Development of composite outcomes for individual patient data (IPD) meta-analysis on the effects of diet and lifestyle in pregnancy: a Delphi survey.

OBJECTIVE: To develop maternal, fetal, and neonatal composite outcomes relevant to the evaluation of diet and lifestyle interventions in pregnancy by individual patient data (IPD) meta-analysis. DESIGN: Delphi survey. SETTING: The International Weight Management in Pregnancy (i-WIP) collaborative network. Sample Twenty-six researchers from the i-WIP collaborative network from 11 countries. METHODS: A two-generational Delphi survey involving members of the i-WIP collaborative network (26 members in 11 countries) was undertaken to prioritise the individual outcomes for their importance in clinical care. The final components of the composite outcomes were identified using pre-specified criteria. MAIN OUTCOME MEASURES: Composite outcomes considered to be important for the evaluation of the effect of diet and lifestyle in pregnancy. RESULTS: Of the 36 maternal outcomes, nine were prioritised and the following were included in the final composite: pre-eclampsia or pregnancy-induced hypertension, gestational diabetes mellitus (GDM), elective or emergency caesarean section, and preterm delivery. Of the 27 fetal and neonatal outcomes, nine were further evaluated, with the final composite consisting of intrauterine death, small for gestational age, large for gestational age, and admission to a neonatal intensive care unit (NICU). CONCLUSIONS: Our work has identified the components of maternal, fetal, and neonatal composite outcomes required for the assessment of diet and lifestyle interventions in pregnancy by IPD meta-analysis.

Reshaping the gut microbiota at an early age: functional impact on obesity risk?

Overweight and obesity can currently be considered a major threat to human health and well-being. Recent scientific advances point to an aberrant compositional development of the gut microbiota and low-grade inflammation as contributing factors, in conjunction with excessive energy intake. A high-fat/energy diet alters the gut microbiota composition, which reciprocally engenders excessive energy harvesting and storage. Further, microbial imbalance increases gut permeability, leading to metabolic endotoxemia, inflammation and insulin resistance. Local intestinal immunologic homeostasis is achieved by tolerogenic immune responses to microbial antigens. In the context of amelioration of insulin sensitivity and decreased adiposity, the potential of gut microbiota modulation with specific probiotics and prebiotics lies in the normalization of aberrant microbiota, improved gut barrier function and creation of an anti-inflammatory milieu. This would suggest a role for probiotic/prebiotic interventions in the search for preventive and therapeutic applications in weight management.

Preventing excessive gestational weight gain--a secondary analysis of a cluster-randomised controlled trial.

BACKGROUND: Healthy diet, physical activity and modest weight gain during pregnancy may prevent developing gestational diabetes mellitus (GDM). We examined whether a lifestyle intervention designed to prevent GDM was effective in reducing excessive gestational weight gain (GWG). METHODS: A cluster-randomised controlled trial (n=399) was conducted in maternity clinics in 14 municipalities in Southern Finland. Pregnant women with at least one risk factor for GDM (for example, overweight) but no pre-existing diabetes were recruited at 8-12 weeks' gestation. The intervention included counselling on GWG, physical activity and healthy eating at five routine visits. Usual counselling practices were continued in the usual care municipalities. Statistical analyses were performed using multilevel linear and logistic regression models adjusted for weeks' gestation at last weight measurement, pre-pregnancy body mass index and smoking status. RESULTS: The intervention group had a lower mean GWG by weeks' gestation than the usual care group (adjusted coefficient for the between-group difference -0.016 kg per day, P=0.041). There was no difference in mean (± s.d.) GWG between the intervention and the usual care groups (13.7 ± 5.8 vs 14.3 ± 5.0 kg, P=0.64). In total, 46.8% of the intervention group and 54.4% of the usual care group exceeded the GWG recommendations. The adjusted odds ratio for excessive GWG was 0.82 (95% CI 0.53-1.26, P=0.36) in the intervention group as compared with the usual care group. CONCLUSIONS: The intervention had minor effects on GWG among women who were at increased risk for GDM. In order to prevent excessive GWG, additional focus on restriction of energy intake may be needed.

Effect of exercise on bone structural traits, physical performance and body composition in breast cancer patients--a 12-month RCT.

In this 12-month RCT, we examined whether aerobic impact exercise training (3x/week) could facilitate breast cancer survivors' recovery by enhancing their bone structural strength, physical performance and body composition. After the adjuvant chemo- and/ or radiotherapy, 86 patients were randomly assigned into the training or control group. Structural bone traits were assessed with pQCT at the tibia and with DXA at the femoral neck. Agility (figure-8 running), jump force and power (force platform), grip strength and cardiovascular fitness (2-km walk test) were also assessed. Training effects on outcome variables were estimated by two-way factorial ANCOVA using the study group and menopausal status as fixed factors. Bone structural strength was better maintained among the trainees. At the femoral neck, there was a small but significant 2% training effect in the bone mass distribution (p=0.05). At the tibial diaphysis, slight 1% to 2% training effects (p=0.03) in total cross-sectional area and bone structural strength were observed (p=0.03) among the postmenopausal trainees. Also, 3% to 4% training effects were observed in the figure-8 running time (p=0.03) and grip strength (p=0.01). In conclusion, vigorous aerobic impact exercise training has potential to maintain bone structural strength and improve physical performance among breast cancer survivors.

Cancer morbidity in a cohort of 9175 Finnish women treated for infertility.

BACKGROUND: Results of earlier studies on cancer risk in infertile women are inconsistent for many cancer types. Our goal was to study cancer incidence among a cohort of women treated with IVF, including ICSI and frozen embryo transfer (FET), compared with that of a control population. METHODS: A cohort of women who purchased drugs for IVF (including ICSI and FET treatments, n= 9175) in the period 1996-1998 in Finland (later called IVF women) and their age and residence-matched controls further adjusted for socio-economic position and marital status were linked to the Finnish Cancer Registry 1996-2004. RESULTS: The overall cancer incidence and combined incidence of hormonal-related breast, uterine and invasive ovarian cancers were similar among IVF women and controls. IVF women had statistically significantly less cervical cancer [odds ratio (OR): 0.51, 95% confidence interval (CI): 0.30-0.85], but more skin cancers other than melanoma (OR: 3.11, 95% CI: 1.02-9.6). IVF women had three times more invasive ovarian cancers than controls, but this difference was not statistically significant, possibly due to the small number of cases. IVF women had slightly fewer breast cancers but difference was likewise not statistically significant. All cases of pulmonary cancer were diagnosed among controls (P= 0.03). CONCLUSIONS: General cancer risk or risk of hormonal-related cancers in women was not increased by IVF. The differences in certain cancers suggest a healthy patient effect or may be partly caused by residual socio-economic differences. More large studies and reanalysis of existing studies are needed to evaluate cancer risk among infertile women by subgroups regarding the cause of infertility. When evaluating risk of cancer after drug exposure, dosage and the use of different medicaments should be taken into consideration.

Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial.

UNLABELLED: The ability of combined step aerobic- and circuit-training to prevent bone loss after breast cancer treatments was related to skeletal site and patients' menopausal status. Among premenopausal breast cancer survivors, a 12-month exercise intervention completely prevented bone loss at the femoral neck, whereas no exercise effect was seen at lumbar spine or at neither site in postmenopausal women. INTRODUCTION: The primary objective of this randomised clinical trial was to determine the preventive effect of supervised weight-bearing jumping exercises and circuit training on bone loss among breast cancer patients. METHODS: Of 573 breast cancer survivors aged 35-68 years randomly allocated into exercise or control group after adjuvant treatments, 498 (87%) were included in the final analysis. The 12-month exercise intervention comprised weekly supervised step aerobic- and circuit-exercises and similar home training. Bone mineral density (BMD) at lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical performance was assessed by 2-km walking and figure-8 running tests, and the amount of physical activity was estimated in metabolic equivalent-hours/week. RESULTS: In premenopausal women, bone loss at the femoral neck was prevented by exercise, the mean BMD changes being -0.2% among the trainees vs. -1.4% among the controls (p = 0.01). Lumbar bone loss could not be prevented (-1.9% vs. -2.2%). In postmenopausal women, no significant exercise-effect on BMD was found either at the lumbar spine (-1.6% vs. -2.1%) or femoral neck (-1.1% vs. -1.1%). CONCLUSIONS: This 12-month aerobic jumping and circuit training intervention completely prevented femoral neck bone loss in premenopausal breast cancer patients, whereas no effect on BMD was seen in postmenopausal women.

Hormonal contraception and mental health: results of a population-based study.

BACKGROUND: The effects of oral contraceptives (OCs) on mental health are not clear, and no study has been focused on the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on mental health. The aim of this study was to analyse the association between the use of OCs and the LNG-IUS and psychological well-being and psychopathology. METHODS: The associations between the current use of OCs and the LNG-IUS, and their duration versus mood symptoms [Beck Depression Inventory (BDI)], psychological well-being [(General Health Questionnaire-12 (GHQ-12)] and recent psychiatric diagnoses [(Composite International Diagnostic Interview (CIDI)] were examined among women who participated in the Finnish-population-based Health 2000 study. Analyses were performed on the 30- to 54-year-old sample (n = 2310); some of the analyses were extended to include the younger age group (18- to 54-year-old sample; n = 3223). RESULTS: Overall, hormonal contraception was well tolerated with few significant effects on psychological well-being. The length of OC use was inversely associated with some BDI items ('dissatisfaction, irritability, lost interest in people, earlier waking and lost interest in sex'), and directly associated with 'worries about one's health' (BDI) and with a current diagnosis of 'alcohol dependence' (CIDI). The current use of the LNG-IUS was inversely associated with 'earlier waking' (BDI) and with 'impaired concentration' (GHQ), while the length of LNG-IUS use was inversely associated with 'strain' (GHQ). CONCLUSIONS: The influence of hormonal birth control on mental health is modest and mainly favourable. The length of current OC use seems to have some beneficial effects on mood although the longer the duration of use, the greater the association with a diagnosis of alcohol dependence. Knowledge of the use of hormonal contraception might be of value when assessing psychopathology in women. The cross-sectional design, with partly retrospective data collection, precludes any causal conclusions.

Quality of life and physical performance and activity of breast cancer patients after adjuvant treatments.

OBJECTIVE: The study aimed at investigating the quality of life (QoL) and physical performance and activity, and their interrelations, in Finnish female breast cancer patients shortly after adjuvant treatments. METHODS: A total of 537 disease-free breast cancer survivors aged 35-68 years were surveyed at the beginning of a one year randomized exercise intervention. The patients were interviewed using EORTC QLQ-C30, FACIT-F, RBDI, and WHQ (for vasomotor symptoms) questionnaires. Physical performance was tested by a 2 km walking test. Physical activity was measured by a questionnaire and a prospective two-week diary. Multivariate analysis was used to study the factors associated with QoL. RESULTS: About 26% of the patients were rated as depressed, 20.4% as fatigued, and 82% suffered from menopausal symptoms. The global QoL was lower than in general population (69.4 vs 74.7, p<0.001). About 62% of the walking test results were below the population average. Fatigue (p<0.001), depression (p<0.001), body mass index (p = 0.016) and comorbidity (p = 0.032) impaired, and physical activity (p = 0.003) improved QoL. Physical activity level correlated positively to physical performance (r = -0.274, p<0.0001). CONCLUSIONS: The QoL of the patients shortly after adjuvant treatments was impaired and the physical performance poor as compared to general population. In particular, depression and fatigue were related to impaired QoL. Physical performance and activity level were the only factors that correlated positively to QoL. Thus, physical exercise could be useful in rehabilitation of cancer survivors, especially for depressed and fatigued patients.

Health and life style among infertile men and women.

OBJECTIVE: Lifetime prevalence of infertility among couples is approximately 10-15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility. DESIGN: Cross-sectional survey. SETTING: Finland. POPULATION AND METHODS: Data from a population-based survey (n=7021) was utilized. Life style of infertile men (n=289) and women (n=155) were compared to other men and fertile women. MAIN OUTCOME MEASURES: Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms. RESULTS: After adjusting for age, area and education, infertile women under 50 years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03-1.46), less saturated fat (OR 0.83, 95% CI 0.74-0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00-1.05) than fertile women. Infertile men under 50 years consumed more total fat (OR 1.06, 95% CI 1.03-1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05-1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06-1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50 years were more often current smokers than fertile women, but the differences in other age-groups were not significant. CONCLUSIONS: Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

Prevalence of menopause symptoms and their association with lifestyle among Finnish middle-aged women.

BACKGROUND AND AIM OF THE STUDY: The aim of this study is to report the prevalence of menopausal symptoms by severity among the Finnish female population and the association of their symptoms with lifestyle (smoking, use of alcohol, physical activity) and body mass index (BMI). MATERIAL AND METHODS: Health 2000 is a nationally representative population-based study of Finnish adults. Data were collected by home interview, three self-administered questionnaires and a clinical examination by a physician. This study included women aged 45-64 years (n=1427). All symptoms included menopause-specific symptoms. Both univariate analysis and a factor analysis based on symptom factors were performed by menopausal group. Multiple regression analysis included each symptom factor as a dependent variable and confounding and lifestyle factors (age, education, smoking, alcohol use, physical activity, BMI, use of hormonal replacement therapy (HRT) and chronic disease status). RESULTS: Over one-third (38%) of the premenopausal, half of the perimenopausal, and 54% of both postmenopausal and hysterectomized women reported bothersome symptoms. The difference between pre- and perimenopausal women was largest and statistically most significant in the case of back pain and hot flushes. Physically active women reported fewer somatic symptoms than did women with a sedentary lifestyle. Smoking was not related to vasomotor symptoms. CONCLUSION: Bothersome symptoms are common in midlife, regardless of menopausal status. Inverse association between physical activity and menopausal symptoms needs to be confirmed in randomized trials.

Psychiatric disorders leading to hospitalization before and after infertility treatments.

BACKGROUND: This study aimed at determining the psychiatric morbidity of women undergoing infertility treatments, before and after treatment as compared with control women. METHODS: The number of women hospitalized because of psychiatric disorders was obtained from the Hospital Discharge Register (1969-2006) in a cohort of women who purchased drugs for in vitro fertilization, intra-cytoplasmic sperm injection or frozen embryo transfer treatments (n = 9175) in 1996-1998 in Finland and their controls (n = 9175). The age- and residence-matched controls were further adjusted in the analysis for socio-economic position and marital status. RESULTS: Women with infertility treatments had fewer hospitalizations due to depression, psychotic disorders, personality disorders, anxiety disorders, bipolar disorder or mania, eating disorders, adjustment disorders and alcohol or other intoxicant abuse before their treatments than did controls. However, the difference was statistically significant only for psychotic disorders [Odds ratios (OR) 0.38, 95% confidence intervals (CI) 0.20-0.72]. Differences in hospitalization remained similar also during the 10-year post-treatment follow-up. The exceptions were increased risk of hospitalizations due to adjustment disorders (OR 3.43, 95% CI 1.03-11.4) and decreased risk of alcohol or other intoxicant abuse (OR 0.44, 95% CI 0.25-0.75) among the women with infertility treatments. The infertile women who gave birth had fewer hospitalizations for all psychiatric diagnoses than did infertile women who did not have a baby. The difference was statistically significant for anxiety disorders (OR 0.38, 95% CI 0.18-0.81), depression (OR 0.63, 95% CI 0.41-0.96) and alcohol or other intoxicant abuse (OR 0.38, 95% CI 0.18-0.80). Hospitalizations among infertile women who did not have a baby and controls were similar, with the exception of significantly more hospitalizations for psychotic disorders among controls (OR 0.38, 95% CI 0.19-0.77). CONCLUSIONS: Women treated for infertility had less serious psychiatric morbidity leading to hospitalization than did the controls, both before and after treatments, suggesting a healthy patient effect. After treatments, the risk of hospitalization due to adjustment disorders was increased among the infertile women. Having a baby after infertility treatments was associated with fewer hospitalizations following psychiatric diagnosis.

The impact of perinatal probiotic intervention on the development of overweight and obesity: follow-up study from birth to 10 years.

BACKGROUND: The achievements in combating the increasing trend of overweight and obesity have thus far been inadequate. The recently discovered instrumental role of the gut microbiota in host metabolism may offer a novel target in the prevention and management of obesity. OBJECTIVE: To evaluate the impact of perinatal probiotic intervention on childhood growth patterns and the development of overweight during a 10-year follow-up. PATIENTS AND METHODS: Altogether 159 women were randomized and double-blinded to receive probiotics (1 × 10(10) colony-forming units of Lactobacillus rhamnosus GG, ATCC 53103) or placebo 4 weeks before expected delivery; the intervention extending for 6 months postnatally. Anthropometric measurements of the children were taken at the ages of 3, 6, 12 and 24 months and at 4, 7 and 10 years in 113 (72%) children. RESULTS: The excessive weight gain was detected to be two-parted; the initial phase of excessive weight gain initiating during fetal period and continuing until 24-48 months of age and a second phase of excessive weight gain starting after the age of 24-48 months. The perinatal probiotic intervention appeared to moderate the initial phase of excessive weight gain, especially among children who later became overweight, but not the second phase of excessive weight gain, the impact being most pronounced at the age of 4 years (P=0.063, analysis of variance for repeated measures). The effect of intervention was also shown as a tendency to reduce the birth-weight-adjusted mean body mass index at the age of 4 years (P=0.080, analysis of covariance). CONCLUSIONS: Early gut microbiota modulation with probiotics may modify the growth pattern of the child by restraining excessive weight gain during the first years of life. This novel observation calls for further epidemiological and clinical trials, with precise data on early growth patterns and on confounding factors influencing weight development.

Incidence of necrotizing enterocolitis in very-low-birth-weight infants related to the use of Lactobacillus GG.

BACKGROUND: One of the five level III neonatal intensive care units (NICU) in Finland has used prophylactic Lactobacillus GG (LGG) for very-low-birth-weight (VLBW) infants since 1997. AIM: To examine retrospectively the incidence of necrotizing enterocolitis (NEC) in all five university hospital NICUs in Finland in relation to the use of LGG during the years each unit has belonged to the Vermont Oxford Network (VON). METHODS: The incidence of NEC was analysed from the national database and from the VON databases separately in all five level III NICUs and additionally in three groups according to the probiotic practice in the hospitals: prophylactic LGG group, probiotics 'on demand' group and no probiotics group. RESULTS: The incidence of NEC was 4.6% vs. 3.3% vs. 1.8% in the prophylactic LGG group, the no probiotics group and the probiotics 'on demand' group [corrected] respectively; p = 0.0090, chi-square. LGG had no influence on the clinical course of NEC. CONCLUSIONS: The results of this retrospective report failed to show that LGG prophylaxis protects VLBW infants from the occurrence of NEC, in contrast to previously published results. Our results call for more research regarding effective ways to administer probiotics, including data on appropriate bacteria, strain, dose and timing of administration to achieve clinically robust effects.

Pre-eclampsia is a risk factor of carotid artery atherosclerosis.

BACKGROUND: A history of pre-eclampsia has been shown to be associated with an increased risk of subsequent coronary artery disease. The intima-media thickness of carotid arteries and the detection of plaques are useful measures as regards preclinical atherosclerosis. The aim of this study was to examine whether women with a history of pre-eclampsia more often show signs of atherosclerosis compared with 2 control groups. METHODS: We used data from a large Finnish cross-sectional health examination survey. We had women with previous pre-eclampsia (n = 35) or pregnancy-induced hypertension (n = 61) and 2 control groups. Laboratory tests and physical examination were performed. Information on reproductive and medical history was obtained at the home interview. Carotid atherosclerosis was assessed by ultrasonography. RESULTS: The women with previous pre-eclampsia had significantly (p = 0.008) more atherosclerotic plaques than the healthy parous controls. The intima-media thickness in the women with previous pre-eclampsia also tended to be higher than in the other groups, although the differences did not reach statistical significance. In logistic regression analysis, advanced age (OR: 1.08; 95% CI: 1.04-1.13; p < 0.001) and pre-eclampsia (OR: 3.63; 95% CI: 1.50-8.79; p = 0.004) were independent risk factors as regards plaque, and in linear regression analysis advanced age (estimate: 0.012; 95% CI: 0.010-0.014; p < 0.001), HDL cholesterol (estimate: -0.049; 95% CI: -0.088 to -0.010; p = 0.013), systolic blood pressure, BMI (estimate: 0.005; 95% CI: 0.000-0.009; p = 0.043) and high-sensitivity C-reactive protein (estimate: -0.003; 95% CI: -0.007 to -0.000; p = 0.048) were independent risk factors with respect to intima-media thickness. CONCLUSIONS: Our data suggest that pre-eclampsia is an independent risk factor as regards developing plaque later in life.

Success of infertility treatments in Finland in the period 1992-2005.

OBJECTIVES: The objective was to study the success rates of infertility treatments in the period 1992-2005 in public and private clinics. STUDY DESIGN: Aggregate IVF statistics (1992-2005) and nationally representative cross-sectional survey (2002). RESULTS: The success rates of infertility treatments remained stable, despite a substantial increase in single-embryo transfers. In 2005, the clinical pregnancy rate was 23/100 initiated cycles and a live birth rate of 17/100 cycles. The proportions of term singletons and singletons weighing at least 2500g improved over time and both rates were 14/100 in 2005. Pregnancy rates improved most among older women during the study period. The success rate in the private sector was significantly better than that in the public sector among women younger than 35 years. CONCLUSION: The single-embryo policy has not decreased pregnancy and birth rates. The proportions of term singletons per initiated cycle and singletons weighing at least 2500g per initiated cycle have improved over time. The higher success rate in the private sector may be because of different clientele.

Diagnosis and treatment of menorrhagia.

One-third of all women experience heavy menstrual bleeding at some point in their life. In western countries, about 5% of women of reproductive age will seek help for menorrhagia annually. Half of all women who consult for hypermenorrhea have some uterine abnormality, most often fibroids (among patients under 40 years of age) and endometrial polyps (above 40 years of age). Appropriate treatment considerably improves the quality of life of these patients, and it is important to make a rigorous assessment of the patient to provide the best treatment options. This guideline provides instructions on how to examine and treat women of fertile age who have menorrhagia. The subject's own assessment of the amount of menstrual blood loss does not generally reflect the true amount. All patients should undergo a pelvic examination and, if the menstrual pattern has changed substantially or if anaemia is present, a vaginal sonography should be carried out as the most important supplemental examination. Vaginal sonography combined with an endometrial biopsy is a reliable method for diagnosing endometrial hyperplasia or carcinoma, but it is insufficient for diagnosing endometrial polyps and fibroids; these can be diagnosed more reliably by sonohysterography or hysteroscopy. Non-steroidal anti-inflammatory drugs and tranexamic acid reduce menstrual blood loss by 20-60%, and the effectiveness of a hormonal intrauterine system (IUS) is comparable with that of endometrial ablation or hysterectomy. Cyclic progestogens do not significantly reduce menstrual bleeding of women who ovulate. Treatment should be started with one of the drug therapies, i.e. the IUS, tranexamic acid, anti-inflammatory drugs, or oral contraceptive. Drug treatment should be used and evaluated before surgical interventions are considered. With an effective training and feedback system, it is possible to organise the diagnostics, medical treatment and follow-up of heavy menstrual bleeding in the primary health care setting or in outpatient clinics, which reduces the burden on specialist health care.

Preventing excessive weight gain during pregnancy - a controlled trial in primary health care.

OBJECTIVE: To investigate whether individual counselling on diet and physical activity during pregnancy can have positive effects on diet and leisure time physical activity (LTPA) and prevent excessive gestational weight gain. DESIGN: A controlled trial. SETTING: Six maternity clinics in primary health care in Finland. The clinics were selected into three intervention and three control clinics. SUBJECTS: Of the 132 pregnant primiparas, recruited by 15 public health nurses (PHN), 105 completed the study. INTERVENTIONS: The intervention included individual counselling on diet and LTPA during five routine visits to a PHN until 37 weeks' gestation; the controls received the standard maternity care. RESULTS: The counselling did not affect the proportion of primiparas exceeding the weight gain recommendations or total LTPA when adjusted for confounders. The adjusted proportion of high-fibre bread of the total weekly amount of bread decreased more in the control group than in the intervention group (difference 11.8%-units, 95% confidence interval (CI) 0.6-23.1, P=0.04). The adjusted intake of vegetables, fruit and berries increased by 0.8 portions/day (95% CI 0.3-1.4, P=0.004) and dietary fibre by 3.6 g/day (95% CI 1.0-6.1, P=0.007) more in the intervention group than in the control group. There were no high birth weight babies (>or=4000 g) in the intervention group, but eight (15%) of them in the control group (P=0.006). CONCLUSIONS: The counselling helped pregnant women to maintain the proportion of high-fibre bread and to increase vegetable, fruit and fibre intakes, but was unable to prevent excessive gestational weight gain.

Effect of hysterectomy on incidence trends of endometrial and cervical cancer in Finland 1953-2010.

The hysterectomy-corrected age-adjusted incidence rate of endometrial cancer was 29%, and for cervical cancer 11% higher than the uncorrected rate. Correction factors for such cancer sites are recommended for regular use. The levelling-off of the incidence of endometrial cancer appears to be an artefact caused by the increasing prevalence of hysterectomy.

Pregnancy weight gain from 1960s to 2000 in Finland.

OBJECTIVE: To study secular trends in average pregnancy weight gain between the 1960s and 2000 in Finland, and whether the changes were related to body mass index (BMI), age or parity. DESIGN: Three cross-sectional population surveys in Finland from three different periods. SUBJECTS: Women who were pregnant in Helsinki in the period 1954-1963 (N=2262), or in Tampere in the period 1985-1986 (N=1771) or in 2000-2001 (N=371). MEASUREMENTS: Pregnancy weight gain was determined from self-reported prepregnancy weight and measured weights during pregnancy. RESULTS: The mean age and prepregnancy BMI of all pregnant women increased between the 1960s and 2000 (from 26.5 to 29.6 y, from 21.9 to 23.7 kg/m(2)). The mean pregnancy weight gain, adjusted for mother's age, BMI and parity, increased from the 1960s to the mid-1980s from 13.2 to 14.3 kg. The increase was observed in all BMI categories. Compared to the 1960 cohort, the proportion of women with a pregnancy weight gain of less than 10 kg decreased and the proportion of women with a weight gain of 15 kg or more increased in the 1980 cohort. After the mid-1980s, the average pregnancy weight gain remained the same. In all cohorts, overweight women gained least weight during pregnancy, but age and parity were not associated with BMI and parity-/age-adjusted pregnancy weight gain. Higher pregnancy weight gain was associated with higher mean child's birthweight and higher proportion of high birthweight babies in all cohorts. CONCLUSIONS: The mean pregnancy weight gain has increased since the 1960s, which may be of importance with regard to the development of later obesity. Factors other than changes in prepregnancy BMI, age and parity must explain the increased pregnancy weight gain over time.

Associations between health-related behaviors: a 7-year follow-up of adults.

BACKGROUND: The study examines pairwise associations between smoking, alcohol use, physical activity, dietary behavior and body mass index using long-term follow-up data of Finnish adults. METHODS: Respondents to large nationwide health behavior surveys conducted in 1989/1990 were recontacted in 1997. First, we examined whether each health behavior predicted other behaviors 7 years later. Second, we examined whether changes in each health behavior were accompanied by changes in other behaviors. RESULTS: Smoking at baseline predicted all other health behaviors except body mass index in men. On the other hand, other behaviors tended to predict smoking. Physical inactivity and unhealthy diet were predictive of each other in men. Those with an unhealthy diet at baseline were less likely to be high alcohol users in the follow-up. Baseline body mass index did not predict any of the other behaviors. Concurrent changes in health behaviors involved either smoking or body mass index. Changes in diet and alcohol use were differently related to changes in body mass index in men than in women. CONCLUSIONS: Overall, smoking seemed to play a central role in the associations between health behaviors. Smoking was predictive of most other health behaviors. Concurrent changes in health behaviors related either to smoking or to body weight. The associations between health behaviors were fairly similar for men and women, but the variation in the associations between body mass index and some other health behaviors suggests gender differences in the behavioral response to body weight.