Functional abilities of elderly coronary heart disease patients

The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease. The aim of our study was, firstly, to describe functional abilities among elderly CHD patients and, secondly, to analyze the relationships between physical disability and the severity of chest pain or dyspnea. The third aim was to assess whether there is an independent association between physical disability and CHD. The study was carried out at the health center of the municipality of Lieto, southwestern Finland. From a population of 1196 community-dwelling persons aged > or = 64 years, 89 men and 73 women with CHD (angina pectoris and/or a past myocardial infarction) were selected along with 178 male and 146 female sex- and age-matched controls without CHD. Physical functioning was assessed by means of interviewer-based questionnaires, compared between patients and controls and described in relation to the severity of chest pain and dyspnea among patients. The associations between dependence or difficulties in mobility, ADL (activities of daily living) and IADL (instrumental activities of daily living) and CHD, age, smoking, comorbidities, drug therapy and clinical characteristics were assessed by logistic regression analyses. On items representing mobility and managing in IADL, patients reported more difficulties or dependence than controls. Among female patients, more severe chest pain was associated with poor managing in IADL and tended to be associated with poor mobility. More severe dyspnea was associated with poor mobility among both male and female patients, and with poor managing in IADL among male patients. Logistic regression analyses failed to show that CHD was associated independently with physical disability among the elderly. However, physical disability was associated with the use of cardiovascular drugs in the models among both genders, which probably indirectly indicated an association between physical disability and CHD. Several confounding factors, such as higher age, depression, cancer and the use of psychotropic drugs, contributed to the decline in functional abilities even among persons with CHD. In conclusion, elderly CHD patients have greater limitations in their functional ability than matched controls, which may depend on the severity of the disease. Especially male patients' limitations in physical abilities may be influenced by the fact that men with CHD are more likely to be depressed. Although an independent association between physical disability and CHD was not found, the associations found between physical disability and the use of cardiovascular drugs probably indicate a causal relationship between CHD and physical disability.

Relationships between infant temperament, demographic variables, and family dynamics of childrearing families

Relationships between infant temperament, demographic variables, and family dynamics of child-rearing families were investigated in this study. The revised Infant Temperament Questionnaire (RITQ), the Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were sent to 118 families who had participated in the first stage of the study as child-bearing families. About 8 months after childbirth 96 mothers and 95 fathers completed the questionnaires. The characteristics of infant temperament and demographic variables related to the variance of dimensions of family dynamics. Characteristics of the temperamentally easy baby related to more positive family dynamics perceived by child-rearing parents. Fathers rearing their first child reported that their families functioned better than fathers with their second infant. In child health clinics families rearing their second child should also be supported, especially families with arrhythmic and negative mood infants.

Growth of prepubertal children with inflammatory bowel disease

BACKGROUND

Growth retardation has been reported in children with chronic inflammatory bowel disease, especially in those with Crohn's disease. Most of these studies concern adolescent patients.

METHODS

The growth of 47 prepubertal children (20 boys and 27 girls, mean age at diagnosis 7 years) with inflammatory bowel disease was studied at Tampere University Hospital, Department of Paediatrics. The mean height and height velocity standard deviation scores were calculated at diagnosis and, after that, yearly. The cumulative doses of oral and rectal prednisone per year were calculated. The severity of the disease was scored. The statistical analysis was carried out using the analysis of variance for repeated measurements.

RESULTS

During the year preceding the diagnosis, children with inflammatory bowel disease had grown more slowly than their healthy peers. At diagnosis, they were slightly shorter as a group than are healthy children. During treatment and follow-up the mean height velocity of children with inflammatory bowel disease increased (change in the mean height velocity standard deviation scores from -0.84 to +1.08), normalizing the mean heights of these children compared with those of their healthy peers (change in the mean height standard deviation scores from -0.32 to +0.05). In the analysis of covariance, the poorest growth was seen in children with Crohn's disease, scored as severe, and the best growth in children with mild ulcerative colitis. No difference was seen in groups with or without prednisone treatment.

CONCLUSIONS

Growth retardation is an important sign of chronic inflammatory bowel disease in prepubertal as well as adolescent children. During treatment, increasing growth velocity brings these children as a group to normal heights for age and sex.

Disability pensions in severely disturbed in-patient adolescents. Twenty-year prospective study

BACKGROUND

Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce.

METHOD

In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up.

RESULTS

Of the former in-patients, 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity. Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder.

CONCLUSIONS

The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity. Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.

Coronary heart disease and depression in the elderly--a population-based study

BACKGROUND

Growing interest is nowadays focused on the quality of life of elderly people who survive with chronic diseases. Coronary heart disease (CHD) is one of the most common diseases among the elderly and may have an unfavourable impact on the patient's emotional well-being.

OBJECTIVES

We aimed to describe the prevalence of depression and the occurrence of depressive symptoms among elderly CHD patients, with a special emphasis on the relations between depression and the severity of CHD, and to find out the possible association between CHD and depression.

METHODS

The study was carried out at the health centre of the municipality of Lieto, in south-west Finland. The study population consisted of 488 community-dwelling men and 708 women, over 64 years old, from among whom the participants with CHD (89 men and 73 women) were selected, and for whom 178 male and 146 female sex- and age-matched controls (free of CHD) were drawn from the population. CHD patients were selected on the basis of the presence of angina pectoris or a past myocardial infarction. Depressive symptoms were measured with the Zung Self-rating Depression Scale. Depression was described in relation to the severity of dyspnoea and chest pain among patients. The associations between depression and age, health, health behaviour, drugs, functional ability and social, psychosocial and environmental factors were analysed by logistic regression analyses.

RESULTS

The prevalence of depression was 29% among male patients and 20% among female patients. Depression was significantly more common among male CHD patients than among male controls (P = 0.011). Among women, depression was not associated with CHD. Earlier, depression had gone undiagnosed among many CHD patients and controls, especially male patients. Among male CHD patients, depression was associated with more severe dyspnoea, but no similar association was found among female CHD patients. Among men the occurrence of CHD, physical disability, widowhood or divorce, and among women previous clinical depression, physical disability and the use of angiotensin-converting enzyme (ACE) inhibitors, were associated with depression.

CONCLUSION

Depression is common among patients with CHD. It seems that CHD is not an independent factor in the aetiology of depression among the elderly. The association of CHD with depression among men is explained by the acute or chronic psychic stress caused by CHD. It may be that the more complicated the patient's CHD, the more probable is the presence of depression.

Renal and cardiovascular predictors of 9-year total and sudden cardiac mortality in non-insulin-dependent diabetic subjects

BACKGROUND

The objective was to evaluate the impact of urinary albumin excretion rate (UAER), glomerular filtration rate (GFR) and subclinical autonomic neuropathy (SANP) on 9-year total (TM) and sudden cardiac mortality (SCM) in recently diagnosed (< 1 year; RD; n = 150) and known (mean duration 11 years; KD; n = 146) NIDDM subjects.

METHODS

The study was prospective and controlled (n = 150). Mortality predictors were analysed by logistic regression analysis. The dependent variables were TM and SCM, the predictors were UAER, GFR, SANP, age, gender, BMI, mean arterial pressure (MAP), fasting serum cholesterol, HDL-cholesterol, triglycerides, insulin, haemoglobin A1c, diabetes duration, QTc-interval (ECG), coronary heart disease (CHD), peripheral vascular disease (PVD), cerebrovascular disease (CVD), congestive heart failure (CHF), antihypertensive therapy, and smoking habits.

RESULTS

CHD predicted TM and SCM in both RD (P = 0.041 and 0.029) and KD (P = 0.034 and 0.006). PVD predicted TM and SCM in KD only (P = 0.001 and 0.003). CVD predicted TM and SCM in RD only (P = 0.001 and 0.017). In RD male gender (P = 0.049), fasting serum cholesterol (P = 0.007) and CHF (P = 0.001) predicted TM and in kDa haemoglobin A1c (P = 0.004), age (P = 0.001) and MAP (P = 0.014) predicted TM. Serum triglycerides predicted SCM in both RD and kDa (P = 0.001 and 0.003). SANP predicted TM (P = 0.009) and SCM (P = 0.044) in KD only. GFR (inverse value) predicted TM and SCM (P = 0.04 and 0.027) in kDa only. The UAER did not predict mortality in the diabetic subjects.

CONCLUSION

SANP and a slightly reduced GFR still in the normal range predicted mortality in KD. Microalbuminuria (30 < UAER < 300 mg/24 h) did not independently predict 9-year mortality in the NIDDM subjects studied.

Relationships between demographic variables and family dynamics of childbearing families

In this study relationships between demographic variables and family dynamics of childbearing families in Finland were studied. The sample was 160 urban families expecting their first or second child in the third trimester of pregnancy. One-hundred and eighteen families participated in the study. The Family Dynamics Questionnaire (FDQ) and the Family Dynamics Measure (FDM) were used in this study. Most expectant parents reported their family was well-functioning. Mothers of higher socioeconomic status found more flexibility in their families than mothers of lower socioeconomic status. Fathers in families expecting their first baby reported more mutuality, role reciprocity and more stability than second-time fathers. The findings contribute cues for public health nurses and midwives regarding parity, socioeconomic status and family dynamics to provide more specific family guidance during the transition to parenthood. Realistic information on the changes in family dynamics after childbirth should be given to pregnant parents.

New biomarker evidence of oxidative DNA damage in patients with non-insulin-dependent diabetes mellitus

Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) has been reported to serve as a sensitive biomarker of oxidative DNA damage and also of oxidative stress. We have investigated oxidative DNA damage in patients with non-insulin-dependent diabetes mellitus (NIDDM) by urinary 8-OHdG assessments. We determined the total urinary excretion of 8-OHdG from 24 h urine samples of 81 NIDDM patients 9 years after the initial diagnosis and of 100 non-diabetic control subjects matched for age and gender. The total 24 h urinary excretion of 8-OHdG was markedly higher in NIDDM patients than in control subjects (68.2 +/- 39.4 microg vs. 49.6 +/- 37.7 microg, P = 0.001). High glycosylated hemoglobin was associated with a high level of urinary 8-OHdG. The increased excretion of urinary 8-OHdG is seen as indicating an increased systemic level of oxidative DNA damage in NIDDM patients.

High incidence and prevalence of adult coeliac disease. Augmented diagnostic approach

BACKGROUND

The diagnosis of coeliac disease is easily overlooked as patients can present with mild or atypical symptoms, or the condition can even be clinically silent. Our aim was to detect coeliac disease patients with such atypical or no symptoms as well as those with typical features.

METHODS

The incidence of adult coeliac disease in Tampere was calculated from 1975 to 1994 and the prevalence as of 31 December 1994. Open-access endoscopy was available for general practitioners, and small-bowel biopsy was done routinely. Serologic screening was applied to patients with an increased risk of coeliac disease.

RESULTS

The incidence of coeliac disease increased tenfold, and the prevalence was 270 per 100,000 inhabitants in 1994. Twenty per cent were found by serologic screening and 10% as a result of routine biopsy; 24% had dermatitis herpetiformis.

CONCLUSIONS

Our diagnostic approach gave a coeliac prevalence similar to that found in population screening studies. One-third had silent coeliac disease.

Factors predicting fractures during falling impacts among home-dwelling older adults

OBJECTIVE

To investigate the predictors of fractures during falling impacts among home-dwelling older adults.

DESIGN

A case-control study within a prospective, population-based survey.

SETTING

Five rural municipalities in northern Finland.

PARTICIPANTS

The study population consisted of all home-dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow-up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period.

MEASUREMENTS

During a 4-year follow-up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4-year follow-up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross-tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed.

RESULTS

According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel-shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5-kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture-causing falls were frequent fear of falling (OR 2.50; CI 1.11-5.65), reduced knee extension strength (OR 3.38; CI 1.00-11.4), and poor distance visual acuity (OR 3.45; CI 1.13-10.6), whereas limited social participation (OR 0.29; CI 0.11-0.79) protected against the occurrence of fractures.

CONCLUSION

Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors.

Neurological signs in relation to cancer in patients with asbestosis

OBJECTIVE

To chart the subtle neurological abnormalities in patients with asbestosis relative to possible development of cancer.

METHODS

In 1979-81 a standardised neurological examination was made of 115 patients with asbestosis who carried a high risk of occupational cancer and their cancer morbidity was analysed 15 years later.

RESULTS

Slight disturbances of unknown aetiology were found in the central nervous system (CNS) of 33 and in the peripheral nervous system (PNS) of 41 patients. Of these 17 had disturbances of both the CNS and PNS. This cohort was followed up to the end of 1994. During this time 47 of the patients developed cancer. Statistical analyses showed that disturbances of the CNS such as psycho-organic syndrome, cerebellar dysfunction, and motor disturbances of unknown origin were significantly associated with cancer, whereas no such association was found for peripheral neuropathy. Interaction between the radiological progression of asbestosis and disturbances of the CNS was an even stronger predictor of cancer.

CONCLUSIONS

It seems that slight disturbances of the CNS are predictors of development of cancer. Whether or not these disturbances are manifestations of involvement of a paraneoplastic nervous system or some factor associated with progression of asbestosis remains open.

The effect of short-term fasting, apolipoprotein E gene polymorphism, and sex on plasma lipids

The effect of 1 wk of supervised fasting on plasma lipid concentrations in subjects with different apolipoprotein E (apo E) phenotypes was studied in 58 healthy free-living volunteers. The participants consumed an 870-kJ(208 kcal)/d liquid diet containing fruit and berry juices, tea, and water. The decline in plasma total cholesterol during 1 wk of fasting was 0.46 mmol/L in women and 0.35 mmol/L in men. The decreases were significant in both women and men. The response patterns of plasma total cholesterol were not significantly different between the sexes. In men, the changes in plasma low-density-lipoprotein cholesterol during the fast differed significantly (P = 0.0181) between the apo E phenotypes, whereas in women there were no differences due to phenotype (P = 0.695). The magnitude of the change in plasma triacylglycerol during the fast was different between the sexes (P = 0.0099). The changes in plasma triacylglycerols differed significantly between apo E phenotype groups in men (P = 0.0295) but not in women (P = 0.0661). Statistical comparison between different apo E phenotypes was performed with and without the small apo E3,2+E2,2 group, with essentially similar results. During fasting, plasma high-density-lipoprotein cholesterol concentrations decreased slightly but not significantly. The study shows significant differences in the associations of apo E alleles and sex on plasma lipid responses during fasting and illustrates the importance of gene-diet interactions in the regulation of lipid metabolism in humans.

Six-year survival of depressed elderly Finns: a community study

BACKGROUND

The 6-year survival of depressed elderly (N = 290) Finns was assessed and compared to that of a non-depressed population (N = 982), and the factors related to high mortality were analysed.

METHOD

Depression was determined according to the DSM-III criteria, and a majority of the depressed population suffered from dysthymic disorder. Survival distributions were represented as Kaplan-Meier survival curves. The Cox proportional hazards model was used to analyse the simultaneous relationships between mortality and certain variables.

RESULTS

The survival curves showed an increased mortality of the depressed elderly in both men and women. However, when the simultaneous relationships of age, marital status, education, smoking, functional abilities, somatic illnesses and depression were taken into account, depression did not predict mortality. The predictors of mortality were high age, a high number of medicines, smoking, disability, male sex and occurrence of somatic illnesses.

CONCLUSIONS

Evidence of once measured depression is not predictive of increased mortality in an unselected elderly population (60+) when the other factors known to influence survival probability are taken into account.

Psychosocial functioning in adolescent psychiatric patients: a prospective study on changes in psychosocial functioning among severely and moderately impaired adolescent out-patients

Changes in psychosocial functioning during out-patient treatment among 73 adolescent male and 100 female subjects, aged 12 to 19 years, were studied. The mean number of total treatment sessions was 15 sessions among the severely impaired and 14 sessions among the moderately impaired patients. The level of psychosocial functioning improved among the severely impaired (Global Assessment Scale (GAS) at treatment entry 3.9 vs. 4.7 at the last session, 95% CI, -1.085 to -0.577) and the moderately impaired patients (GAS 5.5 vs. 6.0, 95% CI, -0.682 to -0.355). The improvement was highly dependent on the psychiatric diagnosis. The level of psychosocial impairment improved in about two-thirds of subjects with adjustment and non-comorbid mood disorders, in about one-third of those with non-comorbid personality disorders, and in about a quarter of those with disruptive disorders. Careful diagnostic evaluation and assessment of psychosocial functioning are essential elements in the development of adolescent psychiatric services.

Effects of lifelong ethanol consumption on cerebellar layer volumes in AA and ANA rats

Aging and chronic alcohol consumption can cause degenerative changes in the cerebellar cortex. In this study, the effects of aging and lifelong alcohol consumption on cerebellar cortical layer volumes (molecular and granular) and also white matter layer volumes were studied in alcohol-preferring (AA) and nonpreferring (ANA) rats of both sexes. The ethanol-consuming animals (EtOH) had 12% (w/v) ethanol as the only available fluid from 4 to 22 months of age, whereas the young (3 month) and old controls (24 months) had only water to drink. The volumes of molecular, granular, and white matter layers of the cerebellar vermis in folia II, IV, VII, and X were measured by using systematic sampling and a point-counting method. The volumes of the granular and white matter layers showed consistent increase between 3 and 24 months of age, whereas the volume of the molecular layer remained unchanged with increasing age. Individual ethanol intake was measured over a 1-week period at the beginning and at the end of chronic ethanol exposure. Significant (ANOVA, p = 0.000) sex difference was found in the drinking behavior in both lines, with females consuming more alcohol than males (daily ethanol consumption at 22 months of age 3.2 +/- 0.3 vs. 7.1 +/- 0.3 g/kg for AA males and females; 3.2 +/- 0.3 vs. 5.4 +/- 0.4 g/kg for ANA males and females, respectively). The only ethanol-induced effect on the cerebellum was observed in ANA-EtOH females with a 15% reduction in the volumes of the molecular and granular layer in folium II compared with age-matched controls and a significant (p < 0.05, analysis of covariance with ethanol intake as a covariate) line difference in folium II (molecular and granular layers) was observed between ANA-EtOH females and AA-EtOH females. Furthermore, the volume of the molecular layer in folium II was significantly (p < 0.05, analysis of covariance with ethanol intake and body weights as covariates) reduced for ANA-EtOH females, compared with ANA-EtOH males indicating a sex difference in the cerebellar degeneration due to chronic alcohol consumption. Of the three layers studied, the white matter layer was the most resistant layer to the effects caused by chronic alcohol consumption. In view of the fact that AA and ANA rats of both sexes differ regarding the drinking behavior and ethanol metabolism, they provide an important model for further research on ethanol-induced pathological changes in the central nervous system.

Growth of asthmatic children is slower during than before treatment with inhaled glucocorticoids

Reports on the influence of inhaled glucocorticoids on growth have been controversial. We studied the growth of prepubertal asthmatic children prior to and during glucocorticoid therapy. We collected retrospectively the notes of 201 asthmatic children aged 1-11 years receiving inhaled beclomethasone dipropionate or budesonide. We calculated their height and height velocity standard deviation scores (HSDS and HVSDS, respectively) before the treatment and up to 5 years during the treatment and compared those with the growth of healthy peers. The dose of the medication was calculated and the severity of asthma was assessed. The asthmatic children grew similarly to their healthy peers before treatment with inhaled glucocorticoids: the mean HSDS was +0.02 and the mean HVSDS +0.01 for boys and -0.16 and +0.13 for girls, respectively. Growth retardation took place soon after the start of the treatment, the most profound decrease in the growth velocity (the change in the mean HVSDS from +0.05 to -0.88) occurring during the first year of treatment. The growth-retarding effect of inhaled glucocorticoids was not dose dependent. In the covariance analysis the increasing severity of asthma had a significant interaction with repeated measurements, showing more growth retardation along with more severe asthma, especially during long-term treatment. Asthma per se does not impair growth, but inhaled glucocorticoids may do so. Careful monitoring of the growth of all asthmatic children receiving inhaled glucocorticoids is necessary because the growth-retarding effect of the medication is not dose dependent. Individual sensitivity might explain the differences seen in the growth patterns of children receiving inhaled glucocorticoids.

Characteristics of out-patient adolescents with suicidal tendencies

Suicidal adolescent out-patients were compared with non-suicidal subjects with respect to background factors, psychopathology and treatment received. Data for suicidal ideation, suicide attempts, psychiatric diagnoses (DSM-III-R) and other patient-related factors were collected prospectively during treatment of 122 male and 138 female out-patients aged 12-22 years. In total, 42% of subjects displayed suicidal tendencies, and 18% had attempted suicide. According to polychotomous regression, mood disorder, previous psychiatric treatment and low level of psychosocial functioning at treatment entry were associated with suicide attempts and with suicidal ideation for both sexes. Suicidal patients were more often receiving psychotropic medication and had more total appointments (mean number 15 vs. 9) than non-suicidal patients. Suicidal and non-suicidal patients kept their scheduled appointments to the same extent (66% vs. 65%). Treatments which meet the needs of disordered suicidal adolescents need to be developed.

A randomized, controlled study of prophylactic ranitidine in preventing stress-induced gastric mucosal lesions in neonatal intensive care unit patients

OBJECTIVE

To assess endoscopically the effect of prophylactic short-term ranitidine treatment in the prevention of stress-induced gastric lesions in neonatal intensive care unit (ICU) patients.

DESIGN

Prospective, randomized study.

SETTING

Department of Neonatal Intensive Care, University Hospital of Tampere.

PATIENTS

Fifty-three infants were enrolled in a randomized, controlled study. Forty-eight (90%) of these patients underwent endoscopic examination and were evaluated.

INTERVENTIONS

A histamine-2-receptor blocker, ranitidine, was given prophylactically after birth for 4 days to infants mechanically ventilated and treated in the neonatal ICU. The gastric mucosa was both visually and histologically evaluated after 3 to 6 days, and the outcome of the infants was registered.

MEASUREMENTS AND MAIN RESULTS

In the 23 infants prophylactically treated with ranitidine, the gastric mucosa was visually classified as normal in 14 (61%) infants as compared with five (20%) of 25 controls (p < .004). Histologic lesions showed parallel results (57% vs. 16%, p < .004). Eight gastric ulcers were diagnosed endoscopically in the control group vs. none in the treatment group. The ulcers were all clinically "silent" at the time of endoscopy. According to logistic regression modeling, the decreased risk for gastric mucosal lesions in infants receiving prophylactic ranitidine was 0.03 (95% confidence interval 0.003 to 0.178). Surfactant treatment for infant respiratory distress syndrome also decreased the risk for stress-induced gastric mucosal lesions (odds ratio 0.083; 95% confidence interval 0.009 to 0.788), whereas other variables (birth weight, gestational age, Apgar scores, cord blood pH, and duration of intubation) had no significant effect. No side effects could be attributed to the ranitidine treatment.

CONCLUSION

We conclude that short-term prophylactic ranitidine treatment prevents gastric mucosal lesions in newborn infants under stress.

Gastritis classified in accordance with the Sydney system in patients with primary Sjögren's syndrome

BACKGROUND

According to some earlier reports, chronic atrophic gastritis is a common finding in Sjögren's syndrome. However, the findings are controversial. The aim of this study was to investigate the occurrence of gastritis classified in accordance with the Sydney System in patients with primary Sjögren's syndrome.

METHODS

Thirty-two consecutive patients (27 women, 5 men) with primary Sjögren's syndrome, and 64 age- and sex-matched control subjects with dyspepsia underwent gastroscopic examination. Mucosal biopsy specimens were taken from the gastric antrum and corpus.

RESULTS

Eight (25%) patients with Sjögren's syndrome and three (4.1%) control subjects had atrophic antral gastritis (P = 0.01). Atrophic corpus gastritis was more frequently found in control subjects, but the difference was not statistically significant. None of the subjects had severe (grade 3) atrophy. Gastric inflammation, in either the corpus or antrum, was found in 85% of patients with Sjögren's syndrome and in 61% of control subjects (P = 0.02). Helicobacter pylori was present in 31% of Sjögren's syndrome patients and in 39% of controls (NS).

CONCLUSIONS

In patients with primary Sjögren's syndrome mild atrophic changes in the antrum were common, but severe mucosal atrophy was rare. Compared with control subjects, gastric inflammation was seen more often in patients with Sjögren's syndrome.

Incidence of disorders of spermatogenesis in middle aged finnish men, 1981-91: two necropsy series

OBJECTIVE

To investigate if the incidence of disorders of spermatogenesis and testicular tissue morphology have changed in middle aged Finnish men over 10 years.

DESIGN

Two necropsy series completed in 1981 and in 1991.

SETTING

Department of Forensic Medicine, University of Helsinki, Finland.

SUBJECTS

528 men, aged 35 to 69 years, subjected to medicolegal necropsy.

MAIN OUTCOME MEASURES

Scoring of spermatogenesis and morphometric analysis of testicular tissue components. Individual risk factors for testicular disorders obtained by postmortem blind interviews with acquaintances.

RESULTS

Normal spermatogenesis was found in 41.7% of the men (mean age 53.1 years). Between 1981 and 1991, the ratio of normal spermatogenesis decreased significantly (odds ratio 3.5; 95% confidence interval 2.5 to 5.1) from 56.4% to 26.9%, with a parallel increase in the incidence of partial and complete spermatogenic arrest (2.1; 1.4 to 2.9 and 2.9; 1.7 to 5.0, respectively). During this period, the size of seminiferous tubules decreased, the amount of fibrotic tissue increased, and the weight of testicles decreased significantly. Alterations in testicular characteristics over time could not be explained by changes in body mass index, smoking, alcohol drinking, or exposure to drugs.

CONCLUSIONS

The incidence of normal spermatogenesis decreased among middle aged Finnish men from 1981 to 1991, and the incidence of disorders of spermatogenesis and pathological alterations in testicles increased. Deteriorating spermatogenesis may thus be one important factor in the explanation of declining sperm counts observed worldwide.

Age-related changes in the peroxyl radical scavenging capacity of human plasma

Aging and the diseases that typically follow with increasing age, notably atherosclerosis and cancer, are often proposed to be involved in increased oxidative stress. Animal studies, on the other hand, show no clear-cut pattern of age-related changes in enzymatic antioxidant defences. In this study we have demonstrated that total peroxyl radical scavenging antioxidant capacity (TRAP) in human plasma changes with age. We also found that among the antioxidants in human plasma there exists a major fraction of so far unidentified antioxidant(s). A chemiluminescent TRAP assay was used to determine the presence of peroxyl radical scavenging antioxidants in human plasma. The material consisted of 87 healthy volunteers, aged 20-96 years, who used no regular medication, vitamins, or trace elements. In females, total antioxidant capacity increased significantly during the life span. The increase in TRAP was mainly due to unidentified antioxidants. In males, TRAP increased until age 51-74, and then significantly decreased. The decrease observed among males was also due to the sharp decline in the concentration of unidentified antioxidants.

Ubiquinol-10 and total peroxyl radical trapping capacity of LDL lipoproteins during aging: the effects of Q-10 supplementation

Evidence is rapidly accumulating that oxidative modification of low density lipoprotein (LDL) may play an important role in the pathogenesis of atherosclerosis. In this study we measured the total peroxyl radical trapping capacity of human plasma LDL phospholipids (TRAPLDL) with a luminescent method. The study was carried out with 70 healthy volunteers, aged 28-77. In males an age-related decrease in TRAPLDL was observed. In the age group under 50 years the mean TRAPLDL was 31.36 +/- 1.45 pmol peroxyl radicals/nmol Pi; among those over 50 years it was significantly lower at 26.67 0.94 pmol/nmol Pi. As regards the components of TRAPLDL, the concentration of LDL-ubiquinol did not change and a non-significant decrease in the LDL-tocopherol concentration was detected with age. In females, the mean TRAPLDL, LDL-ubiquinol-10 and tocopherol concentrations did not differ between the age groups. When 17 of the participants were given coenzyme Q10 (Q10) supplementation, 100 mg/day, a highly significant increase in LDL-ubiquinol concentration was detected. Our results indicate that LDL antioxidant defenses tend to decrease with age in the Finnish male population. The decline is most significant in males under 50 years; in older age groups the values remain stable at a low level. Q10 supplementation doubles the number of ubiquinol-10-containing LDL molecules and may therefore have an inhibitory effect on LDL oxidation.

Contrast-enhanced magnetic resonance imaging for the detection of acute haemorrhagic necrotizing pancreatitis

Eleven piglets with haemorrhagic necrotizing pancreatitis and nine piglets with oedematous pancreatitis were imaged using a multi-breath-hold TurboFLASH (TR 6.5 ms, TE 3 ms, TI 300 ms, flip angle 8 degrees , three slices) pre-excited T1-weighted sequence with an IV bolus injection of gadopentetate dimeglumine (Gd-DTPA, 0. 3 mmol/kg) as a contrast agent to show dynamic contrast enhancement of the pancreas by MRI. All piglets were imaged according to the same protocol before inducing the disease. Following the IV Gd-DTPA bolus, time-enhancement curve of the pancreas during haemorrhagic necrotizing pancreatitis was significantly lower than during oedematous pancreatitis. The enhancement curves for the healthy piglets and piglets with oedematous pancreatitis did not differ significantly. Each piglet served as its own control. Because the results of this initial study are similar to those obtained with contrast-enhanced CT, we conclude that our results may encourage further clinical trials, and contrast-enhanced dynamic MRI may be an alternative to the established method of CT for diagnosing acute haemorrhagic necrotizing pancreatitis.

Prognostication of Bell's palsy using transcranial magnetic stimulation

Transcranial magnetic stimulation (TMS) provides a method to noninvasive excitation of the facial nerve in its intracranial segment close to the internal acoustic meatus. Thus, the site of facial nerve activation with TMS is proximal to or within the site of the lesion in Bell's palsy. To evaluate the prognostic capability of TMS in unilateral Bell's palsy we examined 137 patients with this method, and compared the results with electroneuronography (ENoG). Within 0-4 days from the onset of palsy, the patients with elicitable TMS responses recovered better than those in whom TMS responses were not elicitable. If TMS was performed 5-9 days or 10-28 days after the onset of palsy, it did not provide any prognostic information. Based on amplitude side-to-side differences, ENoG did not contribute prognostic information during the first 9 days from the onset of palsy. Later on, 10-28 days after the onset of palsy, ENoG showed an increased capability to discriminate the patients with poor prognosis. Thus, elicitable facial motor response with TMS predicts good prognosis of Bell's palsy at an early stage whereas poor response with ENoG predicts less favorable prognosis at a later stage.

Sudden deafness: a comparison of anticoagulant therapy and carbogen inhalation therapy

Sudden deafness (SD) is a sudden or rapidly progressive, partial or complete, typically unilateral sensorineural hearing impairment that has no known specific etiologic factor. This study was designed to compare, in a group of 168 consecutive patients with SD, the effect of anticoagulant therapy and carbogen inhalation therapy. Special attention was paid to the shape of the audiogram relative to the clinical outcome and the treatment modality. We found that the configuration of the audiogram of SD patients is prognostic of the outcome, and that patients with a low-frequency-sloping hearing impairment have a better prognosis compared to the patients with a high-sloping loss. Anticoagulant treatment was most effective in low-sloping hearing losses, while carbogen inhalation may be more effective for patients with high-sloping hearing losses.

Factors related to choosing oral contraception at age 15

This report aims to identify factors which are related to use of oral contraceptives at an early age. A self-administered questionnaire was completed at schools in 1988 and 1992 in southern and western Finland (N = 1339). Sexually experienced girls (mean age 15.8 years) who had answered the question concerning their oral contraceptive use were included (N = 389). Logistic regression analysis was used to compare oral contraceptive users (N = 121) with the group of non-users. Total number of coital experiences was associated with oral contraceptive use: the odds ratio for those having at least 10 coital experiences was 6.30 compared with those with only one intercourse. The proportion was 73% among oral contraceptive users and 30% among non-users. Girls using oral contraceptives perceived more often (67%) that parents accept their sexual relationship (30% among non-users). Oral contraceptive users were less afraid of getting pregnant (9% compared with 31% among non-users) and felt more often that sex was very important in their life (31 and 13%, respectively). Other factors that entered the model were age at menarche, having a steady partner and frequency of disco visits. When a young girl asks for oral contraceptives, she is probably at true risk of pregnancy, and regular contraception should be considered both in view of effective prevention of pregnancies and sexually transmitted diseases.

Some fundamental studies on clinical measurement conditions in acoustic rhinometry

Acoustic rhinometry is a new method to measure the patency of the nasal airway. In this study the clinical measuring conditions were systematically evaluated. The test-retest validity was analysed by repeated measurements in ordinary, not specially trained patients and was found to be at the level of approximately 15%. The need for acclimatization before measurements was tested by making a series of measurements on two separate occasions: one after a rest period following the patient's arrival at the nose laboratory, and a second in another session where no rest was allowed for. Statistically, no significant differences between the repeated measurements in the two occasions were found. However, there was a tendency towards smaller nasal volumes in the measures of the repeated recordings made without an acclimatization period. Therefore, it seems to be advisable to have an acclimatization period before acoustic rhinometry measurements.

Cancer of the tongue in patients younger than 40 years. A distinct entity?

BACKGROUND

An increase in the incidence of oral cancer among patients younger than 40 years has been reported worldwide. It has been suggested that the disease behaves more aggressively among young people.

OBJECTIVE

To evaluate the clinical and biologic behavior of tongue cancer among younger patients.

PATIENTS AND METHODS

Data on all patients younger than 40 years in whom tongue cancer was diagnosed in Finland between 1980 and 1989 (34 cases) were collected; pertinent clinical data were available for risk factor screening. A follow-up of at least 5 years or until death was available for all 34 patients. Immunocytochemical staining techniques were used to assess the expression of p53 and bcl-2 proteins, and p53 mutation analysis was performed by using the nonradioactive single-strand conformation polymorphism technique.

RESULTS

The incidence of tongue cancer in this age group in Finland did not change during the study period. The clinical behavior of tongue cancer in young people was not more aggressive compared with that of older patients in general, with the overall 5-year survival being as good as 70.6%. Altogether, p53 mutations were found in 17 of 33 tumors (51.5%). The p53 and bcl-2 protein expression was strong or moderate in 33.3% and 30.3% of the samples, respectively. Intense p53 protein expression was associated with the larger tumor size (P < .05). The poorest prognosis was found in patients with tumors greater than 4 cm in diameter (P = .01) or moderately or poorly differentiated cancer (P = .01). There was a trend for the adverse prognosis to accumulate in patients with moderately or poorly differentiated carcinoma and mutations in p53 (P = .09).

CONCLUSIONS

The cause of tongue cancer in patients younger than 40 years seems to be multifactorial. Those patients had a similar clinical course, prognosis, and function of p53 as found in the reports of a normal age variation. Mutations of p53 seemed to be an additional prognostic marker that was associated with moderate or poor differentiation of the tumors.

Respiratory health of workers exposed to low levels of chromium in stainless steel production

OBJECTIVES

To determine whether occupational exposure to chromite, trivalent chromium, or hexavalent chromium causes respiratory diseases, an excess of respiratory symptoms, a decrease in pulmonary function, or signs of pneumoconiosis among workers in an integrated chain of stainless steel production.

METHODS

This cross sectional study was carried out in 1993 and the inclusion criterion was a minimum of eight years of employment in the same production department. A self administered questionnaire was collected, and spirometry, measurement of diffusing capacity, chest radiography, and laboratory tests were carried out by a mobile research unit.

RESULTS

There were 221 workers in the exposure groups and 95 in the control group. The average duration of employment was 18 years. No significant differences in the odds ratios (ORs) of the symptoms were found between the exposure and the control groups. In a logistic regression analysis age and smoking significantly explained the occurrence of most of the respiratory symptoms. The smokers in the chromite group had significantly lower forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and diffusing capacity than the corresponding values of the control group. The analysis of variance between study groups, smoking, and exposure time, without modelling for interactions, showed that the chromite group had lower values for FVC, FEV1, and diffusing capacity than the other groups. The occurrence of small opacities was more frequent on the chest radiographs of the workers in the chromite group.

CONCLUSIONS

An average exposure time of 18 years in ferrochromium and stainless steel production and exposure to dusts containing low concentrations of hexavalent or trivalent chromium do not lead to any respiratory changes detectable by lung function tests or radiography nor to any increase in symptoms of respiratory diseases. The lung function values were lower and the occurrence of radiological findings was more frequent among the workers from the chromite mine than among the controls. The difference was partly caused by differences in age and smoking habits, but evidently also partly by higher exposures more than two decades ago or by the fibrous components of the dust.

Decreased interleukin-4 and increased gamma interferon production by peripheral blood mononuclear cells of patients with Lyme borreliosis

Spontaneous and Borrelia burgdorferi-stimulated proliferation of peripheral blood mononuclear cells (PBMCs) and their interleukin-4 (IL-4), gamma interferon (IFN-gamma), and NO production were measured in 36 patients with second- or third-stage Lyme borreliosis (LB) and 11 control subjects. Spontaneous proliferation of PBMCs was significantly higher (P = 0.0003) in the LB patients than in the control subjects. Spontaneous production of IL-4 was significantly lower in patients than in control subjects (P = 0.0007), but spontaneous production of IFN-gamma was slightly higher in patients. The proliferative response of PBMCs to stimulation with B. burgdorferi was significantly higher (P = 0.01) in patients. The B. burgdorferi-induced production of IFN-gamma (P = 0.002) was also significantly higher in patients. The spontaneous and B. burgdorferi-induced production of NO showed no significant difference between patients and control subjects. These findings indicate that the activation of PBMCs in patients with late LB is enhanced in vivo. Furthermore, the production of IL-4 is effectively suppressed spontaneously, whereas the production of IFN-gamma by PBMCs is slightly increased spontaneously and significantly enhanced during stimulation with B. burgdorferi in vitro. The "spontaneous" or disease-induced alterations in cytokine levels of patients, in this case suppression of a Th2-type cytokine production and activation of a Th1-type cytokine production, may contribute to the pathogenesis of LB.

Fine-needle aspiration biopsy in the diagnosis of parotid gland lesions: evaluation of 438 biopsies

The usefulness of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of salivary gland lesions is still controversial. The 438 FNABs taken at the Turku University Central Hospital between 1984-1991 were reviewed. Of these FNABs, 218 had been confirmed histologically. Within this subset, 136 FNABs were taken from benign neoplasms, and of these, 103 were correct (sensitivity 76%, specificity 83%). Only 26 of the 47 FNABs from malignant lesions were cytologically considered to be malignant (sensitivity 55%) and 11 samples raised a false suspicion of malignancy (specificity 92%). Out of 35 FNABs from non-neoplastic lesions, 27 were correct (sensitivity 77%, specificity 80%). There were 175 patients (217 FNABs), who had not been operated on: the follow-up of these patients showed that false malignant and false benign findings were rare. FNAB was safe and no serious complications occurred. However, there was a delay in the treatment of six patients probably because of the physicians' limited understanding of the diagnostic role of FNAB. FNAB offers valuable information about the type of parotid lesion, but the clinician must know how to interpret the cytologic statement, and the decision to use operative and other treatment should not be based solely on the result of FNAB. Diagn Cytopathol 1996; 15:185-190.

Age-dependent variation in the serum concentration of mannan-binding protein

Mannan-binding protein (MBP) is an acute phase reactant, and its deficiency is associated with the common opsonic defect and suspectibility to infections and atopic constitution. The aim of this study was to investigate the changes occurring in the serum level of MBP in infancy and during later childhood. We studied the serum concentration of MBP in 611 Finnish children of different ages and 110 adults by using an enzyme immunoassay. In an analysis of successive serum samples from infants at the day of birth and at the ages of 1 and 5 months, and at 1 and 2 years, the serum concentration of MBP increased significantly after birth, and was at its highest (the mean and median were 8.13 and 8.49 mgl-1, respectively) at the age of 1 month. After that, it declined to the initial level until the age of 5 months. The MBP concentration continued to decrease during childhood, and after the age of 12 years the MBP values reached the adult level. In Finnish adults the mean and median concentrations of MBP were 4.48 and 4.02 mgl-1, respectively, which seem to be higher than those reported previously in other populations. The high concentration of MBP in infants may best be explained by exposure to novel environmental antigens in early childhood, which suggests a protective role for MBP during the period of immaturity of the immunosystem. In older children the high level of MBP can probably be explained by childhood infections and the ensuing need of MBP.

Excess mortality among former adolescent male out-patients

Mortality among 156 males and 122 females referred to an out-patient adolescent psychiatric clinic in a Finnish town between 1984 and 1989 was examined. During the follow-up (mean duration 6 years; range 0-6.3 years for the deceased, 0.6-10.3 years for the survivors), 16 male subjects but no females had died. Among those who had died, the mode of death was suicide in 11 cases. The mortality for any cause for males was 10.3% and that for suicide was 7.1%. All male victims had similar high levels of individual and familial disturbances. Current suicidal ideation and suicide attempts, poor psychosocial functioning and a recommendation for psychiatric hospital treatment during the index treatment were associated with male mortality/suicidality. A high risk for mortality for several years after psychiatric treatment was found. It is concluded that, in clinical settings, perceived current suicidal tendencies should be assessed carefully.

Chlamydia pneumoniae antibodies in chronic obstructive pulmonary disease

BACKGROUND

The significance of persistent or recurrent respiratory infections in adult life for the development of chronic obstructive pulmonary disease (COPD) is still to a large extent unknown. A few clinical and experimental animal studies suggest that peripheral airways diseases may be due to the cumulative effects of recurrent respiratory infections over an extended period.

METHODS

C. pneumoniae-specific IgG and IgA antibody levels were determined in two elderly groups of male patients with COPD and in control subjects without the disease. The first group (N = 36) consisted of patients who were hospitalized due to an acute exacerbation of COPD. The second group of patients (N = 54) and the controls (N = 321) were participants in a community survey on respiratory diseases in the elderly. The criteria for seropositivity were defined as an IgG titre of >=16.

RESULTS

89% of the hospitalized patients (group I) and 66% of the non-hospitalized patients (Group II) were IgA seropositive as compared to 55% of the controls. Derived from the logistic regression analysis, the odds ratio (OR) WAS 7.4 (95% CI : 2.1-25.7) between group I and the controls and 1.5 (0.7-2.9) between group II and controls. Furthermore, the difference in the age-adjusted geometric mean titres (GMT) of lgA antibodies between the group I and the controls was significant (53.0 for the patients versus 19.1 for the controls). On the contrary, no significant differences between the patients and the controls were found either in the proportion of IgG-seropositive or in the GMT of IgG antibodies. Two of the 29 patients with an exacerbation of COPD, for whom paired sera were available, showed an antibody response suggesting a current acute or reactivated chlamydial infection.

CONCLUSIONS

The results showed that C. pneumoniae lgA antibodies are found more frequently and in higher concentrations in COPD patients than in disease-free controls. The finding may indicate a chronic C. pneumoniae infection in these patients. The association persisted after controlling for the potential confounding effect of smoking.

Is there an unidentified defence mechanism against infection in human plasma?

The total peroxyl radical scavenging capacity (TRAP) of human plasma was measured from pneumonia patients and controls. TRAP and its main components, ascorbic acid, alpha-tocopherol, uric acid or protein thiol groups, were unaltered, but the concentration of unidentified antioxidants in pneumonia patients was significantly reduced. Our results indicate that human plasma may contain so far unidentified antioxidants depleted in infection.

Moderate alcohol consumption and disorders of human spermatogenesis

Environmental factors are suspected to be responsible in part for the deterioration in semen quality observed worldwide during the recent few decades. Alcohol might be one factor, considering the frequent changes in testicular function associated with heavy drinking. The dose-dependent effects of alcohol on human spermatogenesis are, however, not well known. We analyzed spermatogenesis and testicular tissue morphology of 195 men, aged 35-69 years, with computer-assisted microscopy in this autopsy study. The men were categorized into controls and four "consumption groups" according to the average daily alcohol consumption, which was determined on the basis of blind interviews with relatives and acquaintances. When the average daily alcohol consumption was 40 g or less, 59 (66%) of the 90 men showed normal spermatogenesis, whereas 31 (34%) had partial spermatogenic arrest (SA). Of the 31 men with average daily intake between 40 and 80 g, 17 (54%) showed normal spermatogenesis, 13 (42%) had partial or complete SA, and 1 man exhibited more severe testicular damage-"Sertoli cell only" (SCO) syndrome. Among men with daily intake between 80 and 160 g, only 13 of 35 men showed normal spermatogenesis (37%), 19 (54%) had partial or complete SA (odds ratio = 2.92), and 3 (9%) had the SCO syndrome (odds ratio = 16.85). The frequencies of spermatogenic disorders were similar in men drinking in excess of 160 g. Both SA and the SCO syndrome showed a clear dependence on daily dose; p < 0.0001 and p < 0.0004, respectively. We conclude that long-term average daily consumption of < 40 g of alcohol seems not to be associated with disorders of spermatogenesis. Consumption of moderate amounts of alcohol may affect semen quality more often than previously thought, whereas high alcohol consumption may even be associated with serious disorders of spermatogenesis.

Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elderly

OBJECTIVE

To define the risk factors for recurrent falls in the home-dwelling elderly.

DESIGN

A prospective population-based study covering two years.

SETTING

Five rural municipalities around the city Oulu, northern Finland.

PARTICIPANTS

All home-dwelling elderly persons (N = 1,016) aged 70 years or older living in the municipalities.

OUTCOME MEASURES

The risk factors of recurrent falling by variables related to social status, life changes, housing conditions, health, functional abilities and life style, using cross-tabulations and multivariate analyses.

RESULTS

The recurrent fallers (at least two falls within 365 days after the examination day) consisted of 17 men (6% of the men) and 71 women (14%). Logistic regression analyses showed female sex, urinary urgency, frequent fear of falling, dizziness, a poor pulse rate rise 30 seconds after standing up and falling during the previous year to be risk factors for recurrent falls. After the variable representing previous falls had been removed from the analysis, urinary incontinence and a change in housing conditions during the past two years emerged and urinary urgency dropped out of the model.

CONCLUSIONS

Women particularly are a target group for the prevention of falls among the elderly. Urinary urgency and urinary incontinence, fear of falling, dizziness and changes in the housing conditions should be inquired about to identify the elderly at risk for falling and to take preventive interventions. In addition to testing blood pressure changes after standing up, the changes in pulse rate should be determined to identify and treat elderly people who have orthostatic conditions.

Seroepidemiological study of Helicobacter pylori infection in infancy

The incidence of Helicobacter pylori infection in very young children was determined, based on the emergence of specific IgG antibodies in sequential serum samples from birth to 2 years of age. The risk of acquiring H pylori infection in infancy as a result of maternal exposure to the organism was also assessed, based on the determination of maternal cord-blood antibodies. Serum IgG class H pylori antibodies were analysed in the cord blood samples of 195 newborns and in their follow up samples until the age of 2 years. Maternal antibodies were detected in the cord-blood samples of 21 children (10.6%). These antibodies disappeared in all but one child before 7 months of age and no new seroconversions occurred in these children. Ten originally cord-blood negative children seroconverted up to the age of 2 years (5.1%). It is concluded that a major proportion of H pylori infections observed in young adults in Finland are acquired during the first two years of life. Maternal seropositivity is not a straightforward risk factor for acquiring H pylori infection in infancy.

High diastolic blood pressure: common among women who are heavy drinkers

The present study evaluates the relationship of different alcohol consumption levels to blood pressure among women. Blood pressure values were compared between four groups of women consuming different amounts of alcohol. Three groups were formed from the middle-aged female population participating in a health survey (n = 219): 15 consecutive alcohol abstainers, 136 consecutive moderate drinkers, and 68 consecutive heavy drinkers. Also, 78 consecutive female alcoholics reporting for treatment were included, forming the fourth group. The prevalence of systolic blood pressure > or = 160 mm Hg did not increase in relation to alcohol consumption. In contrast, the percentage of women showing diastolic blood pressure > or = 90 mm Hg clearly increased (p = 0.004) from abstainers (7%) to moderate drinkers (18%), to heavy drinkers (32%), and to alcoholics (37%). The highest blood pressure values were found among heavy drinkers. Compared with abstainers, the mean difference in systolic blood pressure was -12 mm Hg, with a 95% confidence interval from -2 to -23 mm Hg. For diastolic blood pressure, the difference was -6 mm Hg with a 95% confidence interval from 1 to -13 mm Hg. Among alcoholics, the blood pressure values had returned essentially to normal after 4 days of abstinence. It is concluded that alcohol consumption increases both systolic and diastolic blood pressure values among women. However, only diastolic blood pressure values increase enough to be clinically significant. Moderately elevated diastolic blood pressure, combined with normal systolic blood pressure, might thus be a possible sign of alcohol abuse among women. Abstinence should be emphasized as an inexpensive and rapidly effective treatment for mild hypertension among female alcohol abusers.

Women have a larger and less atherogenic low density lipoprotein particle size than men

Some epidemiological studies have shown that serum total cholesterol increases with age. especially in women. On the other hand, the risk of coronary artery disease is smaller in women than in men. Earlier studies have shown that a small dense low density lipoprotein (LDL) is more atherogenic than a large LDL. We studied LDL size and apolipoprotein E (apo E) phenotypes in premenopausal and postmenopausal women and in men at the same age. In this study 342 subjects participating in a health screening study were examined. There were four subgroups: 40-year-old men (n = 85), 40-year-old women (n = 80), 70-year old men (n = 88) and 70-year-old women (n = 89). In the present study LDL size was larger (P < 0.01) in women (26.39 +/- 0.07 nm) than in men (25.95 +/- 0.07 nm). We found that LDL size correlated highly positively (r = 0.606; P < 0.001) with serum high density lipoprotein (HDL) concentration and inversely with serum triglyceride concentration (r = -0.627; P < 0.001). Measuring serum HDL cholesterol and triglycerides in health screening studies gives information indirectly about LDL size and its atherogenicity. Apo E phenotype was not significantly associated with serum triglycerides, but was associated with LDL size, LDL cholesterol, total cholesterol and HDL cholesterol. In our sample LDL size decreased and LDL cholesterol and total cholesterol increased according to the most prevalent apo E phenotypes in the order E2/3, E3/3, E3/4 and E4/4. Subjects with phenotype apo E4/4 had the smallest LDL size (25.70 +/- 0.19 nm), the highest total cholesterol (6.53 +/- 0.35 mmol/l) and the lowest HDL cholesterol values (1.28 +/- 0.04 mmol/l). We conclude that there was a significant interaction between sex and age in serum total cholesterol which was highest in older women. However, their LDL size was larger and their LDL is less atherogenic. Apo E phenotype had a significant influence on LDL size.

Addition of ferrous sulfate to cement and risk of chromium dermatitis among construction workers

Lowering the water-soluble chromium content of cement to < 2 ppm has been suggested to diminish the risk of allergic hand dermatitis caused by chromium among construction workers. The prevalence of chromium dermatitis was determined for a representative sample of 913 house construction workers and 707 concrete element prefabrication workers, with a questionnaire and clinical examination, before the use of cement with such a low content of water-soluble chromium was started on Finnish construction sites in 1987. The prevalence of allergic contact dermatitis caused by water-soluble chromium, diagnoses confirmed with patch tests among the workers with hand dermatitis, was 9/117 (7.7%). 4 of them were new 4/105 (4%) and 5 had been diagnosed earlier. In 1987, the prevalence of work-related hand dermatitis (allergic and irritant together) was 6.8% among the construction workers and 8.9% among the concrete element prefabrication workers. The Finnish Register of Occupational Diseases was checked for reports of chromium dermatitis and other forms of hand dermatitis from 1978 to 1992. The results indicated that, after 1987, the occurrence of allergic contact dermatitis caused by chromium decreased to less than 1/3 the previous level, whereas the occurrence of irritant contact dermatitis remained stable throughout the observation period. Regardless of some potential confounders, the addition of ferrous sulfate to cement during the production process may have reduced the number of cases of allergic contact dermatitis among construction and concrete element prefabrication workers. Our results agree with the results of Danish studies and Swedish observations.

Social and psychosocial factors predicting depression in old age: a longitudinal study

The predictive value of social and psychosocial factors for the occurrence of depression in elderly Finns is described using a longitudinal design. A population determined as not being depressed in an epidemiological study in 1984-1985 was clinically interviewed and examined in a follow-up study in 1989-1990 (N = 679). The potential predictive factors for depression were analyzed by contrasting the persons depressed in 1989-1990 with the ones not depressed. In men, depression was predicted by a poor relationship with one's wife and feelings about low appreciation of old persons or of the participant himself during the initial study and the loss of a mother while under 20 years of age. Certain changes and life events during the follow-up were related to the occurrence of depression in men, such as a change in the relationship with one's wife into a poorer direction, a decrease in the amount of hobbies, getting married, a grandchild's divorce, separation from someone important, moving into long-term institutional care, giving up hobbies or a position in a voluntary organization, and alcohol problems of a close person. In women, depression was predicted by living together with one's husband, living with other people, and a low activity in participating in religious events during the initial study and a loss of father while under 20 years of age. The risk of women living alone was lower compared to women not living alone. Also, certain changes and life events during the follow-up were associated with a high risk of depression in women, including a change in the relationship with one's neighbors into a poorer direction, an increase in the amount of time spent alone, a decline of the social activity level, getting married, occurrence of serious marital problems, separation from someone important, giving up hobbies or a position in a voluntary organization, alcohol problems of a close person, and a small number of social growth events. The results support the hypothesis about psychosocial factors playing a role in the etiology of depression in old age.

Glomerular filtration rate and kidney size after six years disease duration in non-insulin-dependent diabetic subjects

The objective of the present study was to estimate how glomerular filtration rate and kidney size change after six years of diabetes in subjects with non-insulin-dependent disease. It is a population-based prospective study of a cohort of non-insulin diabetic patients (n = 150) diagnosed 1985-1988. The baseline studies utilized a non-diabetic control group, whose basic characteristics were equal to the study group. The setting was a primary health care center in an urban area. Main outcome measures were the glomerular filtration rate and its relation to renal area, mean blood pressure, hemoglobin A1c, serum insulin and cholesterol. Seventeen patients had died and 109 were eligible for evaluation at follow-up. The mean (standard deviation) of the glomerular filtration rate (ml/min/1.73 m2) remained elevated at follow-up, 118 (28), just as it was at baseline, 118 (28) in the diabetic subjects compared to matched non-diabetic subjects, 103 (24) (p = 0.0000). Kidney size (cm2) was larger in diabetic subjects at follow-up, 114 (19) than at baseline, 109 (18) (p = 0.0000) and in non-diabetic subjects 98 (14) (p < 0.0000). This resulted in a decline in glomerular filtration rate per unit renal area in the diabetic subjects at follow-up, 1.0 (0.23) compared to at baseline, 1.09 (0.23) (p = 0.002) and to non-diabetic subjects, 1.07 (0.23). The renal area at baseline was directly and significantly related to the glomerular filtration rate at follow-up (p < 0.001). The relation of baseline serum cholesterol, hemoglobin A 1c and mean arterial blood pressure to the glomerular filtration rate at follow-up was inverse and reached significance in those diabetic subjects having had high filtration rates at baseline but displaying a faster decline than on average i.e. in those patients who were at increased risk of renal insufficiency. We conclude that after the first six years of non-insulin-dependent diabetes the glomerular filtration rate remains high. Kidney size increases further from the attained increase at diagnosis and is an important determinant of continuing hyperfiltration. The deleterious effect of serum cholesterol and high blood glucose on the glomerular filtration rate at this early stage of diabetic kidney disease is suggestive.

Chronic obstructive pulmonary disease and cognitive impairment in the elderly

In a cross-sectional epidemiological study in Lieto, Finland, 61 men and 21 women with chronic obstructive pulmonary disease (COPD) were compared with age- and sex-matched controls from the same community to analyze the associations between COPD, cognitive performance, and occurrence of dementia. The cognitive assessment was based on the Mini-Mental State Examination (MMSE), previous clinical documents, and the assessment made by the research nurse after she had interviewed and tested each subject. These three measures revealed no differences between the COPD patients and the age-matched controls, and MMSE subtest scores did not differ significantly between the patients and controls. The findings suggest that the relative contribution of COPD to the occurrence of cognitive impairment and dementia in the elderly may be none or minimal at the community level.

Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study

To determine the physiological factors and medications predicting injurious falls among the elderly population, the authors conducted a prospective study in a rural home-dwelling population aged 70 years or over, initially 979 persons (377 men and 602 women), from 1 January 1991 to 31 December 1992, in Northern Finland. The independent risk factors for all falling injuries, falls leading to minor injuries and ones leading to major injuries were determined. In men, the independent risk factors for all injuries were gait disturbances [odds ratio (OR) = 3.5] and the use of digitalis (OR = 2.2), those for minor injuries were gait disturbances (OR = 2.7) and the use of calcium blockers (OR = 3.0), and those for major injuries were the absence of a quadriceps reflex (OR = 4.8), gait disturbances (OR = 2.8) and the use of digitalis (OR = 2.9). In women, the corresponding independent risk factors were short step length (OR = 32.1), the use of calcium blockers (OR = 2.5) and the use of medications for improving peripheral circulation (OR = 3.7) for all injurious falls, path deviation (OR = 2.3) the use of calcium blockers (OR = 2.8) and the use of anti-inflammatory drugs (OR = 2.1) for minor injuries, and foot deformity (OR = 2.0), short step length (OR = 15.8), the use of long-acting benzodiazepines (OR = 4.0) and the use of calcium blockers (OR = 2.4) for major injuries. In order to prevent injurious falls, attention should be given to the prescription of tranquillizers, cardiovascular medications and anti-inflammatory drugs. The walking abilities of elderly people should be maintained and chronic diseases leading to peripheral neuropathy should be treated adequately.