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Background: Previously Cloninger’s temperament traits have been researched as a risk factor for depression mostly in cross-sectional studies. In these studies, especially high harm avoidance has been associated with an increased risk of depression. The main objective of this study was to investigate how temperament traits affect the risk of the onset of depression in a previously mentally healthy adult population. Methods: This study includes a follow-up period of 23 years from the age of 31 until 54 in the Northern Finland Birth Cohort 1966 Study. Temperament was measured at the 31-year follow-up using Temperament and Character Inventory (TCI). The outcome of the study was depressive disorder diagnosis during the follow-up in both sexes. To be able to take correlations between temperament traits we also did an analysis using temperament clusters. Results: Our sample size was 3999 individuals, out of which 240 were diagnosed with depression. For women an increase in the TCI score for novelty seeking (NS), harm avoidance (HA) or persistence (P) increased the risk of depression during the follow-up. For men only HA was a significant predictor of depression. An increase in reward dependence (RD) was found to reduce the risk of psychotic depression. In the analysis using the temperament clusters, the cluster including shy and pessimistic individuals was associated with risk for depression diagnosis in men. Conclusions: This prospective general population-based cohort study added to previous knowledge of high HA being a risk factor for depression, but it also found new associations such as higher P and NS.

Objective: To leverage large scale genetic association data to investigate the interplay between circulating cytokines and cardiometabolic traits, and thus identifying potential therapeutic targets. Design: Bi-directional Mendelian randomisation study. Setting: Genome-wide association studies from three Finnish cohorts (Northern Finland Birth Cohort 1966, Young Finns Study, or FINRISK study), and genetic association summary statistics pooled from observational studies for expression quantitative trait loci and cardiometabolic traits. Participants: Data for 47 circulating cytokines in 13 365 individuals from genome-wide association studies, summary statistic data for up to 21 735 individuals on circulating cytokines, summary statistic gene expression data across 49 tissues in 838 individuals, and summary statistic data for up to 1 320 016 individuals on cardiometabolic traits. Interventions: Relations between circulating cytokines and cardiovascular, anthropometric, lipid, or glycaemic traits (coronary artery disease, stroke, type 2 diabetes mellitus, body mass index, waist circumference, waist to hip ratio, systolic blood pressure, glycated haemoglobin, high density lipoprotein cholesterol, low density lipoprotein cholesterol, total cholesterol, triglycerides, C reactive protein, glucose, fasting insulin, and lifetime smoking). Main outcome methods: Genetic instrumental variables that are biologically plausible for the circulating cytokines were generated. The effects of cardiometabolic risk factors on concentrations of circulating cytokines, circulating cytokines on other circulating cytokines, and circulating cytokines on cardiometabolic outcomes were investigated. Results: Genetic evidence (mendelian randomisation P<0.0011) suggests that higher body mass index, waist circumference, smoking, higher concentrations of lipids, and systolic blood pressure increase circulating concentrations of several inflammatory cytokines and C reactive protein. Evidence

Pruritus has an extensive impact on functional, social and psychosocial behaviour. The association between pruritus and psychological well-being has mostly been studied among selected patient groups, whereas population-based studies are lacking. The aim of this study was to determine the association between pruritus and insomnia, quality of life, depression and anxiety at the population level in the general population. A cross-sectional population-based study was conducted in 2012 to 2013. Study subjects (n = 6,809) belonging to the Northern Finland Birth Cohort 1966 Study participated in a large follow-up study at the age of 45–47 years. They completed an extensive health questionnaire including questions on pruritus and several previously validated questionnaires regarding symptoms of psychosocial well-being. Pruritus affected 19.9% of the study subjects weekly, being more common in women than in men (p< 0.001). A significant association was found between both localized and generalized pruritus and symptoms of insomnia, depression, anxiety and decreased quality of life. The association was seen even in those with mild psychological symptoms/insomnia, and it affected both sexes. The severity of psychological symptoms increased with increasing frequency of pruritus. In conclusion, pruritus has a multiple effect on psychosocial well-being. Physicians should consider possible psychosocial symptoms in patients with pruritus.

Atopic dermatitis (AD) is the most common inflammatory skin disease worldwide, accounting for significant skin-related health burden. The clinical picture is characterized by inflamed eczematous lesions on the skin. For the patient carrying the disease, the main symptom is itch, often leading to impaired quality of life and sleep disturbance for the patients and their families. The disease course is variable. The atopic comorbidities linked to AD are well known, but fewer studies have addressed non-atopic comorbidities. This study aimed to increase the knowledge of psychiatric and somatic diseases associated with AD. The data sources used in this study were the Finnish Care Register for Health Care, including information from all Finnish hospitals, and the Finnish Digital Agency (previously Finnish Population Register Centre). The individuals with at least one or two recorded diagnoses of atopic dermatitis were included in the study populations, depending on the inclusion criteria of each separate article. The study periods ranged from 1987 to 2018. Different control populations were used. This study describes the comorbidity in both children and adults with AD. AD is associated with psychiatric diseases, including eating disorders. Anxiety and depression are the most frequently diagnosed psychiatric diseases in adult AD patients, and the strongest associated eating disorder among adolescents with AD is bulimia nervosa. In addition, this study shows that pediatric AD patients have increased risk of celiac disease and dermatitis herpetiformis. Patients with AD need to be met with a comprehensive approach, keeping in mind the possibility of associated somatic and psychiatric comorbidities. The aim of treatment should be disease control and minimizing the effect on the daily life of the patient., Tiivistelmä Atooppinen ekseema eli atooppinen ihottuma on maailmanlaajuisesti yleisin ihon tulehduksellinen sairaus, ja se aiheuttaa merkittävän osan ihosairauksiin liittyvästä kokonaistautitaakasta. Sairaus ilmenee vaihtelevan laajuisina ihottumaläiskinä. Sairauden merkittävin oire on kutina, mikä johtaa usein potilaan ja perheenjäsenten elämänlaadun heikkenemiseen ja unihäiriöihin. Atooppisen ihottuman taudinkulku on vaihteleva. Sairauden atooppiset liitännäissairaudet tunnistetaan hyvin, mutta ei-atooppisia liitännäissairauksia on tutkittu vähemmän. Tämän tutkimuksen tavoitteena oli lisätä tietämystä atooppiseen ekseemaan liittyvistä psykiatrisista ja somaattisista sairauksista. Tutkimuksen aineistoina käytettiin Terveyden ja hyvinvoinnin laitoksen hoitoilmoitusjärjestelmää sekä Digi- ja väestötietoviraston väestörekisteriä vuosilta 1987–2018. Sisäänottokriteerinä oli rekisteriin kirjattu atooppinen ekseema-diagnoosi, jonka tuli tutkimuksen osatyöstä riippuen esiintyä vähintään yksi tai kaksi kertaa. Tutkimuksen eri osa-alueissa käytettiin vaihtelevia verrokkiaineistoja. Tämä tutkimus antaa lisää tietoa atooppisen ekseeman liitännäissairauksista. Atooppista ihottumaa sairastavilla on suurentunut riski psykiatrisille sairauksille, syömishäiriöt mukaan lukien. Ahdistuneisuushäiriö ja masennus ovat yleisimmin kirjatut psykiatriset liitännäissairaudet aikuisilla atoopikoilla. Nuoruusikäisillä atoopikoilla on kohonnut syömishäiriöiden riski, ja suurin riski liittyy bulimiaan. Lisäksi havaitsimme lapsilla yhteyden atooppisen ihottuman ja keliakian sekä ihokeliakian välillä. Terveydenhuollossa atooppista ihottumaa sairastavat potilaat tulee kohdata kokonaisvaltaisesti ottaen huomioon somaattisten ja psykiatristen liitännäissairauksien mahdollisuus. Taudin hyvän hallinnan ohella hoidon tavoitteena tulisi olla mahdollisimman pieni vaikutus potilaan päivittäiseen elämään.

The purpose of this study was to examine and compare the associations between albuminuria and fasting (FPG), 1 h post-load (1 h PG) and 2 h post-load plasma glucose (2 h PG) in an oral glucose tolerance test (OGTT). A total of 496 people free of known diabetes (mean age 72 years) participated in the examinations including the OGTT with plasma glucose measurements at 0, 1, and 2 h and levels of HbA1c. Albuminuria was determined by the urinary albumin-to-creatinine ratio and was defined as ≥3.0 mg/mmol. Compared with those without albuminuria, participants with albuminuria had significantly higher 1 h PG and 2 h PG levels, but not FPG or HbA1c levels. An elevated 1 h PG increased the estimated odds ratio of albuminuria more than three times in people with prediabetic 1 h PG (8.6–11.5 mmol/L: OR 3.60; 95% CI 1.70–7.64) and diabetic 1 h PG (≥11.6 mmol/L: OR 3.05; 95% CI 1.29–7.23). After adjusting for blood pressure and age, the association of elevated 1 h PG with albuminuria remained significant. Prediabetic or diabetic FPG, 2 h PG, or HbA1c did not have a statistically significant association with albuminuria. These findings suggest that 1 h PG seems to be the best glycemic parameter and is useful in recognizing persons with an elevated risk of early kidney disease due to hyperglycemia.

Type 2 diabetes (T2D) is a common metabolic disorder characterized by elevated glucose levels. Recognizing people at high risk for T2D allows interventions that may delay or prevent the development of T2D and diabetes-related complications. The previously accepted methods for identifying these people are fasting plasma glucose (FPG), two-hour post-load glucose (2-h PG) in an oral glucose tolerance test (OGTT) and glycated hemoglobin A1c (HbA1c). However, one-hour post-load glucose (1-h PG) in an OGTT has risen in interest for its high predictive value for future T2D at an even earlier time point than the currently used methods. The aim of this thesis was to investigate the ability of 1-h PG to predict T2D and cardiovascular diseases as well as to evaluate the association between 1-h PG and other diabetic complications including retinopathy signs and albuminuria. The value of 1-h PG measurement was compared with current diagnostic methods. Four Finnish study populations were used for the analyses of the present thesis. The results revealed that 1-h PG was a better predictor of T2D and cardiovascular outcomes than FPG or 2-h PG, also improving the explanatory power of the traditional cardiovascular risk models. Elevated 1-h PG was related to retinopathy signs, while FPG, 2-h PG and HbA1c were not. Both prediabetic ( 8.6 mmol/L) and diabetic ( 11.6 mmol/L) 1-h PG levels were independently associated with albuminuria, but no such an association was seen in FPG, 2-h PG and HbA1c. Furthermore, the 2-h PG did not provide any benefit in addition to FPG and 1-h PG in the prediction of T2D and cardiovascular outcomes or in the detection of albuminuria. In conclusion, these findings indicate that the use of 1-h PG improves the predictability of T2D and cardiovascular diseases and the detection of retinopathy signs and albuminuria. Together with previous findings, these results indicate that the use of 1-h PG and shortened 1-h OGTT seems reasonable to consider in the, Tiivistelmä Tyypin 2 diabetes on yleinen aineenvaihduntasairaus, johon liittyy kohonnut verensokeri. Suuressa sairastumisriskissä olevien potilaiden tunnistaminen on tärkeää, jotta tyypin 2 diabeteksen sekä siihen liittyvien komplikaatioiden kehittymistä voidaan ennaltaehkäistä. Aikaisemmin hyväksytyt menetelmät suuressa sairastumisriskissä olevien potilaiden tunnistamiseksi ovat paastoverensokeri, glukoosirasituskokeen 2 tunnin glukoosi ja glykohemoglobiini A1c (HbA1c). Glukoosirasituskokeen 1 tunnin glukoosi on herättänyt viime aikoina kiinnostusta, sillä sen on havaittu ennustavan hyvin tulevaa tyypin 2 diabetesta jopa varhaisemmassa vaiheessa kuin nykyisin käytössä olevat menetelmät. Tämän väitöskirjan tavoitteena oli tutkia 1 tunnin glukoosiarvon kykyä ennustaa tyypin 2 diabetesta ja sydän- ja verisuonitauteja sekä arvioida 1 tunnin glukoosiarvon yhteyttä retinopatiamuutoksiin ja albuminuriaan. Yhden tunnin glukoosiarvoa verrattiin nykyisiin käytössä oleviin diagnostisiin menetelmiin. Tässä väitöskirjassa hyödynnettiin neljää suomalaista väestöpohjaista aineistoa. Tutkimustulokset osoittivat, että 1 tunnin glukoosiarvo on parempi tyypin 2 diabeteksen sekä sydän- ja verisuonitapahtumien ennustaja kuin paastoglukoosi tai 2 tunnin glukoosi, ja se parantaa myös perinteisten sydän- ja verisuonitautien riskimallien selitysastetta. Retinopatiamuutokset olivat yhteydessä kohonneeseen 1 tunnin glukoosiarvoon, mutta eivät paastoarvoihin, 2 tunnin arvoihin tai HbA1c:hen. Sekä prediabeettinen ( 8.6 mmol/l) että diabeettinen ( 11.6 mmol/l) 1 tunnin glukoosiarvo olivat itsenäisesti yhteydessä albuminuriaan, mutta vastaavaa yhteyttä ei todettu paastoglukoosille, 2 tunnin glukoosille tai HbA1c:lle. Kahden tunnin glukoosiarvo ei myöskään parantanut paastoglukoosin ja 1 tunnin glukoosin lisänä tyypin 2 diabeteksen tai sydän- ja verisuonitapahtumien ennustettavuutta eikä albuminurian tunnistettavuutta. Tutkimustulosten perusteella 1 tunnin glukoosiarvon käyttö parantaa tyypin 2

Background: The Beck Depression Inventory (BDI) and BDI-II (revised version) are some of the most widely used and comparable self-report scales for assessing the presence and severity of depressive symptoms in many countries. However, although the relative mean score of each symptom in different countries may vary, the cultural differences of BDI-II symptoms for each item have not been previously studied. Aims: To examine the overall picture of the magnitude of the symptoms in the Finnish population, and compare the relative mean score of each symptom between all published population-based samples from different countries fulfilling the search criteria. Method: We conducted a search for population-based studies reporting BDI-II item, using Scopus, PsycINFO and PubMed, and five population-based samples were identified. Relative average scores for each item of the scale were calculated for the Finnish population and five populations from other countries. Meta-regression methods were used to test the differences in the relative score of each symptom between each country separately, and results were then visually compared with spider charts. Results: We found significant differences in several BDI-II item scores between countries: lower indecisiveness, higher changes in sleep pattern and higher irritability in Finland; higher loss of pleasure in Norway; higher loss of interest in the Dominic Republic; higher self-criticalness and feelings of punishment in Mexico; and higher sadness in Japan. Conclusions: Based on the study fundings and including all currently published population-based samples with BDI-II scores, cultural differences in depressive symptoms should be considered when interpreting BDI-II item scores.

Aims: This longitudinal study evaluated associations between glucose metabolism and cognitive performance during a 12-year follow-up. Methods: We included 714 subjects, which were followed from the age 55 to 70 years. Using oral glucose tolerance tests the population was classified as normoglycemic (NGT) and based on WHO diagnostic criteria for diabetes and prediabetes. Cognitive performance was assessed with a verbal fluency (category) test and wordlist learning tests of CERAD-nb, a verbal fluency (letter) test, and trail-making tests A and B. Results: Compared to the normal group subjects with long-lasting prediabetes showed significantly greater decline (4.6 versus 2.9 words) on the verbal fluency (category) test (p = 0.041); subjects with long-lasting type 2 diabetes showed significantly greater decline (13 versus 6 s) on the trail making A test (p = 0.021) and on the wordlist learning test (3.3 versus 1.7 words) (p = 0.013); and a combined group of subjects with prediabetes or incident type 2 diabetes showed significantly greater cognitive decline (3.8 versus 2.9 words) in the verbal fluency (category) test (p = 0.039). Conclusion: Prediabetes was associated with cognitive decline during aging. This finding should be incorporated into prevention strategies, because both type 2 diabetes and dementia are increasing world-wide.

Tiivistelmä Kohortti- ja rekisteritutkimuksilla on merkittävä rooli mielenterveyshäiriöiden riskitekijöiden, ennusteen ja hoidon selvittämisessä. Pohjois-Suomen syntymäkohortissa 1966 (Kohortti 66) on tutkittu vuodesta 1990 alkaen mielenterveyshäiriöitä, erityisesti skitsofreniaa ja myös masennusta. Tulosten mukaan skitsofreniaa ennustavat useat varhaiset raskauteen, synnytykseen ja kehitykseen liittyvät tekijät. Skitsofreniaan liittyy muutoksia aivojen rakenteessa ja kognitiivisessa suorituskyvyssä sekä somaattisen terveyden ongelmia. Ennuste on usein epätyydyttävä. Masennuksen osalta on löydetty riskitekijöitä lapsuudesta aikuisuuteen sekä suurentunut somaattisen oheissairastavuuden riski. Kohortissa 66 on tutkittu myös muun muassa persoonallisuushäiriöitä, somatisaatio-oireita, alkoholinkäyttöä ja temperamenttipiirteitä. Tutkimustulokset ovat lisänneet tietoa psykiatristen häiriöiden riskitekijöistä, taudinkulusta ja hoidosta.

Objectives: To study the association between androgenetic alopecia (AGA) and its severity with psychosocial well-being in male subjects aged 46 years at the population level. Design: Cross-sectional study. Setting: The Northern Finland Birth Cohort 1966 (NFBC1966). Participants: Data were available for 892 male subjects aged 46 years. Interventions: Study subjects underwent comprehensive health examinations including a skin evaluation by dermatologists and determination of AGA according to the Norwood classification. They also filled in a questionnaire battery that included previously validated questionnaires: the Hopkins Symptom Checklist-25, the Beck Depression Inventory–II; the Generalised Anxiety Disorder Screener; a 15-dimensional measure of health-related quality of life; a 12-Item General Health Questionnaire. The battery also included questions about self-esteem and sexual health. Main outcome measurements: The presence of AGA and its severity, psychosocial well-being. Results: AGA was found in 68.5% of subjects, 27.8% of the cases were severe, 33.2% moderate and 39.0% mild. There was no significant association between the presence of AGA or its severity with depression, anxiety, quality of life, self-esteem or sexual symptoms. Those with severe AGA reported lower sexual activity when compared with those without AGA; however, the difference was not statistically significant. Conclusions: Middle-aged men with AGA did not differ from men without AGA in terms of psychosocial well-being.

Data are insufficient on the protective effect of a farm environment in childhood regarding sensitization in middle age and new-onset sensitization in adulthood. A skin prick test (SPT) and questionnaire data from the Northern Finland Birth Cohort 1966 study (NFBC66) were used to investigate sensitization at age 46 years related to childhood living environment. A subpopulation of 3409 participants was analyzed to study factors related to new-onset sensitization between ages of 31 and 46 years. Data on complete SPTs were available for 5373 cohort members at age 46. Professional farming by parents (odds ratio (OR) 0.54; 95% confidence interval (CI) 0.43–0.68) and keeping of farm animals (OR 0.53; 95% CI 0.43–0.66) in infancy were associated with a lower risk of sensitization at age 46. Sensitization (OR 0.58; 95% CI 0.47–0.72) and polysensitization (OR 0.43; 95% CI 0.32–0.57) were less common in those who lived in a rural area in infancy compared to a city area. The childhood living environment had no effect on new-onset sensitization between ages 31 and 46. We conclude that living on a farm or in a rural environment in childhood had a protective effect on sensitization even in middle age, but these factors did not protect from new-onset sensitization in adults.

Background: Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods: The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results: Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgrou

We evaluated the survival of a subarctic population and the significance of traditional risk factors for mortality, causes of death and their seasonal variation from the period of 1984–2014. By the end of 2014 (follow-up), 644 (34.4% from 1,869) participants had died (42.1% of cardiovascular causes, 22.4% of neoplastic diseases). The average age at death±SD was 74.6±11.4 years for women (n=284) and 70.2±12.0 years for men (n=360). After adjusting for baseline age, the major risk factors predicting death were male sex (hazard ratio [HR] 1.80; 95% confidence interval [CI] 1.54–2.10), current smoking (HR 1.85; 95% CI 1.58–2.17), obesity (HR 1.75; 95% CI 1.45–2.12), high blood pressure (HR 1.46; 95% CI 1.24–1.72), cardiovascular disease (HR 1.62; 95% CI 1.36–1.93) and depression (HR 1.61; 95% CI 1.21–2.14) at baseline. The most common causes of death and the main risk factors predicting death in this population were the same as reported globally. Lifestyle factors had an important impact in predicting survival. The most common causes of death were the same for men and women. There was no significant difference in overall mortality rate between winter and summer, but cerebrovascular and pulmonary causes of death were more common during winter.

Background: Empathy and self-reflection have been studied among medical students, but fewer studies have examined the presence of these attributes among dental students and investigated the correlation between empathy and self-reflection. Methods: First-year dental and medical students (n = 198) beginning their studies at the University of Oulu, Finland in August 2017 participated in this study, which was conducted via an internet-based questionnaire. Data were collected on personal characteristics and scores on Davis’s Interpersonal Reactivity Index (IRI) and Roberts’s Self Reflection and Insight Scale (SRIS). Results: Differences in IRI scores between dental and medical students were significant only in male students and in two IRI domains. Mean (SD) scores for male dental and medical students were personal distress, 8.2 (4.0) and 10.7 (3.1) (p = 0.022); empathic concern, 15.0 (4.0) and 16.9 (3.5) (p = 0.054). Mean SRIS scores did not differ between sexes or training programs. Positive correlations (r = − 0.3–0.65) were observed between some empathy and self-reflection subscales. Conclusions: A lower degree of empathy was observed among male dental students than in male medical students. A positive correlation between empathy and self-reflection was demonstrated in both study groups and sexes. However, more research in this field is warranted.

Studies on the longitudinal changes in sensitization to aeroallergens in adult populations are sparse. The aim was to evaluate changes in sensitization to aeroallergens [birch, timothy, cat and house dust mite (HDM)] in an unselected adult population aged from 31 to 46 years. Data were gathered from a cohort of adults (Northern Finland Birth Cohort 1966) who had been skin prick tested (SPT) with birch, timothy, cat and HDM allergens at the age of 31 years and at age 46 (n = 5484 and 5373 respectively). Data from both time points were available for 3409 participants, who made up the cohort of the longitudinal study. The overall prevalence of sensitization to any of the selected allergens was 30.3% (n = 1661) in 31-year-olds and 30.7% (n = 1649) in 46-year-olds. In general, men were more sensitized (P < 0.001) and also had more polysensitization (P < 0.001) compared to women. In longitudinal sub-population incidence of sensitization was 7.1%. Birch was the most prevalent new sensitizer, however, the difference was not statistically significant when compared to cat. We conclude that new sensitization, demonstrated by positive findings in SPT, can still occur in middle age and this should be taken into account when managing allergic manifestations in adults as sensitization can be considered the first step in developing clinical allergy.

Background: Depression has been known to affect memory and other cognitive domains. The objective of this longitudinal cohort study was to investigate longitudinal associations between depressive symptoms at age 31 years and visual memory and new learning at the age of 46 years. We investigated whether depressive symptoms at age 31 predicted visual memory deficits at age 46 years, and whether changes in depressive symptoms between 31 and 46 years predicted visual memory at age 46. Methods: Participants were members of the Northern Finland Birth Cohort 1966. Depressive symptoms were assessed with the Symptom Checklist-25 (SCL-25) on both occasions. Visual memory and new learning were assessed using Paired Associative Learning (PAL) test at the age 46 follow-up. PAL total errors adjusted and first trial memory score were used as outcomes and basic educational level, relationship status, physical activity and diet at baseline were considered as confounding factors in linear regression analysis. Results: A total of 5029 (57% female) participants were included in the main analysis. No associations were found between depressive symptoms or change in depressive symptoms and visual memory and new learning scores. The result did not change following cut-offs 1.55 and 1.75 for depression. Limitations: SCL-25 only measures symptoms during the past week. Only one cognitive domain was assessed. Conclusions: Contrary to our hypothesis, neither baseline depressive symptoms nor change in depressive symptoms predicted visual memory scores 15 years later. It appears that sub-clinical depressive symptoms do not effect this cognitive domain in the middle-aged population.

Diabetic retinopathy is a microvascular complication of hyperglycaemia. Little is known about the association of glucose metabolism and retinopathy signs in the non-diabetic middle-aged population. We studied prevalence of retinopathy in a subsample of Northern Finland Birth Cohort study (NFBC1966) of 1809 subjects, at 47 years of age, without previously diagnosed type 2 diabetes and/or blood pressure-lowering medication. All participants underwent clinical evaluations including an oral glucose tolerance test (glucose and insulin values measured at 0, 30, 60 and 120 min) and HbA1c. The retinopathy signs were diagnosed by fundus photographs and classified according to the Eurodiab classification scheme. The overall prevalence of newly diagnosed retinopathy was 1.4%. The retinopathy signs were significantly associated with increased 30 min, 1-h and 2-h glucose levels and 2-h insulin level in an OGTT. After adjustment with systolic blood pressure, only 30 min glucose, 1-h glucose and 2-h insulin levels were associated with retinopathy signs. Our findings show the potential role of 30 min and 1-h post-load glucose and 2-h insulin levels as risk factors for retinopathy lesions among the participants without previously diagnosed diabetes or hypertensive medication.

Background/Objectives: Worldwide, we are observing a rising prevalence of dementia and mild cognitive impairments that often co-occur with the heightened incidence of non-communicable diseases in the elderly. It is suggested that type 2 diabetes and defects in glucose metabolism might predispose to poorer cognitive performances and more rapid decline in old age. Methods: To address existing knowledge gaps in this area, we systematically reviewed the literature to identify whether patients with type 2 diabetes (T2DM) and pre-diabetes are at a higher risk of poorer cognitive performance, and whether the risk (if any) might affect specific cognitive abilities. We concentrated the review on elderly individuals (65 years or older) at intake. In total, 3251 original articles were retrieved, of which 17 met our inclusion and quality control criteria, which comprised 12 structured questions used to define the articles. Results: 11 of 17 studies found a statistically significant decline in cognition among individuals who had T2DM or pre-diabetes compared to their non-diabetic counterparts. The association between diabetes and cognitive decline was not always clear, and the extent of the cognitive tests used seemed to have the greatest effect on the results. Conclusion: Focusing on a population age 65 years and over, we found insufficient evidence to support an association between pre-diabetes stages and mild cognitive impairment. However, there is consistent evidence to support diabetes as an independent risk factor for low cognitive ability in the elderly. Finally, we found insufficient evidence to support effect of T2DM on distinct cognitive ability due to the scarcity of comparable findings.

Objective: To analyze the clinical outcomes of patients with type 2 diabetes (T2D) before and after implementation of a personalized care plan in the primary health care setting. Design: Observational, retrospective, real-world study. Setting: All T2D patients with a care plan in Rovaniemi Health Center, Rovaniemi, Finland, for whom data were available from a baseline visit (in 2013–2015 during which the care plan was written) and from a follow-up visit, including an updated care plan by the year 2017. Subjects: In total, 447 patients were included. Mean age was 66.9 (SD 10.1) years, 58.8% were male, 15.4% were smokers, 33.1% had vascular disease, and 17.0% were receiving insulin treatment. The mean follow-up time was 14.4 months. Main Outcome Measures: Glycosylated hemoglobin A1 (HbA1c), low-density lipoprotein (LDL), blood pressure (BP), and body mass index (BMI). Clinical values were taken at both baseline and follow-up. Results: LDL decreased by 0.2 mmol/L, systolic blood pressure by 2.2 mm Hg, diastolic blood pressure by 1.5 mm Hg, and BMI by 0.5 kg/m² (P < 0.05 for each). The decrease in HbA1c was 0.8 mmol/mol (P = 0.07). Conclusion: We observed statistically significant decreases in LDL, BP, and BMI. Our results indicate that, over 14 months of follow-up, implementation of a written care plan was associated with small improvements in the clinical outcomes of T2D patients in a primary health care study population in a real-world setting.

X-ray microdensitometry on annually resolved tree-ring samples has gained an exceptional position in last-millennium paleoclimatology through the maximum latewood density (MXD) parameter, but also increasingly through other density parameters. For 50 years, X-ray based measurement techniques have been the de facto standard. However, studies report offsets in the mean levels for MXD measurements derived from different laboratories, indicating challenges of accuracy and precision. Moreover, reflected visible light-based techniques are becoming increasingly popular, and wood anatomical techniques are emerging as a potentially powerful pathway to extract density information at the highest resolution. Here we review the current understanding and merits of wood density for tree-ring research, associated microdensitometric techniques, and analytical measurement challenges. The review is further complemented with a careful comparison of new measurements derived at 17 laboratories, using several different techniques. The new experiment allowed us to corroborate and refresh long-standing wisdom but also provide new insights. Key outcomes include (i) a demonstration of the need for mass/volume-based recalibration to accurately estimate average ring density; (ii) a substantiation of systematic differences in MXD measurements that cautions for great care when combining density data sets for climate reconstructions; and (iii) insights into the relevance of analytical measurement resolution in signals derived from tree-ring density data. Finally, we provide recommendations expected to facilitate futureinter-comparability and interpretations for global change research.

Objective: The main objective of this study was to investigate the psychometric properties of the Zung Self-Rating Depression Scale (SDS) and evaluate screening parameters capability of the SDS with the Beck Depression Inventory (BDI-21) among the elderly population. Design: A population-based study Setting: Community Subjects: 520 adults, aged 72–73 years, living in the city of Oulu, Finland. Main outcome measures: The screening parameters of the SDS questions and BDI-21 for detecting severity of depression. The Mini Neuropsychiatric Interview for diagnosing major depression. Results: The optimal cut-off point for the SDS was 39. The sensitivity and specificity parameters for this cut-off point were 79.2% (95% CI 57.8–92.9) and 72.2% (95% CI 67.9–76.1), respectively. Positive and negative predictive values were 12.5% (95% CI 7.7–18.8) and 98.6% (95% CI 96.7–99.5), respectively. Moreover, there was no statistically significant difference in diagnostic accuracy indices of the cut-off points 39 and 40. In a receiver operating characteristic analysis, the area under the curve was 0.85 (95%CI 0.77–0.92) for the SDS total score and 0.89 (95% CI 0.83-0.96) for the BDI-21 (p = 0.137). Conclusion: Using the traditional cut-off point, the SDS was convenient for identifying clinically meaningful depressive symptoms in an elderly Finnish population when compared with the BDI-21 which is one of the most commonly used depression screening scales. The sensitivity and specificity of these two screening tools are comparable. Based on our study, the SDS is convenient for identifying clinically meaningful depressive symptoms among older adults at the community level.

Objective: To assess the association between depressive symptoms and impaired glucose metabolism in the elderly population in arctic latitudes. Design: A population-based study. Setting. Community. Subjects: The study population consisted of 1,830 subjects born between the years 1915 and 1958 in the northernmost part of Finland, the Muonio-Enontekiö district, who participated in a health survey during 1974–1984. In 2014, a health questionnaire was sent to 1,037 subjects, and 757 participants (73%) answered it. Those (n = 629) living in the Muonio-Enontekiö district undergone a clinical examination in 2014 and 2015 including blood collections. Main outcome measures: Depressive symptoms defined by the Beck Depression Inventory II (BDI II) with a cut-off point of 14. Different diabetic states based on WHO’s classification criteria defined by fasting plasma glucose and ADA’s criteria by glycosylated haemoglobin (HbA1c) values. Results: According to logistic regression analysis, depressive symptoms (BDI-II ≥ 14) were associated statistically significantly with previously known type 2 diabetes, the odds ratio (OR) being 4.33 (95% CI 1.53–14.14). Regarding prediabetic fasting glucose/HbA1c values, the corresponding OR was 2.94 (95% CI 1.17–8.94). The prevalence of depressive symptoms (BDI-II ≥ 14) was 7.1%, (men 9.7% and women 5.4%) and 13.7% (men 9.9% and women 17.0%) in subjects living in Muonio-Enontekiö district and in those who had moved away from there, respectively. Conclusions: The association of depressive symptoms between prediabetes and diabetes seems to be present also in the northernmost latitudes of the world.

Atopic dermatitis is associated with several comorbidities. Epidemiological studies on psychiatric comorbidities in adult atopic dermatitis patients are sparse. We analyzed psychiatric comorbidities in a Finnish nationwide adult atopic dermatitis cohort. The study included 57,690 adult patients with atopic dermatitis as cases and 40,363 individuals diagnosed with melanocytic naevi as controls. Data was obtained from the statutory Finnish Care Register for Health Care. The prevalence of preselected comorbidities between the atopic dermatitis and control groups was compared. Every psychiatric disorder studied was more common in patients with atopic dermatitis than in controls. At least one psychiatric diagnosis was found in 17.2% of the atopic dermatitis patients and 13.1% of controls. Psychiatric morbidity is significant in patients with atopic dermatitis and therefore assessing patients’ mental health status should be considered as part of standard care.