Role of adiposity hormones in the mouse during fasting and winter-acclimatization

The influence of fasting and winter-acclimatization (cold and short-day acclimatization) on mouse plasma leptin, ghrelin, growth hormone (GH) and melatonin concentrations was determined from blood samples taken at mid-day and midnight. A 16-h fast decreased the plasma leptin but almost doubled the plasma ghrelin concentrations which contribute to energy saving, appetite stimulation and, in the case of leptin, to inhibition of reproduction. Winter-acclimatization did not affect plasma ghrelin concentrations, whereas leptin decreased to the same level as in fasting. The low leptin concentrations possibly enable an increased caloric intake for the purpose of thermogenesis. Fasting and winter-acclimatization seemed to abolish the diurnal leptin rhythm, but had no effect on that of ghrelin. Plasma melatonin concentration correlated negatively with ghrelin, suggesting a possible role for melatonin in the regulation of ghrelin concentration. SNS-activity and insulin appear to be the main regulators of leptin plasma concentration in the mouse, rather than melatonin as in some seasonal mammals. Interestingly, endogenous ghrelin did not stimulate GH secretion, which is a well-documented reaction to exogenous ghrelin injections.

The life situation of parents over the first year after their child's cancer diagnosis

AIM

To evaluate the impact of childhood cancer on the life of the parents.

METHOD

A 1-y follow-up study, with two time points for questionnaires, was completed in 21 out of 26 eligible families, and there were 46 control families matched by mothers' educational status.

RESULTS

Half of the mothers worked outside home during the first year of their child's illness. The perceived amount of lost family income was high during the first few months. The attitudes of the parents were fairly positive as their family life and spouse relations were concerned. Feelings of being under strain or stressed were, by the mothers, described as intolerable in the beginning. However, standardized anxiety assessment failed to show an increase in feelings of anxiety. Own health was rated significantly negative by cancer parents.

CONCLUSIONS

Despite good family relationships, a need for supportive measures exists, especially during the first few months, and in-depth interviews by psychologists or special nurses might be a way of finding out possible anxiety. The perceived feelings of own health may also be an indicator of the level of distress. Parent support groups could also do more to offer opportunities of physical activities for the parents, not merely disease-related information and group discussions.

The siblings of childhood cancer patients need early support: a follow up study over the first year

BACKGROUND AND METHODS

In a 1 year follow up study, we assessed the life situation of 33 siblings of childhood cancer patients and 357 healthy controls. The hypothesis was that siblings have more behavioural and health related problems just after the cancer diagnosis. Validated assessment methods were used.

RESULTS

Siblings below school age tended to have conduct problems, psychosomatic problems, and a mixed group of other behavioural problems, when assessed 3 months after the cancer diagnosis. These symptoms became less evident during follow up. Among the school aged siblings, however, conduct problems, learning problems, psychosomatic problems, impulsive-hyperactive symptoms, and other behavioural symptoms remained unchanged during follow up. In their self assessments, the school aged siblings showed both state and trait anxiety more often than controls at the first assessment, but later these symptoms settled to the same level as the controls. The overall Children's Depression Inventory (CDI) depression scores did not show differences between the study groups.

CONCLUSIONS

The ratings of the parents were in keeping with the self assessment of the school aged siblings only in a few aspects; the emphasis of findings can be changed when proxies are used. The siblings have symptoms and adverse feelings which probably could be relieved by targeted, early information about the illness, and possibly by group discussions or activities, soon after the cancer diagnosis. In order to obtain necessary support for the siblings with educational problems, school personnel need to be informed about the sibling distress.

Safety and immunogenicity of RIX4414 live attenuated human rotavirus vaccine in adults, toddlers and previously uninfected infants

A live attenuated human rotavirus (HRV) vaccine, strain RIX4414, was tested sequentially in adults, previously infected toddlers, and previously uninfected infants. A single dose was given to adults and toddlers and found well tolerated. Next, a dose ranging (three different viral concentrations) safety and immunogenicity study was conducted in rotavirus IgA antibody negative infants (N= 192), who received two doses of RIX4414 vaccine or placebo at 2 and 4 months of age. No side effects were seen after vaccination. Specifically, administration of RIX4414 vaccine was not temporally associated with fever, diarrhea, or increase in liver transaminases. Rotavirus IgA seroconversion ranged from 50 to 88% after one dose and from 73 to 96% after two doses, depending on vaccine titer. After the first dose, on days 7-9 post vaccination, between 38 and 60% of the infants shed the vaccine virus, whereas after the second dose only 0 to 13% of the vaccinees shed the vaccine virus. It is concluded that RIX4414 strain HRV vaccine is virtually non-reactogenic and, at high titer, highly immunogenic in susceptible infants.

A comparison of the biological and clinical features of invasive lobular and ductal carcinomas of the breast

Altogether 295 consecutive pure lobular invasive breast cancers diagnosed between 1990 and 1999 in the area of Tampere University Hospital were compared to 295 ductal invasive breast cancers. Biological factors, DFS, OS, recurrence types, survival after recurrence and other primary cancers were analyzed. ILC tumors were more often hormone receptor-positive, slowly proliferative and Erbb-2-negative. During the mean follow-up time of 5.1 years 76 recurrences in both groups were discovered. During the whole follow-up time there was more metastation to gynecological organs and GI tract in the ILC group. Bilateral breast cancers did not differ between the groups. DFS and OS were the same between the groups despite the fact that ILC patients received statistically significantly less adjuvant treatment. In conclusion, since ILC cancers are more often hormone receptor-positive, there is a good option to adjuvant endocrine therapy with present and future preparations, this possibly leading to improvement in OS.

Work related and individual predictors for incident neck pain among office employees working with video display units

AIMS

To investigate work related and individual factors as predictors for incident neck pain among office employees working with video display units (VDUs).

METHODS

Employees in three administrative units of a medium sized city in Finland (n = 515) received mailed questionnaires in the baseline survey in 1998 and in the follow up survey in 1999. Response rate for the baseline was 81% (n = 416); respondents who reported neck pain for less than eight days during the preceding 12 months were included into the study cohort as healthy subjects (n = 232). The follow up questionnaire 12 months later was completed by 78% (n = 180). Incident neck cases were those reporting neck pain for at least eight days during the preceding 12 months.

RESULTS

The annual incidence of neck pain was 34.4% (95% CI 25.5 to 41.3). Poor physical work environment and poor placement of the keyboard increased the risk of neck pain. Among the individual factors, female sex was a strong predictor. Smoking showed a tendency for an increased risk of neck pain. There was an interaction between mental stress and physical exercise, those with higher mental stress and less physical exercise having especially high risk.

CONCLUSION

In the prevention of neck disorders in office work with a high frequency of VDU tasks, attention should be given to the work environment in general and to the more specific aspects of VDU workstation layout. Physical exercise may prevent neck disorders among sedentary employees.

Interpositus nucleus inactivation reduces unconditioned response amplitude after paired but not explicitly unpaired treatment in rabbit eyeblink conditioning

The amplitude of unconditioned responses (URs) in unconditioned stimulus (US) alone presentations were measured in six rabbits during explicitly unpaired and classical conditioning treatments. After both phases of the experiment, the interpositus nucleus (IPN) was reversibly inactivated by a cold probe. URs after unpaired treatment were unaffected by inactivation but after acquisition of a robust level of conditioned responses (CRs), URs in US-alone test trials were reduced in amplitude compared with URs immediately before and after inactivation. The results suggest that the IPN has a role in CR-related reflex modification.

Inactivation of the interpositus nucleus blocks the conditioned response acquired by a somatosensory conditioned stimulus in rabbit eyeblink conditioning

1. Earlier studies suggest that the memory trace for the conditioned eyeblink reflex is formed and maintained in the interpositus nucleus (IPN) in the deep cerebellar nuclei when either an auditory or visual stimulus is used as a conditioned stimulus (CS). 2. In the present study, the eyeblink reflex of the rabbit was conditioned to a somatosensory CS (an airpuff onto the back). 3. In well-trained animals, the IPN was reversibly inactivated by local cooling and the existence of the learned responses to the CS was then tested. 4. The reversible IPN inactivation blocked the memory trace the somatosensory CS. The finding further supports the view that IPN-mediated memory trace formation is not dependent on the modality of the CS.

Somatosensory event-related potentials in the rabbit cerebral and cerebellar cortices: a correspondence with mismatch responses in humans

Somatosensory event-related potentials (ERPs) were recorded from the cerebellar (CerCx), somatosensory (SomCx) and visual (VCx) cortices in rabbits in two stimulus conditions. In the oddball condition, airpuffs to two different locations in the rabbit's muzzle corresponded to infrequently presented deviant stimuli (oddball-deviants) interspersed with frequently presented standard stimuli. In the deviant-alone condition, deviants (alone-deviants) were presented without standards. ERPs to oddball-deviants differed significantly from those to standards in CerCx and SomCx, but not in VCx. Furthermore, some of these differences were not found between ERPs to alone-deviants and those to standards. Thus, ERPs to oddball-deviants contributing these differences were dependent on the presence of preceding standards. The results are in line with the elicitation of mismatch negativity-like ERPs to somatosensory changes in humans.

International quit and win 1996: standardized evaluation in selected campaign countries

BACKGROUND

Quit and Win '96 recruited 70,000 smokers in 25 countries. The participants tried to abstain from smoking for at least 4 weeks. All participating countries followed the jointly agreed rules. Half of the countries implemented the campaign nationally and half, regionally.

METHODS

A 1-year follow-up study was conducted in the participating countries. The aim of this study was to provide a standardized evaluation based on data from eight European campaign sites. Three measures were used to evaluate the effectiveness of the campaigns. The first measure was the participation rate, which is the proportion of participants among the smoking population targeted in each site. The second measure was a cautious estimate for the continuous 1-year abstinence rate, which is the proportion of abstainers among the follow-up sample regarding all non-respondents as relapsed. Third was the measure of the population impact, which is the efficacy of the intervention multiplied by its reach, where the efficacy equals the abstinence rate and the reach equals the participation rate.

RESULTS

The participation rates varied from 0.1 to 2%, being highest in North Karelia, Finland, and Pitka;auranta, Russia. The abstinence rates varied from 12 to 35%, being highest in Hungary, Ukraine, and Russia, where the prevalence of smoking is also relatively high. The population impacts varied from 0.02 to 0.5%, being highest in Pitka;auranta, where both the reach and the efficacy of the Quit and Win were relatively high.

CONCLUSIONS

There was great variation in effectiveness, with population impact being affected more by participation rate than abstinence rate. Quit and Win contests are feasible interventions in diverse European populations. To improve the effectiveness, future campaigns should increase the reach of the intervention.

Working memory structure and intellectual disability

The working memory of people with intellectual disability has been found to generally lag behind their mental age. However, studies concerning the structure of working memory or its connections to other cognitive functions are rare. The present study employs a versatile battery of tests for the evaluation of working memory structure in adults with intellectual disability of unknown aetiology. In addition, connections between working memory and cognitive skills valid for everyday functioning are evaluated. Working memory performance in the study participants was found to stem from two distinct components which could be regarded to represent phonological and general working memory. General working memory was closely related to intelligence, whereas phonological working memory was not. The subjects in the study group differed in their working memory profiles. These distinct profiles were significantly related to academic skills (e.g. reading, writing and mathematics) and sentence comprehension because the profile of the working memory predicted these abilities even when the intelligence and educational background of the participants was taken into consideration.

International Quit and Win 1996: comparative evaluation study in China and Finland

OBJECTIVES

To compare background and process variables, as well as follow up status, of the participants in the International Quit and Win '96 contests of China and Finland, and analyse factors contributing to sustained maintenance.

DESIGN

A standardised 12 month follow up was conducted in both countries with random samples of participants. The sample sizes were 3119 in China and 1448 in Finland, with response rates of 91.2% and 65.2%, respectively.

INTERVENTIONS

The International Quit and Win '96 contest was the second coordinated, multinational smoking cessation campaign targeted at adult daily smokers. Altogether 25 countries participated, including China with 15 000 and Finland with 6000 smokers registered.

MAIN OUTCOME MEASURES

Conservative (considering all non-respondents relapsed) and non-conservative (based on respondents only) estimates were calculated for one month abstinence, 12 month continuous abstinence, and point abstinence at the time point of follow up.

RESULTS

Great differences were found in the background and process variables, as well as in the outcome measures. At one year follow up, the conservative continuous abstinence rates show that the Chinese participants maintained their abstinence better (38%) compared to the Finnish ones (12%). In China women reached higher abstinence rate (50%) than men (36%), whereas in Finland men achieved a better result (14%) than women (9%).

CONCLUSIONS

The Quit and Win contest is a mass smoking cessation method feasible in countries showing great variance in smoking habits and rates. However, in countries with different stages of anti-smoking development, such as China and Finland, different practical implementation strategies may be needed.

Neurological development of 5-year-old children receiving a low-saturated fat, low-cholesterol diet since infancy: A randomized controlled trial

CONTEXT

Early childhood introduction of nutritional habits aimed at atherosclerosis prevention is compatible with normal growth, but its effect on neurological development is unknown.

OBJECTIVE

To analyze how parental counseling aimed at keeping children's diets low in saturated fat and cholesterol influences neurodevelopment during the first 5 years of life.

DESIGN

Randomized controlled trial conducted between February 1990 and November 1996.

SETTING

Outpatient clinic of a university department in Turku, Finland.

PARTICIPANTS

A total of 1062 seven-month-old infants and their parents, recruited at well-baby clinics between 1990 and 1992. At age 5 years, 496 children still living in the city of Turku were available to participate in neurodevelopmental testing.

INTERVENTION

Participants were randomly assigned to receive individualized counseling aimed at limiting the child's fat intake to 30% to 35% of daily energy, with a saturated:monounsaturated:polyunsaturated fatty acid ratio of 1:1:1 and a cholesterol intake of less than 200 mg/d (n = 540) or usual health education (control group, n = 522).

MAIN OUTCOME MEASURES

Nutrient intake, serum lipid concentrations, and neurological development at 5 years, among children in the intervention vs control groups.

RESULTS

Absolute and relative intakes of fat, saturated fatty acids, and cholesterol among children in the intervention group were markedly less than the respective values of control children. Mean (SD) percentages of daily energy at age 5 years for the intervention vs control groups were as follows: for total fat, 30.6% (4.5%) vs 33.4% (4.4%) (P<. 001); and for saturated fat, 11.7% (2.3%) vs 14.5% (2.4%) (P<.001). Mean intakes of cholesterol were 164.2 mg (60.1 mg) and 192.5 mg (71. 9 mg) (P<.001) for the intervention and control groups, respectively. Serum cholesterol concentrations were continuously 3% to 5% lower in children in the intervention group than in children in the control group. At age 5 years, mean (SD) serum cholesterol concentration of the intervention group was 4.27 (0.63) mmol/L (165 [24] mg/dL) and of the control group, 4.41 (0.74) mmol/L (170 [29] mg/dL) (P =.04). Neurological development of children in the intervention group was at least as good as that of children in the control group. Relative risks for children in the intervention group to fail tests of speech and language skills, gross motor functioning plus perception, and visual motor skills were 0.95 (90% confidence interval [CI], 0.60-1.49), 0.95 (90% CI, 0.58-1.55), and 0.65 (90% CI, 0.39-1.08), respectively (P =.85,.86, and.16, respectively, vs control children).

CONCLUSION

Our data indicate that repeated child-targeted dietary counseling of parents during the first 5 years of a child's life lessens age-associated increases in children's serum cholesterol and is compatible with normal neurological development. JAMA. 2000;284:993-1000

Receptor structure for F1C fimbriae of uropathogenic Escherichia coli

F1C fimbriae are correlated with uropathogenic Escherichia coli strains. Although F1C fimbriae mediate binding to kidney tubular cells, their receptor is not known. In this paper, we demonstrate for the first time specific carbohydrate residues as receptor structure for F1C-fimbria-expressing E. coli. The binding of the F1C fimbriated recombinant E. coli strain HB101(pPIL110-54) and purified F1C fimbriae to reference glycolipids of different carbohydrate compositions was evaluated by using thin-layer chromatography (TLC) overlay and solid-phase binding assays. TLC fimbrial overlay analysis revealed the binding ability of purified F1C fimbriae only to glucosylceramide (GlcCer), beta1-linked galactosylceramide 2 (GalCer2) with nonhydroxy fatty acids, lactosylceramide, globotriaosylceramide, paragloboside (nLc(4)Cer), lactotriaosylceramide, gangliotriaosylceramide (asialo-GM(2) [GgO(3)Cer]) and gangliotetraosylceramide (asialo-GM(1) [GgO(4)Cer]). The binding of purified F1C fimbriae as well as F1C fimbriated recombinant E. coli strain HB101(pPIL110-54) was optimal to microtiter plates coated with asialo-GM(2) (GgO(3)Cer). The bacterial interaction with asialo-GM(1) (GgO(4)Cer) and asialo-GM(2) (GgO(3)Cer) was strongly inhibited only by disaccharide GalNAcbeta1-4Galbeta linked to bovine serum albumin. We observed no binding to globotetraosylceramide or Forssman antigen (Gb(5)Cer) glycosphingolipids or to sialic-acid-containing gangliosides. It was demonstrated that the presence of a GalCer or GlcCer residue alone is not sufficient for optimal binding, and additional carbohydrate residues are required for high-affinity adherence. Indeed, the binding efficiency of F1C fimbriated recombinant bacteria increased by 19-fold when disaccharide sequence GalNAcbeta1-4Galbeta is linked to glucosylceramide as in asialo-GM(2) (GgO(3)Cer). Thus, it is suggested that the disaccharide sequence GalNAcbeta1-4Galbeta of asialo-GM(2) (GgO(3)Cer) which is positioned internally in asialo-GM(1) (GgO(4)Cer) is the high-affinity binding epitope for the F1C fimbriae of uropathogenic E. coli.

Cortical and subcortical visual event-related potentials to oddball stimuli in rabbits

Event-related potentials (ERPs) to changes in the visual environment were recorded in rabbits. In the oddball condition, infrequently presented (deviant) stimuli occurred in a series of frequently presented (standard) stimuli. In the deviant-alone condition, standards were omitted. ERPs to oddball-deviants differed from those to standards in all recording sites (cerebellar cortex, visual cortex, dentate gyrus). No corresponding differences were found between ERPs to deviants in the oddball condition and those in the deviant-alone condition. However, because ERPs to deviants in the deviant-alone condition and those to standards did not differ either, ERPs to stimulus changes in the oddball condition seemed to be dependent on the presence of standards, thus representing an analogue to mismatch negativity (MMN) in humans.

Cerebral glucose metabolism in survivors of childhood acute lymphoblastic leukemia

BACKGROUND

Cranial radiation therapy (CRT) has been suggested to be a principal factor responsible for long term neurocognitive deficits in survivors of acute lymphoblastic leukemia (ALL). However, neither reduction of the irradiation dose nor the elimination of irradiation entirely appear to have abolished neurocognitive impairment in long term ALL survivors. Positron emission tomography (PET) and [(18)F]-fluorodeoxyglucose (FDG) can be used to quantitate cerebral glucose metabolism, a potential indicator of treatment-induced adverse central nervous system (CNS) effects. The purpose of this study was to assess whether CRT is associated with defects in cerebral glucose metabolism in long term ALL survivors. The authors also studied whether chemotherapy and/or the severity of disease have deleterious effects on glucose metabolism.

METHODS

Forty long-term survivors of childhood ALL were studied using FDG PET. All subjects went through an elaborate neurocognitive assessment. In 20 of these children, the prophylactic treatment of the CNS had been CRT combined with methotrexate (MTX), and it was MTX only in the remaining 20 children.

RESULTS

No major differences were found in the regional cerebral glucose utilization or in neurocognitive performance between the irradiated and nonirradiated groups. A high leukocyte count at the time of diagnosis was found to be associated inversely with cerebral glucose utilization.

CONCLUSIONS

CRT does not appear to affect cerebral glucose metabolism in long term survivors of ALL. By contrast, the association between the leukocyte count and glucose utilization implies that disease severity may be partly responsible for adverse CNS effects in long term survivors of childhood ALL.

International Quit and Win: successful global action for smoking cessation

Quit and Win has rapidly grown in popularity as a practical international smoking cessation activity. This is likely to be due to Quit and Win's unique, positive approach to a problem that is receiving increasing attention worldwide as a major health threat. The campaign is also a concrete channel for large international health collaboration, which is necessary considering the global nature of marketing efforts of the tobacco industry. Based on encouraging experiences of three previous international campaigns in 1994, 1996 and 1998, the next International Quit and Win will be organized in 2000. It will be larger than ever and support the new WHO Tobacco-Free Initiative.

Evolution of bacterial pathogenesis

The evolution of bacteria is associated with continuous generation of novel genetic variants. The major driving forces in this process are point mutations, genetic rearrangements, and horizontal gene transfer. A large number of human and animal bacterial pathogens have evolved the capacity to produce virulence factors that are directly involved in infection and disease. Additionally, many bacteria express resistance traits against antibiotics. Both virulence factors and resistance determinants are subject to intrastrain genetic and phenotypic variation. They are often encoded on unstable DNA regions. Thus, they can be readily transferred to bacteria of the same species or even to non-related prokaryotes. This review article focuses on the main mechanisms of bacterial microevolution responsible for the rapid emergence of variants with novel virulence and resistance properties. In addition, processes of macroevolution are described with special emphasis on gene transfer and fixation of adaptive mutations in the genome of pathogens.

Variation of apolipoprotein B as a possible cause of decreased low density lipoprotein clearance and hypercholesterolemia

The fractional catabolic rate (FCR) for low density lipoprotein (LDL) apolipoprotein B (apo B) was studied to explore the variations in apo B as a possible cause of hypercholesterolemia. The FCR of radioiodine labelled autologous LDL and homologous LDL isolated from a normocholesterolemic subject were compared in forty-nine type II hypercholesterolemic males and females with the mean plasma concentration of total cholesterol of 7.78 mmol/l, LDL-cholesterol 5.41 mmol/l and triglycerides 2.09 mmol/l. In most patients the autologous LDL was catabolized at an equal rate and sometimes even faster than the homologous LDL. However, twelve out of forty-nine patients catabolized homologous LDL 0.8-19.3% faster than autologous LDL and several apo B polymorphisms were determined. No apo B-3500 or apo B-3531 mutations were detected. Patients with XbaI -/- (absence of cutting site) had lower total, IDL and LDL cholesterol and LDL apoB than the other genotypes. Patients with EcoRI +/+ (presence of cutting site) had higher total, VLDL and LDL cholesterol and slower FCR for autologous LDL, and their VLDL was richer in cholesterol than that of patients with the EcoRI +/-. The MspI and ins/del polymorphisms were not associated with variations in the measured parameters. The apo E 4 was associated with higher VLDL and IDL cholesterol, higher triglycerides and LDL apo B than E 3/3. Overall, the determined apo B polymorphisms were not related to the slow clearance of autologous LDL among the 12 patients, in whom autologous LDL was cleared at a slower rate than homologous LDL. In conclusion, hypercholesterolemia can be due to particle-related slow clearance of LDL in some patients. However, this is not a common cause of hypercholesterolemia.

Cerebral blood flow and glucose metabolism in long-term survivors of childhood acute lymphoblastic leukaemia

Central nervous system treatment for childhood acute lymphoblastic leukaemia (ALL) has been reported to cause changes in cerebral blood flow and glucose metabolism. Little is known about the association of these functional changes with neuropsychological defects and structural changes. The aim of the present study was to assess the relationship between changes in regional cerebral blood flow and glucose utilisation in long-term survivors of ALL, and the association of these functional abnormalities with neurocognitive and structural defects. 8 survivors of childhood ALL were studied with single photon emission tomography (SPECT) using Tc99m-ethyl cysteinate dimer (ECD) as tracer and with positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) as tracer. 8 healthy controls also underwent FDG-PET. All subjects also underwent magnetic resonance imaging and neuropsychological assessment 5 years after cessation of the therapy. Focal cerebral blood flow abnormalities were found in ECD-SPECT in 5 of the 8 survivors. Glucose utilisation appeared normal in the corresponding regions. However, glucose utilisation was decreased in thalamus and cerebellum in the survivors of ALL as compared with healthy controls. 3 patients had severe and 5 patients mild neurocognitive difficulties. The changes in cerebral blood flow and FDG uptake did not correspond neuroanatomically with the neurocognitive defects. Focal defects in cerebral blood flow in long-term survivors of ALL are not associated with changes in local cerebral glucose utilisation. Neurocognitive difficulties are not consistently associated with either changes in cerebral blood flow or with decreased glucose utilisation. Therefore, based on the present set of studies FDG-PET and ECD-SPECT cannot yet be recommended for the evaluation of long-term neurocognitive defects associated with treatment of ALL.

Quit and Win campaigns as a long-term anti-smoking intervention in North Karelia and other parts of Finland

OBJECTIVE

To evaluate Quit and Win campaigns repeated in North Karelia and rest of Finland.

DESIGN

Repeated comparisons of participation rates, abstinence rates, and other measures between North Karelia and the rest of Finland.

SUBJECTS

Adult daily smokers in Finland participating in the Quit and Win contests in 1986-1997.

INTERVENTIONS

Quit and Win smoking cessation campaigns targeted at adult daily smokers throughout Finland in 1986, 1989, 1994, 1996, and 1997, including more intensive activities in North Karelia.

MAIN OUTCOME MEASURES

Participation rates, self reported six-month abstinence rates, other effectiveness measures (% of smokers who attended, intended, tried, and succeeded in cessation).

RESULTS

North Karelia's participation rates were significantly higher in each campaign compared with the rest of Finland. The abstinence rates in North Karelia were also higher, the difference being significant in 1986 and 1994 (p < 0.05). In the target population in 1996 over 75% of smokers in North Karelia, compared with 40% of smokers surveyed elsewhere, reported awareness of the campaign (p < 0.001). Approximately 9% of the smokers in North Karelia and 6% elsewhere intended to participate (p = NS). Over 2% in North Karelia, compared with less than 1% elsewhere, tried to quit (p < 0.001). Among the targeted group, 0.3% of North Karelian smokers were complete abstainers throughout the 12 months of follow up, compared with an average of 0.1% in other areas (p < 0.001).

CONCLUSIONS

The Quit and Win campaign is a feasible cessation method in long-term community-wide programmes. Intensified community activities are associated with higher success. In repeat campaigns, high participation and abstinence rates can be maintained.

Neurocognitive sequelae of scaphocephaly

OBJECTIVE

Early cranioplasty for scaphocephaly has become routine in most countries. In addition to normalizing the shape of the skull, it has been found to decrease intracranial hypertension. Whether corrective surgery benefits the child's cognitive outcome has been poorly documented.

DESIGN

Eighteen children whose sagittal suture showed premature fusion at birth or soon thereafter were operated on at age 1 week to 7 months. All patients healed without complications and were followed-up at regular intervals. At the age of 7.8 to 16.3 years they were examined to clarify their neurocognitive development and to compare the results with their age- and gender-matched healthy controls.

RESULTS

Originally scaphocephalic children, although operated on, had mild deficiencies in auditory short-term memory and language development when examined with the general comprehension, similarities, and digit span subscales of the Wechsler Intelligence Scale for Children-Revised. In all other respects their developmental outcome was equal to that of the controls.

CONCLUSIONS

Despite relative early correction of the skull shape, originally scaphocephalic children's neurocognitive performances do not reach the same level in all of the neurocognitive domains as their matched controls at school age. Early operation (</=1 month) may decrease this developmental delay. This implies that impairment of brain function has already taken place in utero. For the same reason an early operation seems to be justified not only for correction of the skull shape, but also to allow unrestricted development for the brain. Postponement of the operation would not serve either of these aims.

The effect of the apolipoprotein E phenotype on cholesteryl ester transfer protein activity, plasma lipids and apolipoprotein A I levels in hypercholesterolaemic patients on colestipol and lovastatin treatment

BACKGROUND

Apolipoprotein E (apo E) allele E 4 is associated with high atherogenic lipid levels and coronary heart disease. Cholesteryl ester transfer protein (CETP) transfers cholesteryl esters from (high density lipoprotein) HDL to other lipoproteins. CETP gene expression is enhanced in hypercholesterolaemia and correlates with plasma apo E concentration.

OBJECTIVE

The effect of the apo E phenotype on plasma CETP activity and the hypolipidaemic efficacy of colestipol and lovastatin was studied in patients with type II a or II b hypercholesterolaemia.

RESULTS

The baseline mean plasma total, low density lipoprotein (LDL) and HDL cholesterol, triglyceride, apolipoprotein A I (apo A I) concentrations and CETP activity were 8.89 mmol x l(-1), 6.78 mmol x l(-1), 1.39 mmol x l(-1), 1.59 mmol x l(-1), 1.49 g x l(-1) and 114 nmol x h(-1) x ml(-1), respectively. The colestipol-induced changes were -26%, -36%, +5%, + 12%, -1% and -17%, and the lovastatin-induced changes -34%, -44%, +6%, -18%, +1% and -19%. The lipid and apo A I concentrations or the CETP activity did not differ statistically significantly according to the apo E phenotype, although the HDL cholesterol and apo A I levels were lowered in patients with apo E 4/4 but elevated in patients with the other phenotypes. The CETP activity correlated with the LDL cholesterol concentration (r = 0.52, P = 0.01) and the change in the LDL cholesterol during colestipol (r = 0.51, P = 0.02) and lovastatin (r = 0.65, P = 0.001) treatment, but only in patients without the apo E 4 allele.

CONCLUSION

Colestipol and lovastatin reduced CETP activity to the same amount, regardless of the apo E phenotype. The apo E phenotype seems to modify the interaction between CETP activity and LDL cholesterol in hypercholesterolaemia and during pharmacological lowering of cholesterol.

Smoking cessation advice from health professionals: process evaluation of a community-based program

The study assessed whether exposure to advice to quit smoking from health care professionals was greater in North Karelia, an area with a community-based, long-term intervention integrated within the health care structure, than in the rest of Finland. Data were collected by health behavior surveys during 1978-1995. Adult regular smokers and those who had quit during the preceding 12 months were surveyed. We measured exposure to cessation advice by questioning, whether the person had been advised by a doctor or public health nurse to give up smoking at least once during the year preceding the survey. Men from the intervention area had a significantly higher likelihood of having been advised to quit than those elsewhere in Finland. The same trend emerged among women, but it was not significant. It is concluded that a community-based intervention program can encourage health professionals to increase their smoking cessation advice.