Effects of growth and aging on the reference values of pulmonary nitric oxide dynamics in healthy subjects

The lung just like all other organs is affected by age. The lung matures by the age of 20 and age-related changes start around middle age, at 40-50 years. Exhaled nitric oxide (F_ENO) has been shown to be age, height and gender dependent. We hypothesize that the nitric oxide (NO) parameters alveolar NO (C_ANO), airway flux (J_awNO), airway diffusing capacity (D_awNO) and airway wall content (C_awNO) will also demonstrate this dependence. Data from healthy subjects were gathered by the current authors from their earlier publications in which healthy individuals were included as control subjects. Healthy subjects (n = 433) ranged in age from 7 to 78 years. Age-stratified reference values of the NO parameters were significantly different. Gender differences were only observed in the 20-49 age group. The results from the multiple regression models in subjects older than 20 years revealed that age, height and gender interaction together explained 6% of variation in F_ENO at 50 ml s^-1 (F_ENO₅₀), 4% in J_awNO, 16% in C_awNO, 8% in D_awNO and 12% in C_ANO. In conclusion, in this study we have generated reference values for NO parameters from an extended NO analysis of healthy subjects. This is important in order to be able to use these parameters in clinical practice.

Development of Early PCLP1-Expressing Haematopoietic Cells within the Avian Dorsal Aorta

The first haematopoietic stem cells (HSC) develop in the dorsal aorta as haematopoietic intra-aortic clusters (HIAC). To evaluate the initial steps of definitive haematopoiesis, we have studied the emergence and the expression profile of podocalyxin-like protein 1 (PCLP1)-expressing cells in early chick embryos. Here we demonstrate that at embryonic day 2 (E2), the PCLP1+ cells are present in the splanchnic mesoderm and in the ventral lining of the paired dorsal aorta. Following aortic fusion at E3, the PCLP1-expressing cells are exclusively found in the aortic floor and as the development proceeds, both the haematopoietic clusters and the aortic endothelial cells express PCLP1. In parallel with the early PCLP1 expression, bone morphogenetic protein 4 (BMP4) expression was detected in the splanchnopleura and thereafter in the densely packed mesenchymal cells beneath the HIAC. The microarray analyses of early E3 PCLP1+ cells revealed elevated expression of genes known to be involved in the stem cell function. These data suggest that splanchnopleura-derived PCLP1-expressing cells give rise to the earliest definitive haematopoietic progenitors.

Thalidomide therapy and polyneuropathy in myeloma patients

Thalidomide is today an increasingly used therapy in advanced and refractory myeloma patients, especially in patients relapsing after high dose therapy. One important and well-known side effect of thalidomide is polyneuropathy (PNP). The purpose of this study was to investigate 1) how severe the thalidomide-induced PNP is in patients treated for myeloma 2) which neurophysiological tests and parameters are most sensitive in detecting the thalidomide-induced PNP and 3) how neuropathic symptoms correlate with neurophysiological changes. Twelve patients received thalidomide for treatment of relapsed multiple myeloma for at least 5 months. Prior to the thalidomide treatment, all patients had been treated with chemotherapy including vincristine, and seven patients had also received cisplatin. PNP symptoms, clinical findings and neurophysiological tests before and after the therapy were evaluated. Prior to thalidomide treatment, 7 patients had minimal and one patient slight PNP. After thalidomide treatment, 4 patients had minimal, 4 patients slight, and 3 patients moderate PNP. Thalidomide-induced PNP mainly affected sensory myelinated axons, but also alpha motor neuron axons were affected to some extent. Thermal thresholds were not altered, indicating that thin myelinated and unmyelinated axons are spared. The most sensitive parameter for detecting thalidomide-induced PNP was the sensory nerve compound action potential amplitude. The neuropathic symptoms deteriorated significantly during the therapy, but clinically, no patient developed a disabling PNP that would have required interrupting the therapy. The neuropathic side effects of thalidomide seem to be acceptable in myeloma patients.

Use of alternative drugs in Finland

OBJECTIVES

The purpose of this study was to assess the use of alternative drugs among the adult population in Finland, especially to find out how the health status, health behaviour and use of licensed drugs and health care services are related to the use of alternative drugs.

DESIGN

A telephone interview was conducted in March 1992 with a response rate of 85%.

SUBJECTS

A random, representative sample of 2134 Finns aged between 15 and 74 years.

RESULTS

A total of 39% of the respondents had used one or more types of alternative drugs during the last year. Most common was the use of health food products. Women used all types of alternative drugs more often than men. The use of alternative drugs was more common among educated and urban respondents. Perceived health or existence of a long-standing illness was not related to alternative drugs use whereas reporting of psychosomatic symptoms was. Non-smoking was positively related to the use of alternative drugs and also active exercise among men. The use of non-prescription drugs, official and unofficial health services were positively related to alternative drugs use.

CONCLUSIONS

The use of alternative drugs is popular and it may increase in the future. The use of alternative drugs can be considered a form of medicalization. More information on products used and people using alternative drugs is needed.

Chicken B-Cell-Activating Factor: Regulator of B-Cell Survival in the Bursa of Fabricius

Previous studies on mammals have demonstrated that a tumour necrosis factor family member, B-cell-activating factor (BAFF) (BlyS, TALL-1), is mainly produced by myeloid and dendritic cells and that BAFF promotes B-cell differentiation and survival in a paracrine fashion. We have recently shown that BAFF is upregulated at the bursal stage of the avian B-cell development. We now show that the avian bursal B cells and B-cell lines, RP-9, RP-13 and DT40, express chicken BAFF (cBAFF). In situ hybridization confirms strong cBAFF expression within the bursal follicles. Like mammals, cBAFF is expressed in the avian myeloblast and myelomonocytic cell lines but not in the peripheral blood alphabeta and gammadelta T cells. The binding of recombinant human BAFF (hBAFF) to the bursal B-cells indicates a conserved receptor-ligand binding. Furthermore, the recombinant hBAFF has a positive effect on bursal cell proliferation and transiently inhibits cell death in vitro. In conclusion, cBAFF is highly conserved structurally, but as a novel observation we suggest cBAFF to function in an autocrine fashion to promote the growth and maturation of follicular B cells in bursa of Fabricius.

The asthma programme of Finland: an evaluation survey in primary health care

OBJECTIVE

To evaluate the basic structures and processes of asthma care 6 years after the launch of the Finnish Asthma Programme. The evaluation will serve as the baseline for the implementation of the evidence-based guidelines for asthma published in 2000.

DESIGN

A descriptive type-2 evaluation (managerial monitoring of a policy implementation), based on operationalised statements of the Asthma Programme.

RESULTS

A co-ordinating doctor for asthma, usually a general practitioner (GP), was interviewed in 248 (91%) health centres; 83% of the health centres have at least one GP nominated as the local asthma co-ordinator and 94% have a nurse. Asthma education for the professionals had been organised in 71% of the health centres in the previous 2 years. First-line treatment consists of an inhaled corticosteroid. Guided self-management is used in 98% of the health centres, but its components were not clear to the doctors.

CONCLUSION

The basic structure of equipment and organisation for the diagnosis and treatment of asthma has been set up in the primary health care services.

Sleep apnoea: Finnish National guidelines for prevention and treatment 2002-2012

(1) After negotiations with the Finnish Ministry of Social Affairs and Health, a national programme to promote prevention, treatment and rehabilitation of sleep apnoea for the years 2002-2012 has been prepared by the Finnish Lung Health Association on the basis of extensive collaboration. The programme needs to be revised as necessary, because of the rapid development in medical knowledge, and in appliance therapy in particular. (2) Sleep apnoea deteriorates slowly. Its typical features are snoring, interruptions of breathing during sleep and daytime tiredness. Sleep apnoea affects roughly 3% of middle-aged men and 2% of women. In Finland, there are approx. 150,000 sleep apnea patients, of which 15,000 patients have a severe disease, 50,000 patients are moderate and 85,000 have a mild form of the disease. Children are also affected by sleep apnea. A typical sleep apnea patient is a middle-aged man or a postmenopausal woman. (3) The obstruction of upper airways is essential in the occurrence of sleep apnoea. The obstruction can be caused by structural and/or functional factors. As for structural factors, there are various methods of intervention, such as to secure children's nasal respiration, to remove redundant soft tissue, as well as to correct malocclusions. It is possible to have an effect on the functional factors by treating well diseases predisposing to sleep apnoea, by reducing smoking, the consumption of alcohol and the use of medicines impairing the central nervous system. The most important single risk factor for sleep apnoea is obesity. (4) Untreated sleep apnoea leads to an increase morbidity and mortality through heart circulatory diseases and through accidents by tiredness. Untreated or undertreated sleep apnoea deteriorates a person's quality of life and working capacity. (5) The goals of the Programme for the prevention and treatment of sleep apnoea are as follows: (1) to decrease the incidence of sleep apnoea, (2) to ensure that as many patients as possible with sleep apnoea recover, (3) to maintain capacity for work and functional capacity of patients with sleep apnoea, (4) to reduce the percentage of patients with severe sleep apnoea, (5) to decrease the number of sleep apnoea patients requiring hospitalisation and (6) to improve cost effectiveness of prevention and treatment of sleep apnoea. (6) The following means are suggested for achieving the goals: (1) to promote prevention of obesity, weight loss and weight control; (2) to promote securing of nasal respiration in child patients and removal of obstructing redundant soft tissues; (3) to promote the correction of children's malocclusions, (4) to enhance knowledge about risk factors and treatment of sleep apnoea in key groups, (5) to promote early diagnosis and active treatment, (6) to commence rehabilitation early and individually as a part of treatment and (7) to encourage scientific research. (7) On the national level, the occurrence of sleep apnoea can be prevented, for example, by encouraging weight control. The programme gives examples of such measures and appeals to various authorities and voluntary organisations to reinforce their collaboration. Preventive measures should be individualised, and based on due consideration. (8) The efficacy of diagnosing sleep apnoea should be increased. Attention should be paid to the symptoms of risk group patients at different units of the primary and occupational health care. Even mild forms of the disease should be treated appropriately. Diagnosis and treatment of the disease involve cooperation between the primary and specialised health-care sectors. Methods of treatment are (1) treatment of obesity, (2) positional therapy, (3) reduction of the use of medicines impairing the central nervous system, (4) reduction of smoking and the consumption of alcohol, (5) devices affecting the position of the tongue and lower jaw, (6) treatment with Continuous Positive Airway Pressure (CPAP-treatment), (7) surgical methods of treatment and (8) rehabilitation. (9) The hierarchy of referrals in the prevention and treatment of sleep apnoea should be revised to accord a greater role to the primary health-care sector. Good exchanges of information and cooperation between the primary health care and specialised medical-care sectors should be developed. Hospitals districts in cooperation with provincial governments and municipalities should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. (10) Rehabilitation of sleep apnoea should be goal-orientated and cover all forms of rehabilitation: medical, occupational and social. Rehabilitation should prevent the effects caused by the disease. Thus, it is possible to support self-care, increase the patient's resources and improve quality of life. (11) Information and training should be directed primarily towards health-care personnel, patients and their families. Organisations should produce materials for health and patient education as well as organising training events. To support the activities. financing will be needed from organisations such as Finland's Slot Machine Association. The Social Insurance Institution should disseminate information about questions of social security. Regional direction and training will mainly be the responsibilities of hospital districts, provincial governments and local health centres. The media will play an important role in the dissemination in-depth information about prevention and treatment of sleep apnoea.

Single-cell analysis of Ets-1 transcription factor expression during lymphocyte activation and apoptosis

The Ets-1 proto-oncogene is a prototype member of Ets family of transcription factors. It is preferentially expressed in lymphoid cells, where it is essential for the maintenance of the normal pool of resting T and B cells. We have investigated the protein expression of the Ets-1 transcription factor during the activation and apoptosis of T and B cells by flow cytometry and confocal microscopy. Cells of the thymus, spleen and bursa expressed high levels of Ets-1 protein, while resting peripheral blood mononuclear cells had lower Ets-1 expression. Activation and proliferation of T cells induced the upregulation of Ets-1. alphabeta-T cells were found to upregulate Ets-1 expression more than gammadelta-T cells. Increased Ets-1 protein expression was located predominantly in the perinuclear area. In contrast, during apoptosis, Ets-1 expression was downregulated. Collectively, our results indicate that Ets-1 expression can be accurately determined by flow cytometry and confocal microscopy. Ets-1 expression level and distribution are differentially controlled in resting, activated and apoptotic lymphocytes.

Men, women and friends--are there differences in relation to mental well-being?

This is a study on associations between the number of close friends and mental well-being in a nationwide sample of the Finnish general population (n = 1,603). Mental well-being was assessed by means of the 12-item General Health Questionnaire. A total of 3% of the sample had no close friends and another 3% had only one. Over half of the sample (52%) reported having five or more friends. The overall prevalence of mental distress was 15% in men and 21% in women. According to multivariate analyses the risk of mental distress was increased in men among those with no friends (odds ratio [OR]: 2.70) and among those who had one (OR: 4.32) or two to four friends (OR: 1.75), as compared with those who had more friends. In women, having only one friend (OR: 2.30), insufficient family support (OR: 1.63) and insufficient support from relatives (OR: 1.77) associated with the risk of mental distress. These results suggest that mental well-being might be promoted if mentally distressed men seeking professional help were supported in building up and maintaining social networks and mentally distressed women were supported in harmonizing their family life.

Gender differences in associations between religious attendance and mental health in Finland

We investigated in a nationwide sample of the Finnish general population (869 women and 773 men) whether there were gender-differences in associations between religious attendance and mental well-being. Respondents were asked during telephone interviews about sociodemographic variables, frequency of religious attendance and social contacts, and perceived social and family support. Mental health was screened by means of the 12-item General Health Questionnaire (GHQ-12). More women than men (62% vs. 50%) attended religious events, and there was a corresponding difference in percentages relating to regular religious attendance (17% vs. 10%). Regular religious attendance was most common among those over 65 years of age. In women, minor mental disorder (GHQ-12 score > or = 3) was more common among those who never attended religious events than among the others (25% vs. 16%). In men there was no difference. In women, religious attendance associated positively with social contacts, in men with happy family life. In multivariate analyses an independent positive association between religious attendance and absence of minor mental disorder was found in women (adjusted OR 1.58, 95% CI 1.12 to 2.24) but not in men. These results suggest that there may be gender-differences in associations between religious attendance, social and family life, and mental health.

Prethymic progenitors from the avian para-aortic mesoderm express GATA-3 and distinct chTcf isoforms but still lack T-cell receptor-gamma rearrangements

Haematopoietic precursors first colonizing the avian embryonic thymus are derived from the intraembryonic sites located around the dorsal aortae. These intraembryonic precursors have previously been demonstrated to include cells that harbour T-cell progenitor capacity and express the Ikaros transcription factor, known to be a prerequisite for lymphocyte development. In this study, we further evaluated the properties of these prethymic cells. We show that early intraembryonic cells and prethymic progenitors already express the GATA-3 transcription factor. The chicken homologue of T-cell factor-1, chTcf, is also detected in cells isolated from the avian para-aortic region. However, these intraembryonic cells retain their T-cell receptor gamma loci in germline configuration. Interestingly, chTcf was found to express different alternatively spliced isoforms during early ontogeny and thymic T-cell development, which indicates developmentally regulated expression of chTcf variants. Taken together, these results demonstrate that, although the avian prethymic progenitor cells express T-lineage-associated transcription factors, they have not yet undergone TCR rearrangements. It is therefore suggested that activation of lineage-associated genes is an early event in the generation of haematopoietic progenitor cells during ontogeny.

Serum oncostatin M in multiple myeloma: impact on disease severity and prognosis

Since high levels of serum IL-6 predict a poor prognosis of patients with multiple myeloma (MM), we investigated if a related cytokine, oncostatin M (OSM), correlates with clinical or biochemical findings or has prognostic significance in patients with MM. Among 82 newly diagnosed MM patients, OSM was detected in the sera in 45 (55%). Serum OSM had a borderline statistical correlation with serum IL-6 (r = 0.198, p = 0.074) and C-reactive protein (r = 0.199, p = 0.074) concentrations. However, OSM did not have prognostic significance alone or in combination with other factors. The median survival of patients with detectable serum OSM concentration was 41 months (range 2-124 months) and of OSM negative patients 35 months (1-75 months). Serum OSM concentration was not associated with clinical factors or severity of bone disease at diagnosis. We conclude that serum OSM concentration is not a prognostic factor in MM patients.

Chronic bronchitis and chronic obstructive pulmonary disease: Finnish National Guidelines for Prevention and Treatment 1998-2007

1. A national recommendation for the promotion of prevention, treatment and rehabilitation in relation to chronic bronchitis and COPD from 1998 to 2007 has been prepared on the basis of extensive collaboration by order of the Ministry of Social Affairs and Health. The Programme needs to be revised as necessary, because of rapid developments in medical knowledge, and in drug therapy in particular. 2. COPD is a disease characterized by slowly progressing, irreversible airways obstruction. Over 5% of the population suffer from symptomatic forms of the disease. It is estimated that a further 5% of the population may suffer from latent COPD. Most patients (75%) suffer from mild forms of the disease. The disease is often preceded by chronic bronchitis. A total of 400,000 Finns suffer from chronic bronchitis or COPD. Occurrence of these diseases in future will be particularly affected by decreased smoking by men, increased smoking by the young and by women, and aging of the population. 3. In 1997, the annual treatment costs of chronic bronchitis and COPD were estimated to be FIM 1.5 thousand million, total costs FIM 5 thousand million. Without intensification of measures to prevent and treat the diseases, costs will rise significantly. Costs arising from severe COPD (5% of patients with COPD) account for roughly 65% of costs overall and are primarily related to hospitalizations. 4. The goals of the Programme for the Prevention and Treatment of Chronic Bronchitis and COPD are as follows: (a) to decrease the incidence of chronic bronchitis; (b) to ensure that as many patients as possible with chronic bronchitis recover; (c) to maintain capacity for work and functional capacity of patients with COPD; (d) to reduce the percentage of patients with moderate to severe COPD; (e) to decrease the number of hospitalization days of COPD patients by 25% overall; and (f) to decrease annual costs per patient. 5. The following means are suggested for achieving the goals: (a) reduction in smoking; (b) reduction in work-related and outdoor air pollutants and improvement of quality of indoor air; (c) enhancement of knowledge about risk factors and treatment of the diseases is in key groups; (d) promotion of early diagnosis and active treatment, in smokers in particular; (e) improvement of guided self-care; (f) early commencement of rehabilitation, individual planning and implementation, primarily as an element in treatment; and (g) encouragement of scientific research. 6. COPD and exacerbation of its symptoms can be prevented through choices relating to life habits, such as not smoking, maintaining good general condition, and protection against exposure to dusts. The Programme gives examples of such measures and appeals to various authorities and voluntary organizations to increase their cooperation. Preventive methods should be individualized, and based on due consideration. 7. Chronic bronchitis and COPD should be diagnosed at early stages, and treated appropriately from the outset. Treatment consists of: (a) treatment according to causes, such as stopping smoking and work hygiene; (b) early rehabilitation such as patient education and guided self-care: (c) drug therapy; (d) hospital treatment; and (e) rehabilitation. 8. The hierarchy of referrals in the treatment of COPD should be revised to accord a greater role to the primary health care sector. Good exchanges of information and cooperation between the primary health care and specialized medical care sectors will all be necessary if this hierarchial model is to have the desired effect. 9. Hospital districts and health centres should ensure that different levels of the health-care system are capable of fulfilling the tasks assigned to them appropriately. One specialist in each hospital district should be given charge of prevention and assembly of know-how relating to treatment, and of quality of treatment at regional level. (ABSTRACT TRUNCATED)

Costimulatory function of CD28 in avian gammadelta T cells is evolutionarily conserved

CD28 costimulatory signals are required for T-cell proliferation and lymphokine production. In this work, the functional conservation of CD28 was studied in avian gammadelta T cells. The avian CD28 molecule is expressed on all alphabeta T cells and is capable of giving a costimulatory signal. Most peripheral gammadelta T cells are CD28 negative; however, we identified a CD28-positive gammadelta T-cell subset from peripheral blood comprising about 12% of gammadelta T cells. The peripheral CD28+ gammadelta T-cell subset included all CD8+ gammadelta T cells known to be a responding subset during activation. After polyclonal activation, the frequency of CD28+ gammadelta T cells was increased and the activation also up-regulated CD5, CD25 and major histocompatibility complex (MHC) class II molecules. These changes were detected after both polyclonal and antigen-specific T-cell activation. In addition, we also showed that CD28 can give a costimulatory signal to gammadelta T cells and that this signal leads to up-regulation of IL-2 and bcl-x transcripts. These results indicate that the function of CD28 is evolutionarily conserved and can already be detected in avian gammadelta T cells.

Debt and suicidal behaviour in the Finnish general population

We studied the significance of debt as a risk factor for suicidal ideation and suicide attempts in a nation-wide sample (n = 4868) of the Finnish general population. Those experiencing difficulties in repaying their debts more often than others (37 vs. 16%, P<0.001) had a probable minor mental disorder (GHQ-12 score > or =3). Nevertheless, difficulties in repaying debts were found to be a factor independently associated with suicidal ideation (OR, 2.8; 95% CI, 1.9-4.2). The clinical implication of these findings is that individuals experiencing difficulties in repaying their debts may require psychiatric evaluation as well as socio-economic counselling.

Suicidal ideation and parasuicide in the Finnish general population

In a sample of the Finnish general population (n=4868), 2.4% of women and 2.3 % of men reported having thought about suicide during the preceding 12 months. The prevalence of parasuicide was correspondingly 0.9% in women and 1.1% in men, higher figures than have previously been found or estimated. Most suicidal individuals (85%) had contacted general practitioners or other primary care services during the previous 12 months, and a minority (20%) had made contact with psychiatric services. General practitioners and other primary care services are thus in a key position to identify suicidal behaviour in the Finnish general population.

Plasma cell leukemia 3 months after autologous blood cell transplantation for multiple myeloma

We describe a patient with multiple myeloma who was treated with intensive therapy and autologous blood cell transplantation as her first-line treatment. The disease relapsed 3 months after the transplant as plasma cell leukemia and the patient succumbed in 4 weeks. We suggest that an aggressive plasma cell clone may be selected during the course of intensive treatment. Complex karyotypic findings are also presented.

p53 gene mutations are rare in patients but common in patient-originating cell lines in multiple myeloma

We have shown previously that detectable serum concentration of p53 protein is associated with poor prognosis in multiple myeloma (MM). In this study, we studied p53 gene mutations in 29 bone marrow samples of MM patients using polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) and direct sequencing. No p53 mutations were found in these patients although 41% of the patients had an elevated serum p53 protein concentration. This result indicates that the detectable serum level of p53 protein is not associated with p53 mutations. In addition, we have also analysed three MM cell lines established from bone marrow samples. All the cell lines contained p53 mutations in exon 5. However, bone marrow samples of the patients associated with the cell lines did not have these mutations at the time of diagnosis, nor did the original samples which were used to establish the cell lines. This indicates that p53 mutations can arise during the cell passages.

Serum oncostatin M in multiple myeloma: association with prognostic factors

The serum concentration of oncostatin M (OSM) was measured in 40 multiple myeloma patients at diagnosis. Serum OSM level exceeded the sensitivity limit of the ELISA assay in eight (20%) of these patients (OSM+ patients). The serum levels of IL-6, another member of the gp180 cytokine family and C-reactive protein (CRP) as a surrogate of IL-6 were significantly higher in OSM+ patients. There was a trend towards higher serum beta 2M concentration in OSM+ patients, whereas there was no difference in the serum sIL-6R level or clinical data (age, gender, myeloma protein or stage) between the two groups. Two human myeloma cell lines secreted OSM and IL-6, but not IL-11 or leukaemia inhibitory factor (LIF), which suggests an important role for OSM and IL-6 in supporting growth of myeloma cells.

Smart Habit Xylitol campaign, a new approach in oral health promotion

A national 'Smart Habit' Xylitol campaign was organised in Finland in autumn 1992. The aim of the campaign was to increase consumption of xylitol chewing gum in 13-year-old school children, to promote their oral health. The campaign was conducted in elementary schools in the form of a quiz and lesson related to xylitol. Seventh form children from schools in 12 local health authority areas in 10 provinces took part in the campaign. Six thousand seven hundred children were involved. Data were collected with a series of three separate postal questionnaires. The study group consisted of 1,281 children exposed to the campaign. A control group was formed from 1,227 children in the same provinces not exposed to it. Questionnaires were distributed before and after the campaign. A third one was sent out a month later. A high number of the children had consumed xylitol chewing gum even before the campaign. The majority of the respondents reported no changes in consumption of xylitol chewing gum after meals in the first two questionnaires. The results showed that the consumption of xylitol chewing gum after meals increased more in the group exposed to the campaign than in the control group (P = 0.002). Girls in the study group increased their consumption of xylitol chewing gum more than boys (P = 0.016). Also an increase in the daily use of xylitol chewing gum was achieved by the campaign; differences between the study and the control group being significant (P < 0.05). Even though there was knowledge about the beneficial properties of xylitol beforehand, an increase in knowledge was achieved by the campaign. There seems to be potential for positive oral health promotion by means of this type of xylitol campaign.

The association between economic and social factors and mental health in Finland

The aim of the study was to examine the social and economic variables associated with mental health by means of telephone interviews of a randomly chosen population sample (n = 1557) in Finland in 1993. Mental health was evaluated by means of a 12-item General Health Questionnaire. A mental disorder, indicated by the GHQ score, was detected in 18.3% of the interviewees. Mental disorders were more common in women than in men. Other factors associated with a mental disorder were unemployment, financial difficulties and insufficient social support from other people. Mental disorders, indicated by the GHQ score, were common in the long-term unemployed, users of hypnotics and sedatives, and in those who were uncertain about their future. In stepwise logistic regression analyses the statistically independent associates with impaired mental health were suicidal thoughts, receiving of housing allowance and female sex. On the other hand, being on salary was a protective factor.

Long-term Results of Gastroplasty for Morbid Obesity: Binge-Eating as a Predictor of Poor Outcome

We investigated the long-term results after vertical banded gastroplasty (VBG) for morbid obesity and evaluated some predictors of poor outcome. Twenty-seven morbidly obese patients (mean BMI 50 kg/m(2)) who underwent VBG a mean of 5.4 years earlier were studied. The mean weight loss was 31 kg or 40.5% of excess weight. Ten patients (37%) were within 50% of their ideal weight. The patients were classified as bingers (n = 10) and non-bingers (n = 17) according to the modified Binge Eating Scale. One-year postoperative weight losses were 55% and 57% respectively of excess weight, but at the time of the study weight losses were 24% and 50% of excess weight (p = 0.04) in the bingers and non-bingers, respectively. The mean weight regain was 23 kg in the bingers vs 8 kg in the non-bingers, p = 0.01. Two bingers had excellent weight loss results, but otherwise an unsuccessful outcome. Weight reduction did not correlate with age, sex or age of onset of obesity. These results show that binge-eating strongly predicts poor weight loss maintenance after gastroplasty in the long-term, though initial weight reduction is good. We suggest that binge-eating should be evaluated before gastroplasty and taken into consideration in the design of treatment.

Unemployment and mental wellbeing: a factory closure study in Finland

The mental wellbeing of the entire personnel (n = 211) of a wood-processing factory located in Hämeenlinna, Finland was studied by mailing a questionnaire to the subjects 6 months after the factory was closed down. The entire personnel (n = 305) of a similar wood-processing factory acted as a control group. Mental wellbeing was measured by means of the 12-item General Health Questionnaire (GHQ score), the 13-item Beck Depression Inventory (BDI score), and the 13-item questionnaire assessing psychosomatic symptoms. Seventy-nine per cent of the study group and 65% of the control group returned the questionnaire. The two groups were similar sociodemographically. Mental wellbeing was poorer in the men of the study group than in the controls. No such difference was detected in women. Mental wellbeing was poorer in all age groups in the study group, especially in married men, than in the controls. The impaired mental wellbeing in the men in the study group was associated with insufficient social support, subjectively poor health, low income and uncertainty about the future. Based on a discriminant analysis, the two groups differed most in terms of GHQ score, income, sex and BDI score.

VAD regimen in the treatment of resistant multiple myeloma: slow or fast infusion?

The VAD regimen is effective in the treatment of resistant and relapsing multiple myeloma. In the original VAD regimen, vincristine (V) and doxorubicin (A) are given as continuous infusions together with peroral dexamethasone (D). For practical reasons, we have shortened the infusion times: 8 hours for vincristine and 1 hour for doxorubicin. In this retrospective analysis, we have compared the efficacy and toxicity of the original and modified VAD protocols in the treatment of myeloma patients at our institution. Of the 31 consecutive patients with myeloma, primarily or secondarily resistant to alkylating agents, 16 were treated by the original and 15 by the modified VAD protocol. We found no significant difference in the response rates (good responses 31% and 20% respectively), survival times (17 and 9 months respectively) or toxicity between the two protocols. VAD may well be modified so as to consist of short infusions of V and A. The overall efficacy of the traditional and modified regimens is, however, rather unsatisfactory in patients with advanced myeloma.

The impact of unemployment on psychosomatic symptoms and mental well-being

The relationship between psychosomatic symptoms and mental well-being among unemployed (N = 132) and employed (N = 187) personnel of two similar wood-processing factories was studied. Mental well-being was measured by means of the 12-item General Health Questionnaire (GHQ-score) and the 13-item Beck Depression Inventory (BDI-score). The 13-item questionnaire assessing psychosomatic symptoms was used (PS-score). The 33 and 66 percentiles (tertiles) were formed on the basis of PS-score of the two groups separately. The highest PS-score percentile was compared with the combined first and second percentile. Higher PS-score implied impaired mental well-being especially in the unemployed but also in the control group. Insufficient social support and uncertainty about the future was associated with highest PS-score in the study group but not in the control group. High PS-score was associated with subjective mental problems in both groups. Impaired health and PS-score were associated in both groups. Our results suggest that unemployment is a powerful external stress factor and that psychosomatic symptoms were associated with impaired mental well-being.

National TV smoking cessation program and contest in Finland

BACKGROUND

In the fall of 1986 the North Karelia Project in cooperation with Finnish TV 2 arranged an eight-part nationwide smoking cessation TV program. The Project, also arranged a smoking cessation contest coinciding with the TV program in cooperation with four major voluntary public health organizations and the national health service. The TV program featured two studio groups of local volunteers: one from Turku (southwestern Finland) and the other from North Karelia, where there was more intensive community support for the activity.

RESULTS

Based on a national survey of a representative population sample, the reported viewing rates (at least one part) of the working-age population (15-64 years, smokers and nonsmokers) were 64% in North Karelia, 45% in Turku, and 46% nationally (P less than 0.001). Among smokers who had watched at least one session of the TV program, 7.7% reported to have tried to quit smoking in North Karelia, 4.1% in Turku, and 7.5% nationally. Altogether, 16,089 smokers participated in the contest; again the highest participation rate was in North Karelia. The 6-month success rate among the smokers who participated in the contest was 22% in North Karelia, 18% in Turku, and 17% nationally (P less than 0.05). Men were more likely to succeed in quitting: among men the 6-month success rate was 22% and among women 15% (P less than 0.001).

CONCLUSIONS

The results and experiences indicate high viewing and participation and a beneficial cost-effect ratio. They also stress the importance of community support activities in enhancing the effects of a media-based health promotion program.

Psychological symptoms and behavioural changes in Finns caused by fear of AIDS

The purpose of the study was to explore personal fears about AIDS and their consequences in terms of psychological symptoms and behaviour. 1902 individuals, 15 to 64 years old, were selected at random from the Finnish population and interviewed by telephone (94%) or in person (6%). 2.5% regarded AIDS as a personal threat, while 12-13% exhibited psychological symptoms such as insomnia, depression, anxiety or episodes of fear. About 20% had taken measures to prevent HIV infection: 9% had increased their use of condoms, 6% had had themselves tested for HIV, and 5% had taken precautionary measures at work. The psychological status of individuals who feel at risk of AIDS should be assessed within the health care system because persistent feelings of danger may be a sign of incipient psychological decompensation.

Interaction in health education

The usefulness of the application of the psychodynamic frame of reference in person-to-person health education is examined in the present study. The health educator's proper understanding of his client through an integrative use of his own cognitive and emotional responses to the client is first discussed. Depending on the level of maturity of their personalities, and on the nature of their formative relations, the clients will develop different modes of interaction in their relationships with the health educator. Learning to adequately recognize and meet clients showing different interactional modes is considered to substantially increase the prospects of the health educator helping his clients to accomplish a change in health behaviour. Four levels of interaction and their proper encountering are described and discussed. It is concluded that health education and individual health educators would benefit from an increased familiarity with, and use of, the psychodynamic body of knowledge.

The North Karelia project: 15 years of community-based prevention of coronary heart disease

The North Karelia Project - a community-wide health intervention programme - was launched in 1972 as response to the local petition to reduce the heavy toll of heart disease in North Karelia. The strategy of community-based prevention was based on the previous pioneering international work on epidemiology of cardiovascular diseases and prevention in which Finland had in many ways participated. Comprehensive scientific evaluation of the programme was carefully designed. The effects of the programme on risk factor reduction and on prevention of cardiovascular diseases are assessed by large population surveys every five years and by data on incidence of cardiovascular diseases and mortality rates. The authors present the 15 years' results and some of the most recent findings of the North Karelia Project, and discuss the overall experience and its national an international implications.

Results of a one-year worksite and mass media based intervention on health behaviour and chronic disease risk factors

The North Karelia Worksite Intervention Study was carried out to assess the effectiveness of worksite-based innovative intervention on chronic disease risk factors. The one-year intervention combined use of mass media, worksite opinion leaders, risk assessment and counselling and other health education measures. The study used eight medium sized intervention worksites (IW) and eight matched reference worksites (RW). Of the 715 workers 91% participated in the initial survey, and out of these 89% in the one-year follow-up survey. The proportion of current smokers changed from 39% to 30% (p less than 0.05) at the IWs while no change took place at the RWs (33%). The effect on smoking was confirmed by serum thiocyanate analyses. An additive score of the three main CHD risk factors changed from 3.1 to 2.7 at the IWs and from 3.2 to 3.0 at the RWs (p less than 0.05 for the net change). The results and experiences showed the feasibility of the intervention and significant, although modest, effects on risk factors and health behaviour, notably smoking.

Allogeneic bone marrow transplantation in multiple myeloma: a report of four cases

Allogeneic bone marrow transplantation offers a new and promising form for treatment of multiple myeloma incurable with chemotherapy. We present four cases of advanced multiple myeloma given bone marrow transplantation from HLA-identical and MLC-negative sibling donors. One patient had a recurrent plasmacytoma 8 months later and one died 12 days after the transplantation whereas the other two are in good clinical remission 15 and 19 months post-transplantation.

A television format for national health promotion: Finland's "Keys to Health"

A series of televised risk reduction and health promotion programs have been broadcast in Finland since 1978. The five series of programs were the product of a cooperative effort by Finland's television channel 2 and the North Karelia Project. The series has featured a group of volunteers who are at high risk of diseases because of their unhealthful habits and two health educators who counsel the studio group and the viewers to make changes in health behaviors. The "Keys to Health 84-85" was the fifth of the series and consisted of 15 parts, 35 minutes viewing time each. Results of the evaluation surveys, which are presented briefly, indicate that viewing rates were high. Of the countrywide sample, 27 percent of men and 35 percent of women reported that they had viewed at least three parts of the series. Reported changes in behaviors were substantial among the viewers who had seen several parts of the series and were meaningful, overall, for the entire population. Of the countrywide sample, 7.1 percent of smoking viewers reported an attempt to stop smoking--this number was 3.6 percent of all smokers. The percentages of weight loss among viewers and the total population sample were 3.9 for men and 2.1 for women. The reported reductions in fat consumption were 27.2 percent for men and 15.0 percent for women. The reported effects in the demonstration area of North Karelia were even higher, mainly because of higher viewing rates.

Four-year follow-up results of the smoking prevention program in the North Karelia Youth Project

The North Karelia Youth Project was a 2-year intervention study aimed at preventing cardiovascular diseases risk factors among 13-year-old adolescents at the project's start. It was carried out during the years 1978 to 1980 in the county of North Karelia, Finland. The smoking prevention portion of the program was aimed at teaching children skills necessary to handle the social and psychological pressures associated with starting to smoke. During the 2-year program, 10 sessions were carried out in two schools by the project team and by specially trained peer leaders. In about half of the remaining 22 schools in North Karelia, a five-session program was carried out voluntarily by the teachers. After the program, 20% of the children in the two schools where the direct intervention was carried out reported smoking at least once a month. The same rate also was observed in two matched schools representative of the rest of the schools in North Karelia. In two other matched control schools in another county, 30% of the pupils reported to be smokers by the same criteria. Two years after the program (4 years after the beginning of the program), the reported smoking rates in the different school groups were 27, 26, and 37%, respectively. The results of this pilot study indicate that it is possible to reduce smoking onset by this kind of innovative program and that the beneficial effect can last several years.

Effects of smoking and stopping smoking on serum high-density lipoprotein cholesterol levels in a representative population sample

Serum high-density lipoprotein (HDL) cholesterol levels were assessed in a random sample of 939 men and 853 women ages 14-65 years in eastern Finland. Amount of daily smoking measured by serum thiocyanate concentration was negatively and independently associated with serum HDL cholesterol level and HDL/total cholesterol ratio in men. This negative association seemed largely to be due to low HDL cholesterol levels in heavy smokers. Both male and female current smokers had lower HDL cholesterol levels and HDL/total cholesterol ratios than those who had never smoked. This difference was found even after adjustment for age, body mass index, and beer drinking. The reduction of HDL cholesterol level seemed to be reversible, because those who had recently stopped smoking had higher HDL cholesterol levels and higher HDL/total cholesterol ratios than current smokers.

Change in risk factors for coronary heart disease during 10 years of a community intervention programme (North Karelia project)

A comprehensive community based programme to control cardiovascular diseases was started in North Karelia, Finland, in 1972. Reductions in smoking, serum cholesterol concentrations, and blood pressure were among the central intermediate objectives. The effect of the programme during the 10 year period 1972-82 was evaluated by examining independent random population samples at the outset (1972) and five (1977) and 10 (1982) years later both in the programme and in a matched reference area. Over 10 000 subjects were studied in 1972 and 1977 (participation rate about 90%) and roughly 8000 subjects in 1982 (participation rate about 80%). Analyses were conducted of the estimated effect of the programme on the risk factor population means by comparing the baseline and five year and 10 year follow up results in the age range 30-59 years. The effect of the programme (net reduction in North Karelia) at 10 years among the middle aged male population was estimated to be a 28% reduction in smoking (p less than 0.001), a 3% reduction in mean serum cholesterol concentration (p less than 0.001), a 3% fall in mean systolic blood pressure (p less than 0.001), and a 1% fall in mean diastolic blood pressure (p less than 0.05). Among the female population the reductions were respectively, 14% (NS), 1% (NS), 5% (p less than 0.001), and 2% (p less than 0.05). During the first five years of the project (1972-7) the programme effectively reduced the population mean values of the major coronary risk factors. At 10 years the effects had persisted for serum cholesterol concentrations and blood pressure and were increased for smoking.