Type 1 and type 2 diabetes among young adults in Finland : Incidence and perinatal exposures

This study aimed to examine the incidence of young adult-onset T1DM and T2DM among Finns, and to explore the possible risk factors for young adult-onset T1DM and T2DM that occur during the perinatal period and childhood. In the studies I-II, the incidence of diabetes was examined among 15-39-year-old Finns during the years 1992-2001. Information on the new diagnoses of diabetes was collected from four sources: standardized national reports filled in by diabetes nurses, the Hospital Discharge Register, the Drug Reimbursement Register, and the Drug Prescription Register. The type of diabetes was assigned using information obtained from these four data sources. The incidence of T1DM was 18 per 100,000/year, and there was a clear male predominance in the incidence of T1DM. The incidence of T1DM increased on average 3.9% per year during 1992-2001. The incidence of T2DM was 13 per 100,000/year, and it displayed an increase of 4.3% per year. In the studies III-V, the effects of perinatal exposures and childhood growth on the risk for young adult-onset T1DM and T2DM were explored in a case-control setting. Individuals diagnosed with T1DM (n=1,388) and T2DM (n=1,121) during the period 1992-1996 were chosen as the diabetes cases for the study, and two controls were chosen for each case from the National Population Register. Data on the study subjects parents and siblings was obtained from the National Population Register. The study subjects original birth records and child welfare clinic records were traced nationwide. The risk for young adult-onset T2DM was the lowest among the offspring of mothers aged about 30 years, whereas the risk for T2DM increased towards younger and older maternal ages. Birth orders second to fourth were found protective of T2DM. In addition, the risk for T2DM was observed to decrease with increasing birth weight until 4.2 kg, after which the risk began to increase. A high body mass index (BMI) at the BMI rebound between ages 3-11 years substantially increased the risk for T2DM, and the excess weight gain in individuals diagnosed with T2DM began in early childhood. Maternal age, birth order, or body size at birth had no effect on the risk for young adult-onset T1DM. Instead, individuals with T1DM were observed to have a higher maximum BMI before the age of 3 than their control subjects. In conclusion, the increasing trend in the development of both T1DM and T2DM among young Finnish adults is alarming. The high risk for T1DM among the Finnish population extends to at least 40 years of age, and at least 200-300 young Finnish adults are diagnosed with T2DM every year. Growth during the fetal period and childhood notably affects the risk for T2DM. T2DM prevention should also target childhood obesity. Rapid growth during the first years of life may be a risk factor for late-onset T1DM.

Stadilaispojat, rikokset ja lastensuojelu : Viisi tapaustutkimusta kuudelta vuosikymmeneltä

Societal reactions to norm breaking behavior of children reveal, how we understand childhood, the relations between generations and communitie's ratio of tolerance. In Finland the children that repeatedly commit crimes receive social service measures that are based on Child Welfare Act. In the city of Helsinki (Stadi in the slang of Helsinki) existed an agency specifically established for ill-behaving children until the 1980's, agter which an unified agency for the maltreated and maladjusted children was founded. Through five boys' welfare cases, this research aims at defining what kind of positions, social relations and structures are constructed in the social dynamics of these children's everyday lives. The cases cover different decades from the 1940s to the present. At the same time the cases reflect the child welfare and societal practices, and reveal how the communities have participated in constructing deviance in different eras. The research is meta-theoretically based on critical realism and specifically on Roy Bhaskar's transformative model of social activity. The cases are analyzed in the framework of Edwin M. Lemert's societal reaction theory. Thus the focus of the study is on the wide structural context of the institutional and societal definitions of deviance. The research is methodologically based on a qualitative multiple case study research. The primary data consist of classified child welfare case files collected from the archives of the city of Helsinki. The data of the institutional level consist of the annual reports from 1943 to 2004 and the ordinances from 1907 onwards, and of various committee documents produced in the law-making process of child welfare, youth and criminal legislation of the 20th century. Empirical finding are interpreted in a dialogue with previous historical and child welfare research, contemporary literature and studies on the urban development. The analysis is based on Derek Layder's model of adaptive theory. The research forms a viewpoint to the historical study of child welfare, in which the historical era, its agents and the dynamics of their mutual relations are studied through an individual level reconstruction based on the societal reaction theory. The case analyses reveal how the positions of the children form differently in the different eras of child welfare practices. In the 1940s the child is positioned as a psychopath and a criminal type. The measures are aimed at protecting the community from the disturbed child, and at adjusting the individual by isolation. From 1960s to 1980s the child is positioned as a child in need of help and support. The child becomes a victim, a subject that occupies rights, and a target of protection. In the turn of the millennium a norm breaking child is positioned as a dangerous individual that, in the name of the community safety, has to be confined. The case analyses also reveal the prevailing academic and practical paradigms of the time. Keywords: childhood, youth, child protection, child welfare, delinquency, crime, deviance, history, critical realism, case study research

Lapsen osallisuuden mahdollistaminen päiväkodin toimintakulttuurissa : Tilastollinen tutkimus osallisuuden tasomallista

Children s participation has been a subject in the international research since past ten years. This research has explored participation from the standpoint of the UN s Convention of the Rights of the Child and focused mainly on schoolchildren or on the working youth s chances in developing countries to have impact on their own lives (eg. Sinclair, 2004 and Thomas, 2002). In Finland there has been less research about the children s rights while the main focus has been on the customers of the child welfare system. This study examines children s participation in Helsinki metropolitan area via the views and the practices of the personnel of early childhood education. The adopted viewpoint is Shier s level model of participation (2001), in which the children s participation process is building in phases, is observed via the everyday actions of the kindergarten personnel. Attention has been paid on the special characteristics of the Finnish early childhood education. This study was part of VKK-Metro s research project. The inquiry in May 2010 was directed to all working teams in the kindergartens of the Helsinki metropolitan area. Of these 56.59 % (1116 teams) answered. The quantitative data analyzed by principal component analysis gave four principal components, from which three were named after Shier s participation model. The fourth component included variables about rules and power. The level model of participation fit well to assess early childhood education in the Helsinki metropolitan area. The professionalism of the personnel became emphasized in the area of everyday interactions between the personnel and the children. Important aspects of the children s participation are to become heard, to get support in the play and in interaction and to be able to share both power and responsibility with personnel of the early childhood education.

Depression and Cognition in Type 2 Diabetes from a Life Course Perspective

Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.