Emotional identity and pragmatic citizenship: being Palestinian in Sweden

How is identity claimed and created in communities that have experienced multiple processes of refugeeness and patterns of mixed migration? This article explores how Palestinian national identity is moulded, influenced, experienced and lived in a context of protracted refugeeness, exile and diaspora in Sweden. Departing from literature on diaspora and Palestinian identity formation and based on the collection of narratives from Palestinians residing in Sweden, the article sheds light on the processes through which Palestinian identity is strongly related to a moral and political commitment to the homeland lost and to issues of solidarity. Palestinians in Sweden also reveal a strong embracement of Swedish citizenship related to aspects such as the passport, the right to vote, security, liberalism and the welfare system. As Palestinians have arrived to Sweden from different instabilities in the Middle East and in different times, there are also affiliations and links to other spatial surroundings such as refugee camps in Lebanon and Syria. The paper also illuminates how multiple refugeeness create both a shared understanding of identity, but also internal rifts and contradictions, relating to former places of residence, to increasing racism and enforced social boundaries in Sweden, and to the different processes of displacement that have brought them to Sweden.

Effects of occupational cobalt exposure on the heart in the production of cobalt and cobalt compounds: a 6-year follow-up

OBJECTIVE

It has been suspected that cobalt is toxic to the heart. It can cause cardiotoxicity in heavily exposed humans and in experimental systems. The issue of interest for this study is whether cobalt also affects the myocardium at occupational exposure levels.

METHODS

To study the effect of occupational cobalt exposure on the heart, we conducted a follow-up of workers at a cobalt production plant. The workers' hearts had been examined by echocardiography in 1999-2000. Altogether 93 exposed and 49 non-exposed workers examined in 1999-2000 were re-examined in 2006. Occupational history and health data were collected with a questionnaire. Blood pressure was measured, and electrocardiography (ECG), laboratory tests, Holter registration, and echocardiography were conducted for all participants. Analysis of covariance (ANCOVA) was used to analyse the data.

RESULTS

No differences were found between the exposed and unexposed groups for any of the echocardiographic parameters in 2006. There were no differences in the laboratory values, the ECG parameters, or the results of the Holter registration of the exposed and unexposed workers.

CONCLUSIONS

Although the previous results in 2000 suggested an association between cumulative exposure to cobalt and echocardiographic findings, the results of this new cross-sectional study with a tissue Doppler 6 years later did not confirm the association in the present cohort. If cobalt exposure affects heart muscle functions at this exposure level, the effects are smaller than those caused by physiological changes due to ageing, medication, and traditional cardiovascular risk factors, such as elevated blood pressure.

Effects of melatonin on physical fatigue and other symptoms in patients with advanced cancer receiving palliative care: A double-blind placebo-controlled crossover trial

BACKGROUND

Patients with advanced cancer often experience fatigue and other symptoms that negatively impact their quality of life. The current trial investigated the effect of melatonin on fatigue and other symptoms in patients with advanced cancer.

METHODS

Patients who were aged ≥18 years, had a histologically confirmed stage IV cancer (TNM Classification), and who reported feeling significantly tired were recruited from the palliative care unit at the study institution. The study was a double-blind, randomized, placebo-controlled crossover trial. Patients received 1 week of melatonin at a dose of 20 mg or a placebo orally each night, before crossing over and receiving the opposite treatment for 1 week. Between the 2 periods, a washout period of 2 days was implemented. Outcomes were measured using the Multidimensional Fatigue Inventory (MFI-20) and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Physical fatigue from the MFI-20 was the primary outcome. The primary analysis was a complete complier analysis (ie, it included only those patients who had consumed at least 5 capsules per week and who had answered the MFI-20 on days 1, 7, 10, and 17). Sensitivity analysis using multiple imputations including all randomized patients and all patients completing the intervention were conducted.

RESULTS

A total of 72 patients were randomized. Fifty patients completed the intervention and 44 patients were complete compliers. No significant differences between the placebo and melatonin periods were found for physical fatigue, secondary outcomes, or explorative outcomes.

CONCLUSIONS

In the current study, oral melatonin at a dose of 20 mg was not found to improve fatigue or other symptoms in patients with advanced cancer.

Unfavorable influence of structured exercise program on total leisure-time physical activity

In randomized controlled trials (RCTs), with customized structured physical exercise activity (SPEA) interventions, the dose of leisure-time physical activity (LTPA) should exceed the LTPA dose of the nonexercising control (C) group. This increase is required to substantiate health improvements achievable by exercise. We aimed to compare the dose of SPEA, LTPA, and total LTPA (SPEA + LTPA) between a randomized Nordic walking (NW) group, a power-type resistance training (RT) group, and a C group during a 12-week exercise intervention in obese middle-aged men (n = 144) with impaired glucose regulation. The dose of physical activity was measured with diaries using metabolic equivalents. No significant difference (P > 0.107) between the groups was found in volume of total LTPA. The volume of LTPA was, however, significantly higher (P < 0.050) in the C group than in the NW group, but not compared with the RT group. These results indicate that structured exercise does not automatically increase the total LTPA level, possibly, as a result of compensation of LTPA with structured exercise or spontaneous activation of the C group. Thus, the dose of total LTPA and the possible changes in spontaneous LTPA should be taken into account when implementing a RCT design with exercise intervention.

Association of cardio-ankle vascular index with physical fitness and cognitive symptoms in aging Finnish firefighters

PURPOSE

Monitoring cardiovascular risk factors is important in health promotion among firefighters. The assessment of arterial stiffness (AS) may help to detect early signs of atherosclerosis. The aim of this study was to analyze associations between aerobic fitness, cognitive symptoms and cardio-ankle vascular index (CAVI) as a measure for AS among Finnish firefighters.

METHODS

The data are one part of a large 13-year follow-up study of the health and physical and mental capacity of Finnish professional firefighters. The subjects in this substudy comprised 65 male firefighters of a mean age of 48.0 (42-58) years in 2009. Their maximal oxygen uptake was successfully measured in two cross-sectional studies in 1996 and 2009, and they responded to questionnaires at both sessions, and their CAVI was measured in 2009. CAVI was calculated from the pulse waveform signal and pulse wave velocity. The lifestyle habits and subjective cognitive stress-related symptoms were collected via a standardized questionnaire. Muscular fitness was measured by the routine test battery used for Finnish firefighters.

RESULTS

CAVI was related to age. About one-fifth of the firefighters had a CAVI of >8. Aerobic fitness was the main physiological factor correlating with increased CAVI. Interestingly, VO(2)max and the accelerated decrease in VO(2)max during a 13-year follow-up were associated with signs of impaired vascular function. The cognitive symptoms derived from the Profile of Mood States questionnaire (POMS) were mainly associated with stress and sleeping difficulties. No clear association with physical fitness was found in this population of fit firefighters.

CONCLUSIONS

Among firefighters, the decrease in aerobic fitness predicts increased arterial stiffness. The speed of the age-related decline in maximal oxygen consumption is as important as absolute level. Against expectations, the cognitive function did not correlate with vascular health parameters. The cognitive symptoms, however, were only mild.

Early autonomic dysfunction in type 1 diabetes: a reversible disorder?

AIMS/HYPOTHESIS

Cardiac autonomic neuropathy is associated with increased morbidity and mortality rates in patients with type 1 diabetes. The prevalence of early autonomic abnormalities is relatively high compared with the frequency of manifest clinical abnormalities. Thus, early autonomic dysfunction could to some extent be functional and might lead to an organic disease in a subgroup of patients only. If this is true, manoeuvres such as slow deep-breathing, which can improve baroreflex sensitivity (BRS) in normal but not in denervated hearts, could also modify autonomic modulation in patients with type 1 diabetes, despite autonomic dysfunction.

METHODS

We compared 116 type 1 diabetic patients with 36 matched healthy control participants and 12 heart-transplanted participants with surgically denervated hearts. Autonomic function tests and spectral analysis of heart rate and blood pressure variability were performed. BRS was estimated by four methods during controlled (15 breaths per minute) and slow deep-breathing (six breaths per minute), and in supine and standing positions.

RESULTS

Conventional autonomic function tests were normal, but resting spectral variables and BRS were reduced during normal controlled breathing in patients with type 1 diabetes. However, slow deep-breathing improved BRS in patients with type 1 diabetes, but not in patients with surgically denervated hearts. Standing induced similar reductions in BRS in diabetic and control participants.

CONCLUSIONS/INTERPRETATION

Although we found signs of increased sympathetic activity in patients with type 1 diabetes, we also observed a near normalisation of BRS with a simple functional test, indicating that early autonomic derangements are to a large extent functional and potentially correctable by appropriate interventions.

Operation for primary hyperparathyroidism: the new versus the old order. A randomised controlled trial of preoperative localisation

BACKGROUND AND AIMS

In patients with primary hyperparathyroidism (PHPT), parathyroid imaging is nowadays routinely used for the purpose to perform a focused unilateral minimally invasive operation. The outcome of this new strategy has, however, not been established in randomised trials.

MATERIAL AND METHODS

Patients were randomised to either preoperative localisation with sestamibi scintigraphy and ultrasonography (group I) or no preoperative localisation (group II). In group I, a minimally invasive parathyroidectomy was performed in patients in whom both localisation studies were consistent with a single pathological gland, whereas a conventional bilateral neck exploration was performed in cases with negative localisation findings. In group II all patients underwent conventional bilateral neck exploration. Primary outcome measure was normocalcaemia at 6 months postoperatively.

RESULTS

In the preoperative localisation group (group I) 23/50 (46%) of the patients could be operated on with the focused operation whereas 26/50 (52%) were operated on by bilateral neck exploration. All patients in the no localisation group (group II; n = 50) were operated on with the intended bilateral neck operation. Normocalcaemia was obtained in 96% and 94% in group I and II, respectively. Total (localisation and operative) costs were 21% higher in group I.

CONCLUSIONS

Routine preoperative localisation, with the intention to perform minimally invasive parathyroidectomy, is not cost effective if concordant results of scintigraphy and ultrasonography are a prerequisite for the focused operation. Less than half of the patients were successfully managed with this strategy, at a higher cost and without obtaining a more favourable clinical outcome.

Organisational injustice and impaired cardiovascular regulation among female employees

OBJECTIVES

To examine the relation between perceived organisational justice and cardiovascular reactivity in women.

METHODS

The participants were 57 women working in long term care homes. Heart rate variability and systolic arterial pressure variability were used as markers of autonomic function. Organisational justice was measured using the scale of Moorman. Data on other risk factors were also collected.

RESULTS

Results from logistic regression models showed that the risk for increased low frequency band systolic arterial pressure variability was 3.8-5.8 times higher in employees with low justice than in employees with high justice. Low perceived justice was also related to an 80% excess risk of reduced high frequency heart rate variability compared to high perceived justice, but this association was not statistically significant.

CONCLUSIONS

These findings are consistent with the hypothesis that cardiac dysregulation is one stress mechanism through which a low perceived justice of decision making procedures and interpersonal treatment increases the risk of health problems in personnel.

Perceived stress, pain and work performance among non-patient working personnel with clinical signs of temporomandibular or neck pain

The aim of the present study was to assess the associations between different types of perceived stress, pain and work performance among non-patients with clinical signs of muscle pain in the head/neck region. One-fifth (n = 241) of the 1339 media employees who had participated in a previous survey (Ahlberg J. et al., J Psychosom Res 2002; 53: 1077-1081) were randomly selected for standardized clinical examinations. Altogether 49% (n = 118) of these subjects had clinical signs of temporomandibular and/or neck muscle pain and were enrolled in the present study. The mean age of the study sample was 46.9 years (s.d. 6.6) and the female to male distribution 2:1. Of the 118 employees 46.5% reported that the pain problem interfered with their ability to work. Perceived ability to work was not significantly associated with age, gender or work positions. According to logistic regression, reduced work performance was significantly positively associated with continuous pain [odds ratio (OR) 4.38; 95% CI 1.21-15.7], level of perceived pain severity (OR 1.30; 95% CI 1.04-1.63), and health stress (OR 2.08; 95% CI 1.22-3.54). The results of this study indicated an association between specific self-reported stress regarding health and work issues, pain and work performance. From a preventive perspective this indicates a need for increased awareness about these associations on not only individual level but also at the organizational level and in health care.

Reported bruxism and biopsychosocial symptoms: a longitudinal study

OBJECTIVES AND METHODS

In this follow-up study of 30-50-year-old employees (n = 211) of the Finnish Broadcasting Company (YLE), respondents completed questionnaires in both 1999 and 2000 containing items on demographic data, tobacco use, levels of perceived bruxism, affective disturbance, sleep disturbance, somatic symptoms, pain symptoms and temporomandibular disorder (TMD) symptoms.

RESULTS

Bruxism was significantly more prevalent among smokers (P = 0.005). Age, marital status, and gender were not associated with bruxism. Subjects in the frequent bruxism group (n = 74) reported the TMD-related painless symptoms, affective disturbance and early insomnia significantly more often than average. In the multivariate analyses, clustered pain symptoms (P = 0.001), TMD-related painless symptoms (P = 0.004) and smoking (P = 0.012) were significantly positively associated with frequent bruxism, when the independent effects of age and gender were controlled for.

CONCLUSIONS

It was concluded that successful management of TMD necessitates smoking cessation, as tobacco use may both amplify the patient's pain response and provoke bruxism. Psychosocial factors and perceived stress should not be ignored, however.

Reported bruxism and stress experience

The aim of the study was to analyze whether perceived bruxism was associated with stress experience, age, gender, work role, and occupational health care use among a nonpatient multiprofessional population. Altogether, 1784 (age 30-55 years) employees of the Finnish Broadcasting Company were mailed a self-administered questionnaire covering demographics, perceived bruxism, total stress experience and the use of health care services provided by the company. The response rate was 75% (n = 1339, 51% men) and mean age was 46 years (SD = 6) in both genders. There were no significant differences in demographic status by age and gender. Bruxism and stress experiences did not significantly vary with regard to category of work, but both were significantly more frequent among women (P < 0.05). In all work categories frequent bruxers reported more stress, and the perceptions were significantly differently polarized between the groups (P < 0.001). According to logistic regression, frequent bruxism was significantly positively associated with severe stress experience (Odds ratio = 5.00; 95% CI = 2.84-8.82) and female gender (Odds ratio = 2.26; 95% CI = 1.43-3.55). Frequent bruxism was also significantly positively associated with the numbers of occupational health care and dental visits (P < 0.01), and slightly negatively associated with increasing age and work in administration (P < 0.05). It was concluded that bruxism may reveal ongoing stress in normal work life.

Distinct biopsychosocial profiles emerge among nonpatients

OBJECTIVES

The cross-sectional study comprised 30- to 55-year-old permanent employees (N=1784) of the Finnish Broadcasting Company (YLE).

METHODS

The participants (N=1339, response rate 75%) completed standardised questionnaires covering demographic items, physical health, work performance, stress symptoms, pain and musculoskeletal symptoms, and overall biopsychosocial health.

RESULTS

Physical symptoms (present often or continually) were reported by 15%, psychosomatic by 19% and psychosocial by 14%. The intercorrelations between 73 biopsychosocial variables revealed nine factors explaining 54.5% of variance for intrapersonal profiles and four factors explaining 59.2% of variance for interpersonal profiles. The Cronbach alphas for reliability ranged from.76 to.83. Three distinct biopsychosocial cluster profiles were found: Cluster 1 (n=290, 27%) loaded positively with the somatic and psychosocial variables, Cluster 2 (n=558, 51%) loaded negatively with the various biopsychosocial symptoms, and Cluster 3 (n=235, 22%) loaded positively with anxiety.

CONCLUSION

Discriminant function analysis confirmed that this cluster solution correctly classified 95.2% of the subjects in a nonpatient multiprofessional population, which supports the biopsychosocial approach also in work life issues.

Analysis of chromosomal aberrations involving chromosome 1q31-->q53 in a DMBA-induced rat fibrosarcoma cell line: amplification and overexpression of Jak2

In a study of DMBA-induced rat fibrosarcomas we repeatedly found deletions and/or amplifications in the long arm of rat chromosome 1 (RNO1). Comparative genome hybridization showed that there was amplification involving RNO1q31-->q53 in one of the DMBA-induced rat fibrosarcoma tumors (LB31) and a cell culture derived from it. To identify the amplified genes we physically mapped rat genes implicated in cancer and analyzed them for signs of amplification. The genes were selected based on their locations in comparative maps between rat and man. The rat proto-oncogenes Ccnd1, Fgf4, and Fgf3 (HSA11q13.3), were mapped to RNO1q43 by fluorescence in situ hybridization (FISH). The Ems1 gene was mapped by radiation hybrid (RH) mapping to the same rat chromosome region and shown to be situated centromeric to Ccnd1 and Fgf4. In addition, the proto-oncogenes Hras (HSA11p15.5) and Igf1r (HSA15q25-->q26) were mapped to RNO1q43 and RNO1q32 by FISH and Omp (HSA11q13.5) was assigned to RNO1q34. PCR probes for the above genes together with PCR probes for the previously mapped rat genes Bax (RNO1q31) and Jak2 (RNO1q51-->q53) were analyzed for signs of amplification by Southern blot hybridization. Low copy number increases of the Omp and Jak2 genes were detected in the LB31 cell culture. Dual color FISH analysis of tumor cells confirmed that chromosome regions containing Omp and Jak2 were amplified and were situated in long marker chromosomes showing an aberrant banding pattern. The configuration of the signals in the marker chromosomes suggested that they had arisen by a break-fusion-bridge (BFB) mechanism.

ATP, phosphocreatine and lactate in exercising muscle in mitochondrial disease and McArdle's disease

We studied exercise-induced changes in the adenosine triphosphate (ATP), phosphocreatine (PCr), and lactate levels in the skeletal muscle of mitochondrial patients and patients with McArdle's disease. Needle muscle biopsy specimens for biochemical measurement were obtained before and immediately after maximal short-term bicycle exercise test from 12 patients suffering from autosomal dominant and recessive forms of progressive external ophthalmoplegia and multiple deletions of mitochondrial DNA (adPEO, arPEO, respectively), five patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) 3243 A-->G point mutation, and four patients with McArdle's disease. Muscle ATP and PCr levels at rest or after exercise did not differ significantly from those of the controls in any patient group. In patients with mitochondrial disease, muscle lactate tended to be lower at rest and increase more during exercise than in controls, the most remarkable rise being measured in patients with adPEO with generalized muscle symptoms and in patients with MELAS point mutation. In McArdle patients, the muscle lactate level decreased during exercise. No correlation was found between the muscle ATP and PCr levels and the respiratory chain enzyme activity.

High-dose percutaneous ethanol injection therapy of liver tumors. Patient acceptance and complications

PURPOSE

To study the safety of high-dose ethanol injections in liver tumors and their acceptability as out-patient procedures under local anesthesia.

MATERIAL AND METHODS

Twenty-nine patients received 20-95 ml of 95% ethanol by 62 percutaneous injections under local anesthesia. Pain was assessed by a visual analogue scale from 1 to 10 for 33 of the sessions. Side effects, complications, post-treatment requirement of parenteral analgesics, and hospital stay (discharge the same day or later) were recorded. The sessions were compared to 80 injections of <20 ml of ethanol in 18 patients.

RESULTS

High-dose injections with an average volume of 39 ml gave a mean pain score of 5.1, with a weak relationship between pain and volume. Other side effects and complications were unrelated to the ethanol dose. They comprised 1 syncopation, 1 occasion of hypoventilation requiring antidote to opiates, 12 short episodes of nausea or vomiting without need for i.v. fluids, 2 instances of sepsis, and 1 abscess that was drained percutaneously. Thirty-nine of the 62 sessions were performed in day care. Ethanol was given in high doses without apparent complications after or shortly before liver resections (3 patients in each group), and on 4 occasions in 2 HIV carriers. Low-dose injections resulted in a mean pain score of 4.7 with the same requirement of i.v. analgesics as high doses, fewer instances of nausea and no infectious complications.

CONCLUSION

High-dose ethanol injections in patients with liver malignancy had no mortality and a reasonable complication rate. They could be given without general anesthesia, often in day care.

Fetal erythropoietin and endothelin-1: relation to hypoxia and intrauterine growth retardation

BACKGROUND

We have examined whether endothelin-1 (ET-1) and erythropoietin (EPO) in amniotic fluid, and EPO in fetal serum obtained by cordocentesis from fetuses with signs of intrauterine growth retardation (IUGR), were correlated to fetal growth and/or chronic fetal hypoxia.

METHODS

Amniotic fluid and fetal serum were obtained by cordocentesis from 28 fetuses suspected to have IUGR and subsequently analyzed for EPO and ET-1 by ELISA. These data were correlated to blood gas results and fetal/maternal parameters at delivery.

RESULTS

A novel finding was that ET-1 correlated to PO2 in amniotic fluid. The average level of ET-1 in amniotic fluid was 48.3+/-4.7 pmol/L. The results also showed a correlation between EPO levels in amniotic fluid and EPO in fetal serum. Furthermore, EPO correlated weakly to birth weight at delivery. Children with the lowest birth weights had the highest EPO levels. High EPO values, similarly to ET-1, correlated to low pO2 values. The level of EPO in amniotic fluid was 8.0+/-1.6 mIU/ml and in cord blood 29.5+/-9.6 mIU/ml.

CONCLUSIONS

The results indicate that ET-1 levels may be a marker for short-term hypoxia, but not for fetal growth, since ET-1 in amniotic fluid was correlated to PO2 at the time of cordocentesis, but not to birth weight. The results also indicate that EPO levels in amniotic fluid and in fetal cord serum are highly correlated, and thus both can be used as markers for fetal growth and chronic hypoxia before the onset of labor.

Assessment of intermittent claudication: a comparison of questionnaire, visual analogue scale and subjective estimate information with post-exercise ankle-brachial pressure index

In order to assess two simple methods of evaluation of claudication, a standard questionnaire and visual analogue scale, a comparison was made between them and the post-exercise pressure index used as a gold standard. Fifty-eight consecutive stable claudicants were recruited to the study, 51/58 having arterial insufficiency according to post-exercise pressure measurements. Both methods appeared to correlate rather poorly with post-exercise pressures. Thus visual analogue scale cannot be used alone to assess walking tolerance but as it offers qualitative information it may be used to supplement pressure measurements in the assessment of incapacity caused by intermittent claudication.

The diagnosis of molar pregnancy by sonography and gross morphology

BACKGROUND

In modern times molar pregnancies are often terminated before classical symptoms have developed. Sonography may not be conclusive and gross macroscopy may not reveal vesicles. If the aborted material is not sent for microscopy adequate follow-up of these patients will not be performed. The objective of this study was to evaluate the percentage of molar cases that potentially will be missed in a setting where material is submitted for histopathology only when sonography and/or gross macroscopy suggest complete- or partial hydatidiform mole.

METHODS

Charts from 135 patients with complete hydatidiform mole (75) and partial hydatidiform mole (60) between 1989 1997 were evaluated.

RESULTS

In complete hydatidiform mole sonography had been performed in 68 patients. The correct diagnosis had been suspected in 84% of the cases with the aid of sonography and/or gross macroscopy. In partial hydatidiform mole the correct diagnosis was suspected in only 30% of the cases. Three patients with complete mole developed persistent disease despite negative sonography and/or gross macroscopy. One patient with partial mole that was only documented by microscopy also developed sequelae.

CONCLUSION

In a setting where material from curettages in early pathological pregnancies are not routinely sent for histopathology 16% and 70% of complete- and partial hydatidiform moles respectively will be missed. Since a subset of these 'discrete' moles will eventually require chemotherapy, this policy could have serious consequences.

Amniotic septostomy for the treatment of twin oligohydramnios-polyhydramnios sequence

OBJECTIVE

To report our experience with intentional puncture of the intervening membrane ('septostomy') for the treatment of the twin oligohydramnios-polyhydramnios sequence (TOPS).

METHODS

12 patients were diagnosed with TOPS based on ultrasonographic findings. A 20- to 22-gauge spinal needle was used to puncture the membrane between the twins without any attempt at amnioreduction in 9 patients, while the procedure was combined with amnioreductions in 3 patients.

RESULTS

Gestational age was 23.1 +/- 3.3 weeks at the time of septostomy and 31.1 +/- 4.4 weeks at delivery. Rapid accumulation of fluid around the 'stuck' fetus occurred in all cases following a single procedure. Three of the 24 fetuses died in utero and 1 died on the fifth day of life, for a combined survival of 83.3%. In the survivors, the septostomy to delivery interval ranged between 0.6 and 13 weeks (mean +/- SD 8.3 +/- 4.8).

CONCLUSION

Amniotic septostomy is a promising new method for the management of TOPS and is associated with survival rates that are better than, or comparable to, more invasive modalities. A multicenter trial comparing septostomy to other modalities is warranted.

Aerobic endurance exercise or circuit-type resistance training for individuals with impaired glucose tolerance?

The role of physical activity in the prevention of non-insulin-dependent diabetes mellitus (NIDDM) is of utmost importance. The aim of the present study was to evaluate the metabolic effects of aerobic endurance exercise and circuit-type resistance training in subjects with impaired glucose tolerance (IGT). Twenty-two individuals participated in the study. Fourteen subjects were enrolled in the aerobic endurance exercise part of the study; seven exercised regularly for six months, while seven served as controls. Maximal aerobic capacity (VO2max) was measured and insulin sensitivity and insulin secretion were assessed by a frequently sampled intravenous glucose tolerance test (FSIVGTT). Eight subjects participated in a circuit-type resistance training program for three months. Insulin sensitivity and substrate oxidation were then assessed using the euglycemic insulin clamp technique combined with indirect calorimetry. The aerobic endurance exercise program caused in increase in VO2max (21.6 +/- 1.9 to 25.4 +/- 2.4 ml/kg.min; p < 0.05) and HDL-cholesterol (1.14 +/- 0.06 to 1.23 +/- 0.08 mmol/l; p < 0.05), but no change in insulin sensitivity nor insulin secretion occurred. However, comparing the changes between the intervention and control group, the differences disappeared. Circuit-type resistance training increased insulin sensitivity (glucose disposal) by 23% (p < 0.05), primarily due to a 27% increase in non-oxidative glucose metabolism. Both circuit-type resistance training and aerobic endurance exercise seem to have beneficial effects in subjects with impaired glucose tolerance. However, by improving insulin sensitivity, circuit-type resistance training may postpone the manifestations of NIDDM in these high-risk individuals and should therefore be included in an exercise program for IGT subjects.

Hysteroscopy provides proof of trophoblastic tumors in three cases with negative color Doppler images

Color Doppler sonography has replaced pelvic arteriography as well as real-time ultrasound in the assessment of patients with gestational trophoblastic disease. In about 25% of patients in whom human chorionic gonadotropin (hCG) levels are suggestive of trophoblastic disease, there will be no evidence of abnormal vessels in the uterus. In these cases it is assumed that hCG was produced by metastatic lesions. We present here three cases in which color Doppler examination was negative and where myometrial biopsies containing tumor were obtained by means of hysteroscopy. The fact that color Doppler, in its present form, does not detect small areas of trophoblastic tumor might also have implications for other kinds of tumors. Knowledge of the exact microscopic diagnosis in molar patients with persistent disease may have an impact on management.

Physical fitness and endothelial function (nitric oxide synthesis) are independent determinants of insulin-stimulated blood flow in normal subjects

Insulin induces vasodilation via stimulation of nitric oxide (NO) synthesis. This action of insulin exhibits considerable interindividual variation. We determined whether the response of blood flow to endothelium-dependent vasoactive agents correlates with that to insulin or whether other factors, such as physical fitness, limb muscularity, or vasodilatory capacity, better explain variations in insulin-stimulated blood flow. Direct measurements of the forearm blood flow response to three 2-h sequential doses of insulin (1, 2, and 5 mU/ kg.min), endothelium-dependent (acetylcholine and NG-monomethyl-L-arginine) and endothelium-independent (sodium nitroprusside) vasoactive agents, and ischemia (reactive hyperemic forearm blood flow) were performed in 22 normal subjects (age, 24 +/- 1 yr; body mass index, 22.2 +/- 0.6 kg/m2; maximal aerobic power, 40 +/- 2 mL/kg.min). The highest insulin dose increased blood flow by 111 +/- 17%. The fraction of basal blood flow inhibited by NG-monomethyl-L-arginine (NO synthesis-dependent flow) varied from 6-47%. Maximal aerobic power (r = 0.52; P < 0.02), the percentage of forearm muscle (r = 0.50; P < 0.02), and the NO synthesis-dependent flow (r = 0.42; P < 0.05), but not reactive hyperemic, acetylcholine-stimulated, or sodium nitroprusside-stimulated flow, were significantly correlated with insulin-stimulated (5 mU/kg.min) blood flow. In multiple linear regression analysis, 52% of the variation (multiple R = 0.72; P < 0.001) in insulin-stimulated blood flow was explained by NO synthesis-dependent flow (P < 0.005) and the percentage of forearm muscle (P < 0.005). We conclude that endothelial function (NO synthesis-dependent basal blood flow) and forearm muscularity are independent determinants of insulin-stimulated blood flow.

Estrogen-related acetaldehyde elevation in women during alcohol intoxication

Alcohol is more often unpleasant and causes tissue damage more rapidly in women than men. The present study was designed to find out whether acetaldehyde, the primary metabolite of alcohol, could play a crucial role in these actions. Special emphasis was focused on the appropriate determination of blood acetaldehyde and hormonal factors. Occurrence of elevated blood acetaldehyde levels during alcohol oxidation was established in both normally cycling women and ones taking oral contraceptives, but not in men. An association between elevated acetaldehyde levels and high estrogen phases was observed in both groups of women. Estrogen-related acetaldehyde elevation is suggested to be the key factor explaining the gender differences of the adverse effects of alcohol.

Physical fitness, muscle morphology, and insulin-stimulated limb blood flow in normal subjects

The response of limb blood flow to insulin is highly variable even in normal subjects. We examined whether physical fitness or differences in muscle morphology contribute to this variation. Maximal aerobic power, muscle fiber composition and capillarization, and the response of forearm glucose extraction and blood flow to a sequential hyperinsulinemic euglycemic clamp (serum insulin 374 +/- 10, 816 +/- 23, and 2,768 +/- 78 pmol/l) were determined in 16 normal males (age 25 +/- 1 yr, body mass index 24 +/- 1 kg/m2). Maximal aerobic power correlated positively with the proportion of type I fibers (r = 0.67, P < 0.01) and negatively with the proportion of type IIb fibers (r = -0.73, P < 0.01). Fiber composition but not blood flow correlated significantly with forearm and whole body glucose uptake. All doses of insulin significantly increased forearm blood flow, maximally by 123 +/- 21%. The ratio of capillaries per fiber was significantly correlated with basal and insulin-stimulated blood flow (0.58- 0.76, P < 0.05-0.01). Mean arterial blood pressure and the insulin-induced increase in blood flow were inversely correlated (r = -0.59, P < 0.05). We conclude that variation in glucose extraction is significantly determined by muscle fiber composition, whereas variation in insulin-stimulated blood flow is closely associated with muscle capillarization.

Frostbite of the face and ears: epidemiological study of risk factors in Finnish conscripts

OBJECTIVE

To determine the incidence of and the risk factors for local cold injuries of the face and ears in peacetime military service.

DESIGN

Prospective, controlled epidemiological study using a questionnaire.

SETTING

Finnish defence forces, 1976-89.

SUBJECTS

913 young male conscripts with local frostbite of the head that needed medical attention and 2478 uninjured control conscripts.

MAIN OUTCOME MEASURES

Type of activity, clothing, and other risk factors at the time of cold injury. Odds ratios were used to calculate risk. Controls were handled as one group.

RESULTS

The mean annual incidence of frostbite was 1.8 per 1000 conscripts. Frostbite of the ear was most common (533 conscripts (58%)), followed by frostbite of the nose (197 (22%)) and of the cheeks and other regions of the face (183 (20%)). Most conscripts (803 (88%)) had mild or superficial frostbite. Risk factors included not wearing a hat with earflaps (odds ratio 18.5 for frostbite of the ear); not wearing a scarf (odds ratio 2.1 and 3.8 for frostbite of the ear and cheeks respectively); using protective ointments (odds ratio 3.3, 4.5, and 5.6 for frostbite of the cheeks, ear, and nose respectively); being extremely sensitive to cold and having hands and feet that sweat profusely (odds ratio 3.5 for frostbite of the nose); and being transported in the open or in open vehicles under windy conditions (odds ratio 2.2 for frostbite of the cheek).

CONCLUSIONS

Wearing warm clothing, including a scarf and a hat with earflaps, helps to prevent frostbite. Each person's sensitivity to cold may also be important. The routine use of protective ointments should not be recommended.

Neuropsychologic and cardiovascular effects of clemastine fumarate under pressure

Allergic rhinitis and mild respiratory infections have been widely accepted as temporary contraindications for fitness to dive. Nonetheless, several sport and professional divers use antihistamines to ease ear, nose, and throat (ENT) problems, especially for opening tubal ostium. Some divers know they are unfit to dive, but for a variety of reasons (e.g., money or short holiday) they try to clear their ears. Thus, the use of antihistaminic drugs (like clemastine fumarate) is common during diving. This double-blind, crossover study indicates that this special antihistamine does not increase the sedative effects of nitrogen narcosis, nor does it increase the level of cardiac arrhythmias. Liberal use of antihistamines while diving cannot be recommended because of possible complications connected with different preparations and the temporary limitations they impose on the diver.

Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms

OBJECTIVES

To investigate if autonomic nervous system function, reflected in cardiovascular variables, among patients with neck-shoulder symptoms (tension neck group (T)) differed from that in a symptom free control group (C), and to establish its relation with pain and psychological stress.

METHODS

Twelve women with tension neck and nine controls in secretarial jobs were studied. They underwent an orthostatic test, deep breathing test, Valsalva manoeuvre, isometric handgrip test, and muscular endurance test. Pain was measured using visual analogue scales, and psychological stress by the Modified Somatic Perception Questionnaire (MSPQ). Plasma endothelin-1 (ET-1) was measured using high pressure liquid chromatography and radioimmunoassay.

RESULTS

Signs of psychological stress were significantly (p < 0.001) more common in group T than in group C. Mean resting heart rate in group T (77.8 (SE 2.9) beats/min; range 64-100) was significantly greater than that in group C (63.8 (3.1) beats/min; range 52-80) (p < 0.01). In the orthostatic test, the overall changes in R-R intervals during the first 40 heart beats after standing up and during seven minutes of testing differed significantly between the groups (p < 0.001, < 0.05, respectively). The increase in diastolic blood pressure in the three minute isometric handgrip test was significantly less in group T (19.4 (3.5) mm Hg; range -5 to 35) than in group C (30 (3.4) mm Hg; range 15-50) (p < 0.05). The MSPQ score in the study group (n = 21) correlated positively with resting heart rate (r = 0.462, p < 0.05) and negatively with increase in diastolic blood pressure (r = -0.514, p < 0.05). Plasma concentrations of ET-1 did not differ between the groups.

CONCLUSION

Increased sympathetic activity was found among patients having neck-shoulder symptoms. Local mechanisms may have influenced the cardiovascular changes observed during isometric testing in these patients.

Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome

Cardiovascular functional stability of 11 women with thoracic outlet syndrome (TOS; mean age 34.5) and nine female controls (mean age 35.1) was studied using an orthostatic test, a deep breathing test, Valsalva manoeuvre and hand-grip test. The heart rate at rest was significantly higher in TOS patients. The TOS group showed significant accentuation in T wave vacillation in the orthostatic test. The rise in diastolic blood pressure of the TOS group during a hand-grip test was significantly less than that of the control group. TOS patients experienced significantly more distress according to the modified somatic perception questionnaire (MSPQ) than the control group. Pain was correlated with the score of MSPQ, the resting heart rate and increase in diastolic blood pressure in a hand-grip test. The results suggest that TOS patients' symptoms often reflect a wider disturbance than merely anatomical compression in the thoracic outlet. It seems possible that sympathetic tone is higher in TOS patients than in controls. In addition to possible operative treatment, it may be necessary to provide psychological help, relaxation and endurance training.

Bilateral distal biceps tendon avulsions with use of anabolic steroids

A case of a young body-builder who had ingested megadoses of anabolic-androgenic steroids (AAS) for 6 yr and who sustained bilateral avulsions of the distal biceps tendon is presented. Explosive behavior, painful gynecomastia, and a slight hypertrophy of both the left and right ventricular walls of the heart were other possible adverse effects of AAS in this patient. Reinsertion of both distal biceps tendons to the radial tuberosity was performed according to the Boyd-Anderson technique and a good result was achieved.

Prenatal diagnosis of distal arthrogryposis type I by ultrasonography

Two consecutive pregnancies in a woman with initially undiagnosed type I distal arthrogryposis (DA) are reported. A prenatal diagnosis of the condition was made by ultrasound in the 17th week of gestation in one of the pregnancies, whereas in the subsequent pregnancy the disorder was excluded as early as 13 weeks' gestation. The diagnoses were verified at birth. The feasibility of prenatal diagnosis of DA type I in the second trimester is thus confirmed and its possibility in the late first trimester is suggested.

Cardiovascular functional disorder in primary fibromyalgia: a noninvasive study in 17 young men

Cardiovascular functional stability was studied in 17 young men (20-year-old conscripts) with the symptoms of primary fibromyalgia (PF). They were compared to 20 medical students of the same age. The subjects underwent an orthostatic test, deep breathing test, Valsalva maneuver, and a handgrip test. They were evaluated by an autoanamnestic questionnaire on vegetative symptoms and laboratory tests on blood chemistry. The heart rate of the PF group after 8 min of active standing was 32 +/- 15 beats/min greater than at supine rest. The corresponding figure for the controls was 23 +/- 7 beats/min (p = 0.001). Twelve conscripts with PF (71%) presented sympathicotonic cardiovascular reaction on the orthostatic test (p < 0.001). Four of these sympathicotonic conscripts and two other conscripts (total 35%) had an abnormal high index of dystonic symptoms (p = 0.01). The results suggest that young men with symptoms of PF have not only cardiovascular dystonic symptoms but also increased sympathetic nervous reactivity of the cardiovascular system.

Late complications after a Yersinia enterocolitica epidemic: a follow up study

Ninety four Finnish conscripts were affected by a Yersinia enterocolitica epidemic in 1973. Thirteen years later 75 men completed a questionnaire about their present health. One half had no health problems, and the most common complaints in the other subjects were musculoskeletal disorders. Sixteen men wanted to be re-examined. In three cases a chronic connective tissue disease was diagnosed. Two men had ankylosing spondylitis. The most notable results of this study were (a) the fairly low number of late complications, (b) the close correlation between complications and the HLA-B27 antigen, and (c) the correlation between raised yersinia antibody titres and the late complications. The nature of the primary causative agent may affect the development of late complications.

Color Doppler studies in trophoblastic tumors: a preliminary report

Ten women, referred because of a strong suspicion of gestational trophoblastic neoplasia, were examined by abdominal real-time ultrasound and color Doppler. The results were compared to those of pelvic angiography. In all but one case color Doppler examination revealed areas of increased vascularity. In all cases the findings of color Doppler and pelvic angiography agreed. Real-time ultrasound failed to detect abnormal uterine echoes in three of the patients where the other methods indicated tumor. The present study indicates that color Doppler could be of great value in a non-invasive assessment of trophoblastic tumors.

Prevalence of asthma in Finnish young men

OBJECTIVE

To determine the prevalence of asthma in cohorts of Finnish young men in the period 1926-89.

DESIGN

A retrospective analysis using reports and statistics of Finnish defence forces.

SETTING

Call up examinations of candidates for military conscription and examination of conscripts discharged because of poor health.

SUBJECTS

Roughly 900,000 men--that is, 98% of men of conscription age--examined in 1966-89 and a proportional but unknown number examined in 1926-61.

MAIN OUTCOME MEASURES

Asthma recognised at call up examination, exemption from military service, and discharge from military service because of asthma.

RESULTS

During 1926-61 the prevalence of asthma recorded at call up examinations remained steady at between 0.02% and 0.08%. Between 1961 and 1966, however, a continuous, linear rise began, the prevalence increasing from 0.29% in 1966 to 1.79% in 1989--that is, representing a sixfold increase. Compared with 1961 the rise was 20-fold. From 1966 to 1989 the sum of exemptions and discharges from military service due to asthma increased analogously sixfold.

CONCLUSIONS

If the apparent increase in asthma detected in Finnish young men was due entirely to improved diagnostic methods and other confounding effects then some 95% of cases must have gone undiagnosed in the years before 1966. This seems inconceivable, which suggests that much of the increase was real. This conclusion is strengthened by the observed rise in exemptions and discharges due to asthma.

Testicular hydrocele treated by bismuth phosphate injection

Thirty-eight testicular hydroceles were treated by injection with 0.2-0.4 g of bismuth phosphate. The follow-up was completed in 32 cases, 17 (53%) of which showed complete regression although one patient had to wait 24 months for full regression. Eight patients (25%) showed clinical improvement and one patient (3%) had residual scrotal tenderness after otherwise successful treatment. Six patients (19%) did not improve and were treated surgically. The method may present an alternative to surgery in elderly patients with testicular hydrocele.

Nephritis among young Finnish men

During an eight-year period (1975-1982) 174 military conscripts (out of a total of 314,000) were submitted to Helsinki University Central Hospital, Fourth Department of Medicine, on suspicion of renal disease. Eighty-four had isolated hematuria, 61 hematuria and concomitant proteinuria and 29 persistent proteinuria. In 100 of them the urinary abnormality was an incidental finding, 62 suffered from symptoms of infection and the rest had other complaints. A renal biopsy was performed, yielding a representative sample in 171 cases, after other causes of the urinary abnormality had been excluded. Morphological analysis showed that 131 patients had glomerulonephritis, IgA nephropathy being the most common type (70 patients). Tubulo-interstitial nephritis was seen in two cases, and nephrocalcinosis in one. Among 37 cases with apparently normal glomeruli under light microscopy, immunofluorescence analysis revealed glomerular deposits other than IgA in 19 cases and no deposits in 15 (three were inadequate for this analysis). On the basis of the figures in this study the average number of annually detected cases of nephritis was 48 per 100,000 Finnish conscripts. During the same period an annual average of 46 per 100,000 young men were exempted from military service because of nephritis, giving an overall figure of 94 cases of nephritis detected annually per 100,000 young Finnish men.

Laryngeal edema as the only symptom of hypersensitivity to salicylic acid and other substances

Idiosyncrasy to salicylic acid and related substances is well known, the most common symptoms being asthma, rhinorrhea and urticaria. We here describe two cases whose only symptoms were hoarseness and in which inspection revealed laryngeal edema when the patients ingested any of these substances. In cases of chronic recurring hoarseness, a history should be taken with respect to such hypersensitivity and suspect cases should be challenged, since a strict diet may improve the symptoms.

Sectorized psychiatry. A methodological study of the effects of reorganization on patients treated at a mental hospital

The aim of the study was to find relevant methods and use them to investigate the effects of sectorized psychiatry on former mental hospital patients. Seventeen hypotheses were formulated, concerning both positive and negative effects of sectorized psychiatry. Relevance and expected availability decided the variables, which were based on information from medical registers, case records, death certificates, social authorities, courts of law, public health insurance, census office and personal interviews. The hypotheses were tested by the use of two groups of patients, 377 in one experimental group, and 377 in one control group. A matched control method was used. The study patients were domiciled in the catchment area for the first complete trial of sectorized psychiatric service in the Stockholm area. The control patients were domiciled in the catchment area for the remaining divisions of Beckomberga Mental Hospital. During the actual years, an experimental situation was at hand. Comparisons in each pair were performed, regarding the experimental year 1980. A methodological description of variables for measurement of the effects and changes in psychiatric care is presented. The comparison showed no significant differences in the analyses, regarding utilization of inpatient care at Beckomberga Hospital in 1980. Study patients had significantly more outpatient visits and day-care days compared to controls. Study patients reported significantly shorter time of public transportation between home and psychiatric service. Study patients were significantly more often discharged to the division's own agencies compared to controls. Study patients reported significantly less satisfaction with ward staff than controls. No significant differences in direct cost of treatment during the experimental year were registered. The conclusion is, that there are no consistent tendencies proving the new organization superior to the traditional one for these former mental hospital patients.