrome. Conclusions Even mild or occasional physical exercise is beneficial to health in obese individuals. Betablockers may not be the antihypertensive agents of choice when treating obese hypertensive individuals.

Purpose: Psychosocial risk factors are common in headache patients and affect the impact of headache in multiple ways. The aim of our study was to assess how psychosocial risk factors correlate with the headache impact test-6 (HIT-6). To our knowledge this is the first study to evaluate the impact of several psychosocial factors on the HIT-6 score. Patients and methods: Our study population consisted of 469 Finnish female employees reporting headache during the past year. Psychosocial risk factors were assessed using validated, self-administered questionnaires: the generalized anxiety disorder 7-item scale (GAD-7) for anxiety, the major depression inventory (MDI) for depressive symptoms, the ENRICHD short social support instrument (ESSI) for social isolation, the cynical distrust scale for hostility and the Bergen burnout indicator (BBI-15) for work stress. Results: Exploratory factor analysis of the HIT-6 scores revealed two factors, one describing psychological and quality of life aspects affected by headache and the other describing severity of pain and functional decline. Internal consistency of the HIT-6 was 0.87 (95%CI: 0.85–0.89). Correlations between the total HIT-6 score and all measured psychosocial risk factors except for hostility were weak, but statistically significant. Conclusion: The HIT-6 questionnaire has good construct validity and it describes reliably and independently the impact of headache without interference of psychosocial factors in general working-aged female population.

Background Self-rated health is an independent predictor of mortality. However, general health checks in populations unselected for disease or risk factors have not been shown to reduce mortality or morbidity. Aim To describe new comorbidities and cardiovascular risk factors in apparently healthy people and to relate this to their self-rated health. Design and setting A targeted screening programme identified 462 middle-aged people with cardiovascular risk factors without previously diagnosed chronic disease in a Finnish community in 2005–2006. Method Home blood pressure monitoring, oral glucose tolerance test, estimated glomerular filtration rate, and ankle brachial index were used to detect previously undiagnosed conditions. The Short-Form Health Survey and Beck’s Depression Inventory were completed by participants before the diagnostic tests were performed. Results The prevalence of previously undiagnosed disease was: hypertension 113/462 (24% [95% confidence interval {CI} = 21% to 29%]), diabetes 19/462 (4% [95% CI = 2% to 6%]), renal insufficiency 23/462 (5% [95% CI = 3% to 7%]), and peripheral arterial disease 17/462 (4% [95% CI = 2% to 5%]). Of the 139 participants who regarded their health as ‘fair–poor’, 60 (43%) had a previously undetected condition affecting their vasculature. Conclusion Out of the screen-detected apparently healthy cardiovascular risk subjects, one in three had undiagnosed hypertension, diabetes, peripheral arterial disease, or renal insufficiency. Those individuals experiencing ill health tended to be at high risk of cardiovascular problems.

The aim of this study was to investigate whether resistant hypertension differs from uncontrolled and controlled hypertension in terms of target organ damage. Hypertensive subjects with antihypertensive medication (n=385) were identified in a population survey conducted in southwestern Finland. None of the study subjects had previously diagnosed cardiovascular or renal disease or diabetes. Ankle-brachial index, estimated glomerular filtration rate, electrocardiogram-determined left ventricular hypertrophy and cardiometabolic risk factors were assessed. The prevalence of peripheral arterial disease among subjects with resistant, uncontrolled and controlled hypertension was 6/37 (16%), 22/275 (8%) and 0/73 (0%), respectively (P=0.006). There were no differences in the prevalence of renal insufficiency, left ventricular hypertrophy or metabolic parameters between the groups. Resistant hypertension affects vasculature more than uncontrolled hypertension, and thus it can be regarded as a marker of more severe disease.

Little is known about the prevalence of target organ damage in previously undiagnosed hypertension.Cross-sectional population survey.We measured ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and cardiometabolic risk factors in subjects with previously undiagnosed hypertension (n = 138) and normotensive (n = 440) risk subjects, who had metabolic syndrome, glucose disorders, body mass index ≥ 30 kg/m(2) or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had established cardiovascular or renal disease or previously diagnosed diabetes.There was no difference (p = 0.68) among the studied age-groups in the prevalence of previously undiagnosed hypertension, and no interaction (p = 0.10) was found between sex and age groups. Evidence of subclinical organ damage defined as ECG-LVH, ABI ≤ 0.90, or eGFR60 ml/min/1.73 m(2) were found in 22% of the subjects with previously undiagnosed hypertension, and 8% of the non-hypertensive risk persons (p0.001). The prevalence of renal insufficiency did not differ between the study groups. Majority of the subjects with previously undiagnosed hypertension also have multiple cardiometabolic risk factors.Among subjects with previously undiagnosed hypertension, one in five patients had evidence of subclinical target organ damage, and three in four patients may be regarded as having high cardiovascular risk.

Objective To assess factors modifying the effect of blood pressure on erectile function. Methods Nine hundred and twenty-four men at risk for cardiovascular disease or diabetes, but without manifested chronic diseases, were identified in a population survey carried out in south-western Finland during 2005-2007. The main outcome measures were hypertension status, sociodemographic and lifestyle factors, International Index of Erectile Function 5-item questionnaire, and Beck's Depression Inventory. Results When adjusted with age, cohabiting status, waist circumference, and education, the association of hypertension and erectile dysfunction was not statistically significant. Presence of depressive symptoms increased the adjusted odds ratios of erectile dysfunction by 2.44 [95% confidence interval (CI) 1.57-3.80] in normotensive men, by 7.62 (95% CI 1.89-30.65) in previously undiagnosed hypertensive patients, and by 2.04 (95% CI 0.87-4.78) in medically treated hypertensive patients. Conclusions Hypertension per se does not predispose men to erection problems. Instead, psychological factors are the critical component to consider in men suffering from erectile dysfunction.

Introduction. Erectile dysfunction (ED) is especially common in men with cardiovascular diseases (CVDs). However, the data are scarce concerning populations without manifested CVD. Aim. The aim of this study was to describe factors associated with ED, especially those associated with decreasing risk of ED, in men with cardiovascular risk factors but without CVD, diabetes, or chronic renal disease. Methods. In 2004 to 2007, a cross-sectional population-based sample of men 45 to 70 years old in two rural towns in Finland was collected. Men with previously diagnosed CVD, diabetes, or kidney disease were not invited to the study. In total 1,000 eligible men with cardiovascular risk factors, i.e., central obesity, high scores in the Finnish Diabetes Risk Score, high blood pressure, antihypertensive medication, or family history of coronary heart disease, myocardial infarction, or stroke, were included in the analysis. Questionnaires, clinical measurements, and laboratory tests were obtained. The prevalence of ED was studied comparing the means, and risk factors were studied using multivariate logistic regression analysis. Main Outcome Measures. The rate of ED was defined by the International Index of Erectile Function short form (IIEF-5) and by two questions (2Q) about the ability to achieve and to maintain an erection. Results. The prevalence of ED was 57% or 68% using IIEF-5 or 2Q, respectively. Age (odds ratio (OR): up to 9.16; 95% confidence interval (CI), 5.00-16.79; P < 0.001), smoking (OR: 1.41; 95% CI, 1.04-1.91; P = 0.028), depressive symptoms (OR: 4.04 for moderate and severe; 95% CI,1.22-13.45; P = 0.001), high-intensity physical activity (OR: 0.50; 95% CI, 0.29-0.86; P = 0.045), high education (OR: 0.52; 95% CI, 0.33-0.83; P = 0.013), and stable relation- ship (OR: 0.43; 95% CI, 0.21-0.88; P = 0.046) were associated with ED. Conclusions. In apparently healthy men with cardiovascular risk factors, decreasing risk of ED is associated with high-intensity physical activity, stable relationship, and high education level. Ettala OO, Syvanen KT, Korhonen PE, Kaipia AJ, Vahlberg TJ, Bostrom PJ, and Aarnio PT. High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects. J Sex Med 2014;11:2277-2284.

Summary Background In 2002, a new definition and classification of chronic kidney disease was published, and glomerular filtration rate

Our aim was to investigate how health related quality of life (HRQoL) influence on the success of weight management and how to utilize this information. Population-based longitudinal study. A community sample of apparently healthy middle-aged individuals living in Western Finland were invited to clinical survey in order to assess total cardiovascular risk among people who had at least one cardiovascular risk factor but no previous diagnoses of any long-lasting disease. A total of 2,752 individuals, aged 45-70 years, enrolled. The individuals completed HRQoL questionnaire before laboratory tests were completed and overweight people were instructed to lose weight at least 5 %. A physician examined 1950 high risk people during the years 2005-2007. Three years later a trained nurse invited them for a control examination, 1,287 high risk subjects participated, 1,049 had completely filled the questionnaires and 906 of them were overweight or obese at baseline. We assessed the success in weight management in this group of participants. The subjects (53 % women with mean age of 59 ± 7 years) had mean body mass index of 39.6 ± 4.6 kg/m². During the 3 years follow-up period 18 % of them had lost weight ≥5, 70 % had stabilized their weight and 12 % had gained weight ≥5 %. Subjects who had gained weight had worse results in every item of HRQoL both mental and physical at baseline. The results of the HRQoL questionnaire suggested that obesity and deteriorating quality of life interrelate.

Obesity is known to be associated with a range of chronic medical comorbidities, but little is known about the impact of overweight and obesity on health-related quality of life (HRQoL) in persons without chronic diseases. The aim of this study was to assess HRQoL, body mass index (BMI) and health behavior patterns in a community sample of subjects who had no long-lasting medical comorbiditiesWe assessed HRQoL in 1,187 apparently healthy individuals (mean age 57 ± 7 years), of whom 24 % were classified as normal weight, 49 % as overweight, 20 % as obese and 7 % as very obese. Two different instruments of HRQoL were used: the generic Short-Form Health Survey (SF-36) questionnaire and the preference-based instrument EuroQol (EQ-5D).All physical components of the SF-36 decreased linearly according to BMI categories in women. In men, only poorer physical functioning scale showed linearity with rising BMI. Scores on the mental components of the SF-36 did not differ by BMI categories in either gender. The EQ-5D index and EuroQol visual analogue scale scores decreased linearly with rising BMI only in women.In apparently healthy middle-aged subjects, physical HRQoL decreases with increasing level of BMI and more so in women than in men. Mental components of HRQoL do not differ between the categories of BMI in either gender.