Prevalence and incidence of Parkinson's disease in The Faroe Islands

Objective –  A study in The Faroe Islands in 1995 suggested a high prevalence of idiopathic Parkinson's disease (IPD) and total parkinsonism of 187.6 and 233.4 per 100,000 inhabitants respectively.
Methods –  Detailed case-finding methods 10 years later were used and a neurologist has verified the diagnosis.
Results –  The crude prevalence of IPD and total parkinsonism was 206.7 per 100,000 and 227.4 per 100,000 respectively. The age-adjusted prevalence is twice as high as data from Norway and Denmark. Age at initiation of treatment and the fatality rate did not explain the increased prevalence. During 1995–2005, the average annual incidence was 21.1 per 100,000 persons for Parkinson's disease, and 22.9 per 100,000 persons, if including atypical parkinsonism.
Conclusion –  The high prevalence was verified and linked to a high incidence. The cause of the high prevalence is unknown, but neurotoxic contaminants in traditional food may play a role in the pathogenesis in this population, perhaps jointly with genetic predisposition.     

Multiple sclerosis incidence in the Faroe Islands 1986–2007

Joensen P. Multiple sclerosis incidence in the Faroe Islands 1986–2007. Acta Neurol Scand: 2010: 121: 348–353.
© 2009 The Author Journal compilation © 2009 Blackwell Munksgaard. Objective – Epidemiological studies of the isolated Faroese population in 1945 identified a high annual incidence of multiple sclerosis (MS) of 10/100,000. At the time, there was speculation that the disease was brought to the country by British occupation forces resident in the islands from 1940 to 1945. The objective of the current study is to determine the incidence of diagnosis of MS in the Faroe Islands during the period 1986–2007. Methods – All patients in the Faroe Islands diagnosed with MS from July 1, 1986 to July 1, 2007 are documented in the current longitudinal, prospective study. The diagnosis is based on clinical observation, magnetic resonance imaging scanning, cerebrospinal fluid tests, and visual evoked potential response testing. Results – The incidence of MS during the period 1986–2007 is 4.5/100,000 annually. This is generally of the same order of magnitude as other research findings in Scandinavia and Iceland. The incidence of MS from 1986 to 2007 is about double the incidence in the Faroe Islands for the period from 1940 to 1986, calculated to be 2.7/100,000 annually. Conclusion – The observed incidence of MS in the Faroe Islands, where the population is genetically homogeneous and where the diet exposes the population to neuro‐toxic contamination, is at the same level as found in other high‐risk regions. The former detected epidemics of MS in Faroe Islands seems apparently to have leveled out and could not be recognized in the recent period covered by the present survey.     

Multiple sclerosis in the Faroe Islands

Detailed questionnaires were completed in 1978–79 by 23 of the 28 then known resident Faroese multiple sclerosis (MS) patients and 127 controls. These controls were divided into 69 Group A (patient sibs and other relatives), 37 Group B (matched neighbor controls, their spouses and sibs, plus patient's spouse), and 21 Group C (distant matched controls, spouses, relatives living where MS patients never resided and British troops were not encamped during the war). No differences between cases and controls were found for education, occupation, types of residence, bathing, sanitary or drinking facilities, and nature of house construction or heating. Detailed dietary histories, available for half the subjects, revealed no difference, cases versus controls, for four age periods between age 0 and 30 years, and for 16 specified foodstuffs. Animal exposures showed overall no consistent differences by location or type of animal. There was a tendency to greater exposure to British troops during the war for cases versus Groups A and B, but this did not attain statistical significance. Vaccinations for smallpox, tetanus and diphtheria were less common in the MS; no difference was found for other vaccinations. Except for a relative deficit in the cases for rubella and (insignificantly) for measles, mumps and chicken pox, reported illnesses were equally common among all groups. Operations, hospitalizations and injuries did not differentiate the groups, nor did age at menarche for women. Neurologic symptoms were significantly more common in the cases than in the controls.     

Involuntary commitment in Greenland, the Faroe Islands and Denmark.

Greenland, the Faroe Islands and Denmark have common legislation and registration for involuntary commitment. Commitment rates were calculated based on information from the Danish psychiatric register for 1984-1988. Direct standardization with the Danish male and female population as a standard population (1984-1988) was carried out to evaluate differences in rates. An increased risk of commitment was found in Greenland, where the crude commitment rate was 43.5 commitments per 100,000 inhabitants. The commitment rate on the Faroe Islands was 19.2 per 100,000 and 24.2 per 100,000 in Denmark. The relative risk of commitment in Greenland vs Denmark was 2.0 (1.6-2.4) and increased to the same extent for both sexes. Young men constituted a high-risk group for commitment in Greenland. Males between 15 and 34 years accounted for 55% of the total number of commitments in Greenland. The high relative commitment risk in Greenland is related to higher homicide rates, lower psychiatric bed availability, reduced access to psychiatric treatment, small settlements and increased alcohol consumption and violence than in Denmark.     

Familial aggregation of Parkinson's disease in the Faroe Islands

The Faroe Islands are a geographic population isolated in the North Atlantic with a high prevalence of Parkinson's disease (PD). Although environmental risk factors are well described, the familial aggregation of PD on the Islands has yet to be explored. Complete ascertainment of all patients with PD was performed, including 217 cases and 251 control subjects. All patients were neurologically assessed and diagnosed using UK Brain Bank criteria and Hohn and Yahr staging. Comprehensive genealogical and detailed cartographic analyses were performed. Relative risk and risk ratios were calculated with respect to the general population. Patients with PD in the Faroes have a higher age at symptom onset and diagnosis than for neighboring countries. Clinically, patients are similar; however, they are more likely to have affected relatives than randomly selected control subjects, matched by sex and age. Disease is most prevalent within two geographic regions. Overall, the relative risk for PD was 2.3 (95% confidence interval [CI], 1.2‐4.3; P = 0.008) for siblings and 1.4 (95% CI, 1.01‐1.99, P = 0.04) for first cousins. The etiology and excess prevalence of PD on the Faroes is complicated. Regional and familial clustering, and subsequent segregation analysis, suggests the disease best fits a genetic etiology with limited support for an environmental contribution. Pedigree‐based analysis of PD on the Faroe Islands which has few founders and a relatively homogeneous background may elaborate on these possibilities and their joint contribution. © 2015 International Parkinson and Movement Disorder Society     

Multiple sclerosis in the Faroe Islands. 8. Notifiable diseases

Wallin MT, Heltberg A, Kurtzke JF. Multiple sclerosis in the Faroe Islands. 8. Notifiable diseases.
Acta Neurol Scand: 2010: 122: 102–109.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To seek evidence for a possible infectious origin of the type 1 epidemic of multiple sclerosis (MS) in the Faroe Islands. This began in 1943 coincident with their British military occupation throughout World War II. Materials and methods – Data obtained from the Danish National Health Service were assessed for all notifiable diseases in the Faroe Islands reported from 1900 to 1977. Results – Among 38 disorders, selective increases were found for acute infectious gastroenteritis (AIGE) and paradysentery, with outbreaks in late 1940 and in 1943 shortly after the introduction and later marked influx, respectively, of British troops. Five other infections showed elevated numbers in 1941 and 1942. Conclusions – There is a temporal association of AIGE and paradysentery in the Faroe Islands with the first arrival and later marked augmentation of British forces stationed there during the war. Rises in the incidence of other diseases in 1941–1942 seem more likely a consequence of increased foreign commercial travel by Faroese at that time.     

Incidence of amyotrophic lateral sclerosis in the Faroe Islands

Joensen P. Incidence of amyotrophic lateral sclerosis in the Faroe Islands.
Acta Neurol Scand: 2012: 126: 62–66.
© 2011 John Wiley & Sons A/S. Objectives – The establishment of variations in the incidence of amyotrophic lateral sclerosis (ALS) in the Faroese population from that found in other general populations may point to risk factors for the development of this disease among the Faroese. The aim of this study was to estimate the annual incidence of ALS during the period 1987–2009 and to compare the occurrence of ALS in the Faroe Islands with data from three European countries. Method – All Faroese patients diagnosed with ALS in this period are documented in the current longitudinal prospective study. Results – The incidence of ALS in the Faroe Islands during the period 1987–2009 is 2.6 (1.7–3.7) per 100,000 annually. The results yielded no strong evidence of a difference (P = 0.09) in the incidence of ALS between Faroe Islands and Europe. The sample population is small, and this, of course, impacts the statistical precision of the findings. Conclusion – The data clearly suggest, however, that the Faroese population is probably not subject to an increased risk of ALS, even though certain risk factors are present in the general population: (i) a fish‐based diet contaminated with mercury and polychlorinated biphenyl; (ii) the high occurrence of the recessive carnitine transporter genetic defect; and (iii) the anticipated high degree of inbreeding at the fifth generation.     

MS in the Faroe Islands and the possible protective effect of early childhood exposure to the "MS agent"

Epidemiologic data on multiple sclerosis (MS) in the Faroe Islands have been interpreted by the original investigators as supporting a particular infectious disease model. They suggest that MS occurs as a late consequence of extended exposure to an infectious agent which cannot be transmitted to subjects younger than 11 years of age. However, the Faroes data may better fit an alternate model, in which MS results from delayed primary exposure to an infectious agent which more commonly produces benign illness and protection against MS in subjects who are exposed in infancy or early childhood.     

First admissions for psychiatric disorders. A comparison between the Faroe Islands and Denmark

Historical accounts emphasize a high rate of mental morbidity in the Faroe Islands compared with Denmark. As prerequisites for a comparative investigation are now present, we have compared a 10-year period of first admission rates in both areas. We found a lower rate for the Faroes generally, in particular for women, for the age group 30-64, and also for the majority of diagnostic groups. The group manic-depressive psychosis come closest to Danish conditions, followed by reactive psychosis and alcohol and drug abuse. The greatest difference was found for the groups personal disorders, neuroses, and schizophrenia.     

Autism spectrum disorder in Chinese populations: A brief review

This review summarizes the published work on the prevalence and incidence rates of autism spectrum disorder (ASD) in Chinese populations. The authors searched MEDLINE, Web of Science and the PsycINFO database and identified seven studies that were published in the English language. In mainland China, Li and colleagues reported an autism prevalence rate of 2.38/10,000 but admitted the possibility of underestimation. A higher prevalence of 11/10,000 was reported by Zhang and Ji based on a survey that was conducted in Tianjin, China. In Taiwan, Chien and colleagues reported that the cumulative prevalence of ASD increased from 1.79 to 28.72/10,000 from 1996 to 2005 and the annual incidence rate increased from 0.91 to 4.41/10,000 per year from 1997 to 2005. Another study based on the Taiwan national health insurance database reported a high prevalence rate of 122.8/10,000 for the year 2007. Two studies based on the Taiwan national disability registry data reported an increasing trend of ASD for the period 2000–2007 and 2004–2010, respectively. In Hong Kong, Wong and colleagues estimated that the incidence of ASD was 5.49/10,000 and the average prevalence over the 1986–2005 period was 16.1/10,000. We identified 12 studies through the searching of Chinese databases. The prevalences among these studies varied from 2.8 to 29.5/10,000. While existing data appear to suggest, it remains unclear whether there is a true rise in the prevalence of ASD in ethnic Chinese population across geographic sites. More collaborative research on this topic should be conducted in the future.     

Autism and Related Disorders: Epidemiological Findings in a Norwegian Study Using ICD-10 Diagnostic Criteria

Recent studies of the prevalence of autism have suggested higher estimates than previously described. Various diagnostic criteria for autism and related disorders have been applied, with variability in case finding methodology and characteristics of populations as well. In this study, maternal and child health clinics covering 98% of the population were used for screening pervasive developmental disorders. Extensive medical investigation was carried out on the majority of cases. In this Norwegian population of children ages 3–14 years the minimum prevalence estimate for childhood autism was 4–5 per 10,000 using ICD-10 research criteria, and did not confirm the high estimates suggested more recently. Medical disorders identified were associated with mental retardation rather than specifically with autism.     

An Assessment of Food Acceptance in Children with Autism or Pervasive Developmental Disorder-Not Otherwise Specified

Some children with autism and pervasive developmental disorder-not otherwise specified (PDD-NOS) have been reported to have atypical feeding behavior, such as sensitivity to food texture and selective preferences for particular foods. No systematic studies of feeding behavior in this population have been published. Munk and Repp (1994) developed methods for assessing feeding problems in individuals with cognitive and physical disabilities that allow categorization of individual feeding patterns based on responses to repeated presentations of food. In this study, we systematically replicated the Munk and Repp procedures with children with autism and PDD-NOS. Thirty children, ages 3 to 14 years, were exposed to 12 food items across 6 sessions. Food acceptance, food expulsion, and disruptive behavior were recorded on a trial-by-trial basis. Approximately half of the participants exhibited patterns of food acceptance, indicating selectivity by food category or food texture. Others consistently accepted or rejected items across food categories. Whether these patterns of food acceptance are atypical remains to be determined by comparison with the feeding patterns of typically developing children and other children with developmental delays.     

The Epidemiological Study of Autism in Fukushima-ken

Abstract: A survey of children aged under 18 years in Fukushima-ken (prefecture) in Japan showed that 2.33 per 10,000 children suffered from early infantile autism. The average of prevalence rates of autistic children born between 1968 and 1974 was 4.96 per 10,000 children. Based on a comparison between cities and rural districts, the prevalence rates of the former were significantly higher than those of the latter. Autistic boys outnumbered autistic girls with a sex ratio of 9: 1. Psychiatric illnesses; were very rare among the relatives of autistic children. The rate of prenatal and perinatal complications was higher than the national norm among autistic children. Parents of autistic children had a significantly higher education than the national norm. There were more nuclear families in the autistic group than in the national norm.     

Autism spectrum disorder and fetal alcohol spectrum disorder. Part I: A comparison of parenting stress

Abstract

Background There is a long history of research on parents of children with disabilities, but to the authors’ knowledge, no study has compared the stress of parents of children with fetal alcohol spectrum disorder (FASD) to parents of children with autism spectrum disorder (ASD).

Method Twenty-five parents of children with ASD and 25 parents of children with FASD completed the Parenting Stress Index – Short Form (PSI-SF) and the Questionnaire on Resources and Stress – Friedrich's Version (QRS-F).

Results Although both parent groups reported elevated stress, PSI-SF results indicated that parents of children with FASD were experiencing significantly more stress compared to parents of children with ASD. No significant differences were found between groups on the total QRS-F, but parents of children with FASD had higher scores on the Pessimism subscale.

Conclusions The authors call for measures grounded in theory as well as mixed methods research that includes the subjective experience of parents’ stress.     

Multiple sclerosis in the Faroe Islands IV. The lack of a relationship between canine distemper and the epidemics of MS

Clinical onset of multiple sclerosis (MS) occurred in 32 native resident Faroese between 1943 and 1973, comprising 3 consecutive epidemics of decreasing frequency. Relationship of MS with the appearance of canine distemper (CD) was explored by serologic studies, questionnaires, and veterinarian reports. Tested were sera from 12 MS patients and 112 controls among the 22 patients and 192 controls with questionnaires in 1978-1979. The daily treatment ledgers of the Veterinarian of the Faroes 1940-1961 were also reviewed and additional Faroese interviewed 1987-1988 as to CD. History of CD was determined for residence of all 32 MS. There was no evidence of elevated CD antibody titers in MS vs controls for neutralizing titers or ELISA values, nor to ELISA for measles. In the questionnaires only one patient and 2 of his sibs reported owning (the same) dog(s) with CD during the war. One other patient reported a possibly sick dog but not CD. CD occurred in one southern village 1941-1942, was present on Vágar from 1941-1950, and was epidemic on Streymoy 1944-1945 with scattered cases there and elsewhere through 1950. There was no significant correlation between villages with CD and MS residents. We conclude that the occurrence of multiple sclerosis was not related to the presence of canine distemper or sick dogs in the Faroe Islands.     

Autism spectrum disorder and fetal alcohol spectrum disorder. Part II: A qualitative comparison of parenting stress

Abstract

Background Researchers investigating the impact of parenting children with disabilities suggest that regardless of the specific diagnosis, parents experience increased levels of stress. However, particular disabilities may be associated with distinct stressors and strains.

Method Parents of children with autism spectrum disorder (ASD) and parents of children with fetal alcohol spectrum disorder (FASD) participated in in-depth qualitative interviews employing a basic interpretative approach.

Results Both groups described some similar stressors, such as multi-tasking, the diagnostic process, and dealing with behavioural issues, but there are distinct differences between families of children with FASD and families of children with ASD. Whereas parents of children with FASD focused on their children's illegal behaviours, parents of children with ASD struggled with their children's tantrums and anxieties.

Conclusions Supports must be tailored to meet the specific needs of parents of children with different types of disabilities.