Senior Health Clinic for 75-year-old home-dwelling Finns - study design, clinic protocol and non-response analysis

BACKGROUND

In the Finnish policy on older people preventive activities, which maintain functional capacity and independent living, are emphasized. The Turku Senior Health Clinic, aimed at maintaining independent coping of all home-dwelling 75-year-old citizens in the city of Turku, was founded in the beginning of 2020. The aim of this paper is to describe design and protocol of the Turku Senior Health Clinic Study (TSHeC) and provide results of the non-response analysis.

METHODS

The non-response analysis used data from 1296 participants (71% of those eligible) and 164 non-participants of the study. Sociodemographic, health status, psychosocial and physical functional ability indicators were included in the analysis. Participants and non-participants were also compared in respect to their neighborhood socioeconomic disadvantage. Differences between participants and non-participants were tested using the Chi squared or Fisher´s exact test for categorical variables and t-test for continuous variable.

RESULTS

The proportions of women (43% vs. 61%) and of those with only satisfying, poor or very poor self-rated financial status (38% vs. 49%) were significantly lower in non-participants than in participants. Comparison of the non-participants and participants in respect to their neighborhood socioeconomic disadvantage showed no differences. The prevalence of hypertension (66% vs. 54%), chronic lung disease (20% vs. 11%), and kidney failure (6% vs. 3%) were higher among non-participants compared to participants. Feelings of loneliness were less frequent among non-participants (14%) compared to participants (32%). The proportions of those using assistive mobility devices (18% vs. 8%) as well as those having previous falls (12% vs. 5%) were higher in non-participants than in participants.

CONCLUSIONS

The participation rate of TSHeC was high. No neighborhood differences in participation were found. Health status and physical functioning of non-participants seemed to be slightly worse than those of the participants, and more women than men participated. These differences may weaken the generalizability of the findings of the study. The differences have to be taken into account when recommendation for the content and implementation of preventive nurse-managed health clinic in primary health care in Finland is going to be given.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05634239; registration date; 1st of December 2022. Retrospectively registered.

Genetic analyses of metabolic body weight, carcass weight and body conformation traits in Nordic dairy cattle

Improving feed efficiency in dairy cattle by animal breeding has started in the Nordic countries. One of the two traits included in the applied Saved feed index is called maintenance and it is based on the breeding values for metabolic BW (MBW). However, BW recording based on heart girth measurements is decreasing and recording based on scales is increasing only slowly, which may weaken the maintenance index in future. Therefore, the benefit of including correlated traits, like carcass weight and conformation traits, is of interest. In this study, we estimated genetic variation and genetic correlations for eight traits describing the energy requirement for maintenance in dairy cattle including: first, second and third parity MBW based on heart girth measurements, carcass weight (CARW) and predicted MBW (pMBW) based on predicted slaughter weight, and first parity conformation traits stature (ST), chest width (CW) and body depth (BD). The data consisted of 21329 records from Finnish Ayrshire and 9780 records from Holstein cows. Heritability estimates were 0.44, 0.53, 0.56, 0.52, 0.54, 0.60, 0.17 and 0.26 for MBW1, MBW2, MBW3, CARW, pMBW, ST, CW and BD, respectively. Estimated genetic correlations among MBW traits were strong (>0.95). Genetic correlations between slaughter traits (CARW and pMBW) and MBW traits were higher (from 0.77 to 0.90) than between conformation and MBW traits (from 0.47 to 0.70). Our results suggest that including information on carcass weight and body conformation as correlated traits into the maintenance index is beneficial when direct BW measurements are not available or are difficult or expensive to obtain.

The INCA-Pathogens model: An application to the Loimijoki River basin in Finland

Good hygienic quality of surface waters is essential for drinking water production, irrigation of crops and recreation. Predictions of how and when microbes are transported by rivers are needed to protect downstream water users. In this study we tested the new process-based INCA-Pathogens model in the agricultural Loimijoki River basin (3138km²) in Finland, and we quantified ecosystem services of water purification and water provisioning for drinking and recreation purposes under different scenarios. INCA is a catchment scale process based model to calculate pollutant transfer from terrestrial environment and point sources to the catchment outlet. A clear gradient was observed in the numbers of faecal coliforms along the River Loimijoki. The highest bacterial counts were detected in the middle part of the main stream immediately after small industries and municipal sewage treatment plants. In terms of model performance, the INCA-Pathogen model was able to produce faecal coliform counts and seasonality both in the low pollution level sampling points and in the high pollution level sampling points. The model was sensitive to the parameters defining light decay in river water and in soil compartment, as well as to the amount of faecal coliforms in the manure spread on the fields. The modeling results showed that the number of faecal coliforms repeatedly exceeded 1000 bacteria 100ml^-1. Moreover, results lead to the following conclusions: 1) Climate change does not cause a major threat to hygienic water quality as higher precipitation increases runoff and causes diluting effect in the river, 2) Intensification of agriculture is not a threat as long as animal density remains relatively low and environmental legislation is followed, 3) More intensive agriculture without environmental legislation causes a threat especially in tributaries with high field percentage and animal density, and 4) Hygienic water quality in the River Loimijoki can best be improved by improving sewage treatment. We conclude that this catchment scale model is a useful tool for addressing catchment management and water treatment planning issues.

Carditis and arthritis associated with Campylobacter jejuni infection

Three patients who developed carditis after enteritis caused by Campylobacter jejuni are reported. Two had perimyocarditis and one endocarditis. The cardiac sequelae persisted in two patients. Concomitant arthritis appeared in two of these patients, monoarthritis in one and polyarthritis in the other.

Microbial content of drinking water in Finnish and Russian Karelia - implications for atopy prevalence

BACKGROUND AND AIM

The influence of microbial quality of drinking water from different sources on the occurrence of atopy has been poorly examined. This study was undertaken to clarify the association between the overall microbial content in drinking water and the occurrence of atopy among schoolchildren from two neighbouring areas with profound differences in living conditions and lifestyles.

METHODS

Drinking water samples were obtained from kitchens of nine schools in North Karelia, Finland and of nine schools from Pitkäranta, the Republic of Karelia, Russia. The pupils of these schools were participants of the Karelian Allergy Study. Occurrence of atopy, determined by skin prick test positivity (one or more) to 14 common airborne and food allergens, was measured in all 563 children, aged 7-16 years, from these 18 schools. Water samples were analysed using standard methods for drinking water analyses including viable counts for Escherichia coli, intestinal enterococci, coliform bacteria and heterotrophic bacteria. In addition, total cell counts including both viable and nonviable bacteria, algae and protozoans were assessed using epifluorescence microscope with 4'-6-diamidino-2-phenylindole (DAPI) staining.

RESULTS

In Finland, 29% of the children were sensitized to birch when compared with 2% of the Russian children (P < 0.0001). Overall, sensitization rates for any of the pollens were 39% and 8% (P < 0.0001), and for any of the allergens 48% and 16%, respectively (P < 0.0001). Because of substantial differences in raw water sources and treatment practices, the total numbers of microbial cells in drinking water were many-fold higher in Russia than in Finland. A dose-response relationship was found for occurrence of atopy and the DAPI value indicative of microbial cell content in the water (P < 0.0001). Further, multivariate logistic regression analysis revealed that high (>10(6) cells/ml) and intermediate (10(5)-10(6) cells/ml) DAPI values were associated with reduced risk of atopy (odds ratio 0.34, 95% confidence interval 0.20-0.57 and 0.39, 0.23-0.69, respectively), independently from other factors.

CONCLUSION

High overall content of micro-organisms in drinking water may be associated with reduced risk of atopy, independently from other determinants.

Survival of Campylobacter jejuni in potable water biofilms: a comparative study with different detection methods

Campylobacteria are important foodborne pathogens. C. jejuni bacteria have caused several drinking water-related epidemics in Finland. Normally, C. jejuni is not able to multiply in drinking water or in biofilms although it may survive in biofilms. The survival of C. jejuni in biofilms was studied using the Propella biofilm reactor. The number of bacteria was analysed with traditional culture methods and with fluorescence in situ hybridisation (FISH). By culture methods C. jejuni was detectable for only 1 d after spiking whereas bacteria were found from biofilms for at least 1 week after spiking and from outlet water of the reactor for 3 weeks when using FISH. These results suggested that C. jejuni may survive in biofilms and culture methods probably seriously underestimate the real number in water and in biofilms.

The sense of coherence, occupation and all-cause mortality in the Helsinki Heart Study

BACKGROUND

The aim of this study was to test the hypothesis that people with a strong sense of coherence (SOC) have decreased all-cause mortality.

METHODS

The effect of occupation and the SOC on all-cause mortality was studied among 4405 Finnish middle-aged employed men in a prospective 8-year follow-up study.

RESULTS

Using Cox proportional hazards models the crude relative risk for all-cause mortality for the low SOC tertile when compared to the high SOC tertile was 1.23 (95% CI: 0.90-1.68). Adjusting for age, smoking, alcohol and occupation increased the risk slightly to 1.35. Occupation was an effect modifier, since among white-collar workers the corresponding relative risk of the low SOC tertile was 2.27 (95% CI: 1.12-4.59, p = 0.02) and among blue-collar workers the relative risk for all-cause mortality was stable (1.33-1.52) in each SOC tertile. The classic risk factors, smoking and alcohol, showed higher relative risks than the SOC.

CONCLUSIONS

The effect of the health-promoting qualities of the SOC upon all-cause mortality was significant among white-collar workers, but not among blue-collar workers.

Problem drinking and psychological well-being: a five-year follow-up study from adolescence to young adulthood

The psychological well-being of 651 Finnish adolescents (approximately age 17) was followed to young adulthood (age 22) and examined in terms of their drinking styles at age 22. The young adults were grouped into four categories delineating drinking style (non-users, non-problem drinkers, presumptive problem drinkers, and problem drinkers), and each group was examined for evolved paths of psychological well-being. The psychological profile of the participants was comprised of seven variables: self-esteem, trait anxiety, somatic symptoms, eating concerns, and mature, neurotic, and immature defense styles. The comparison of the drinking style categories revealed that future problem drinkers had lower states of psychological well-being already in adolescence and that the differences became more pronounced during the transition to young adulthood. Poor psychological well-being is a risk for the development of later problem drinking, although the profile of this poor psychological state is somewhat different in women and men.

Fecal bacterial enzyme activities in infants increase with age and adoption of adult-type diet

BACKGROUND

The present study was conducted to determine the effects of age and diet (breast milk, milk formula, weaning diet) on the activities of some bacterial enzymes in fecal samples collected from 3- to 24-month-old infants. These bacterial enzymes may generate toxic, mutagenic, or carcinogenic metabolites from plant glycosides (beta-glucuronidase, beta-glucosidase) or from urea (urease).

METHODS

The subjects were 68 healthy children ages 3 (n = 20), 6 (n = 20), 12 (n = 17), and 24 (n = 11) months. None of the children had been given any antibiotics during 4 weeks before collection of the fecal samples. Health status, bowel habits, and food consumption of the children were determined by interview of one of the parents using a structured questionnaire. A spot fecal sample from each child was collected.

RESULTS

The activities of beta-glucuronidase and beta-glucosidase increased from 0.52 and 1.17 nmol/min x mg protein (at 3 months) to 1.41 and 2.38 nmol/min x mg protein (at 2 years), respectively. However, at 2 years of age, the children had not yet reached the levels reported in earlier studies on adult populations. Urease activity increased from 4.18 nmol/min x mg protein (at 3 months) to 19.0 nmol/min x mg protein (at 2 years), reaching by 12 months of age the level observed in adults. Breast feeding as such had no consistent effect on fecal bacterial enzyme activities. beta-Glucuronidase and beta-glucosidase were higher in those 6- and 12-month-old children who consumed more meat, fish, sausages, or eggs.

CONCLUSIONS

It can be concluded that the fecal enzyme activities in the gastrointestinal tract increase and that their profile changes with age and adoption of adult-type diet. It remains open, however, whether these changes are caused by the normal physiological aging process or by stepwise introduction of new foods to the diet.

A prospective study of the precursors to problem drinking in young adulthood

This study was part of the Jyväskylä Longitudinal Study on Social Development. The subjects (196 males, 173 females) were studied at age 8, 14 and 26. Three components in drinking habits were obtained at age 26: social, problem and controlled drinking. Moderate to severe problem drinking was obtained for 26% of the men and 1% of the women, and mild problem drinking for 23% of the men and 15% of the women. Problem drinking (defined by the CAGE Questionnaire, arrest for alcohol abuse and other indicators of heavy drinking) was directly accounted for by poor school success at age 14 and, for men, by conduct problems and low anxiety. Variables at age 8 that contributed indirectly to adult problem drinking were aggression, low anxiety, low prosociality and poor school success for men, and high anxiety and poor school success for women. Women and men differed in the effect of social anxiety; in men, anxiety was a protective factor against problem drinking; in women, it was a risk factor. Although conduct problems often precede severe problem drinking, other risk factors may exist among sons of alcoholic parents. Parental drinking had a significant threshold effect on male off-springs' drinking: if parental drinking was low, there was less problem drinking among the male offspring than if a mild dependence on alcohol was observed in the parents.

Ingredients and contaminants of traditional alcoholic beverages in Tanzania

Home-made but commercially available alcoholic beverages were collected in Dar es Salaam, Tanzania and analysed for their congener alcohol, additive, aflatoxin and heavy metal contents. Ethanol concentrations of the 15 brewed samples ranged from 2.2 to 8.5% w/v whilst the 2 distilled samples contained ethanol 24.2 and 29.3% w/v. Aflatoxin B1 was found in 9 brewed beverages, suggesting the use of contaminated grain or fruit for their production. The amount of zinc in 4 samples was double the World Health Organization recommended maximum for drinking water (5 mg/litre). One brewed beverage contained toxic amount of manganese (12.8 mg/litre). Both distilled spirits were rich in fusel alcohols and one was fortified by caffeine. The results suggested that impurities and contaminants possibly associated with severe health risks, including carcinogens, are often found in traditional alcoholic beverages. Continuous daily drinking of these beverages is certain to increase health risks. Contaminated grain or fruit rejected from foodstuff production should not be used for the production of alcoholic beverages.

Prospective study of the etiology of diarrhea in adult outpatients and inpatients

A prospective study of the etiology of diarrhea in 253 adult outpatients and inpatients was conducted in Helsinki in 1985-86. The outpatients constituted 84.6% of all patients studied. A broad panel of diagnostic techniques was applied, including detection of bacteria and parasites in the feces and determination of the serologic responses to campylobacter, salmonella, Yersinia enterocolitica, and several viruses. Pathogens were identified for 28.5% of the patients. The commonest findings were Campylobacter jejuni/coli in 13.0% and Salmonella species in 7.1% of the patients. Mixed infections of several pathogens were found in 16 patients.

Cutaneous leishmaniasis in a 3-year-old Finnish visitor to France

A child with non-ulcerating cutaneous leishmaniasis after a 3-week visit to Southern France is reported. Diagnosis was histological. The possibility of the patient having had a visceral infection was taken into account when designing the final treatment.

Infection due to Campylobacter jejuni: a report of 524 outpatients

Within a three-year period 712 patients with Campylobacter jejuni infection were diagnosed at our laboratory in Helsinki and 524 (72%) were treated as outpatients. More than half (57%) of the patients became infected when abroad, chiefly during holiday trips in the Mediterranean and in East European countries. The risk of acquiring infection was about 250 times greater abroad than in Finland, and it differed considerably from country to country, being highest in Morocco and Tunisia. Among domestic cases the incidence of infection was significantly higher (p less than 0.001) during the summer and autumn months than during winter or spring. Animal contact prior to infection was reported in 59% of domestic and 31% of imported cases, and previous consumption of poultry in 28% and 42% of those from whom information was obtained. Besides diarrhoea (98%), the main symptoms included abdominal pain (87%), fatigue (81%), fever (78%), malaise (70%) and headache (51%). Arthralgia was observed in 19% and arthritis in 2% of patients. The mean duration of diarrhoea was 10.8 days, of fever 2.8 days.

Antibodies against an acid extract from a single campylobacter strain in hospitalized campylobacter patients

An acid glycine extract from a single Campylobacter jejuni strain was used as the antigen in the enzyme immunoassay (EIA). Elevated values indicating the presence of specific IgM and/or IgG antibodies were found in 73% of 52 patients hospitalized for campylobacter infection. A further 6% of the patients who had lower EIA values in paired serum samples showed at least a 20% change in EIA values. The same sera had been studied earlier for agglutinating antibodies using four reference campylobacter strains. 74% of the patients had shown elevated titres and a further 17% four-fold changes of lower titres in paired sera.

Campylobacter enteritis in 188 hospitalized patients

The clinical picture and epidemiologic characteristics of infection due to Campylobacter fetus subspecies jejuni were studied in 188 patients hospitalized in Finland during a three-year period. All but two patients had diarrhea; 90% had abdominal pain, fever, and fatigue; half had vomiting and headache; one third experienced electrolyte disturbances; and one fifth of the patients had other complications, most commonly pancreatitis (6%) and arthritis (5%). All age groups were affected, most usually those who were 0 to 9 years old and 20 to 29 years old. The incidence of domestic cases increased during the summer months. With only three exceptions (1.3%), all jejuni strains were sensitive to erythromycin. Among Finns who visited ten popular tourist countries, the incidence of hospitalized C jejuni enteritis cases varied from 0 to 63 per 100,000 travelers.

Campylobacter enteritis in 188 hospitalized patients

The clinical picture and epidemiologic characteristics of infection due to Campylobacter fetus subspecies jejuni were studied in 188 patients hospitalized in Finland during a three-year period. All but two patients had diarrhea; 90% had abdominal pain, fever, and fatigue; half had vomiting and headache; one third experienced electrolyte disturbances; and one fifth of the patients had other complications, most commonly pancreatitis (6%) and arthritis (5%). All age groups were affected, most usually those who were 0 to 9 years old and 20 to 29 years old. The incidence of domestic cases increased during the summer months. With only three exceptions (1.3%), all jejuni strains were sensitive to erythromycin. Among Finns who visited ten popular tourist countries, the incidence of hospitalized C jejuni enteritis cases varied from 0 to 63 per 100,000 travelers.

Treatment of Trichuris trichiura infection with a single dose of oxantel pamoate

166 patients with trichuriasis have been treated at the Department of Tropical Diseases, Aurora Hospital, Helsinki, from January 1975 to October 1979. Final results could be confirmed in 141 patients. Thiabendazole was found discouraging, because of frequent side effects and low cure rate (29% of 24 in-patients). In contrast, a single dose of oxantel pamoate gave minimal side effects in 37 in-patients and in 80 outpatients with a high overall cure rate of 98%. Neither allergic nor adverse haematological reactions were encountered during 3 years and 10 months' experience of treatment with oxantel pamoate.

Travellers' diarrhoea caused by Campylobacter jejuni

Over a period of 18 months Campylobacter jejuni was isolated from the faeces of 19 (5.8%) of 329 travellers with diarrhoea, among 2488 patients attending the Outpatient Department of Tropical Diseases at Aurora Hospital. Incidences of Salmonella, Shigella and C. jejuni in diarrhoeal patients were very similar. C. jejuni caused initial symptoms of diarrhoeal disease indistinguishable from travellers' diarrhoea from other causes. Double bacterial or bacterial-parasitic infections were shown in 22 patients. During the same period at Aurora Hospital a total of 48 patients were found to have imported C. jejuni from 21 countries outside Scandinavia. Of these 83% had been on tourist trips.

Clinical and serological studies in patients with Campylobacter fetus ssp. jejuni infection: I. Clinical findings

Stool samples from 775 patients with diarrhoea referred to a hospital over an 18-month period were cultured for Campylobacter fetus ssp. jejuni, and in 55 patients (7.1%), infections were identified. In addition, one asymptomatic patient had a positive stool sample and serological evidence of a current infection. The patients were aged between 11 and 76 years, the majority being in the age group 15 to 39 years. The symptoms included diarrhoea (in almost 100%), fever (in 80%) and abdominal tenderness (in 35%). Almost half the patients vomited. The total leucocyte count was usually normal, but half the patients showed increased numbers of juvenile neutrophils. Eosinopenia and high serum C-reactive protein were frequently seen in the acute phase of the illness. Complications included haematemesis, pancreatic affection, carditis, reactive arthritis, urticaria, and transient malabsorption in one patient who had had a previous Billroth II operation. Invasive disease was occasionally suggested by clinical manifestations of extensive mesenteric lymphadenitis, septicaemia and focal bone necrosis.

Clinical and serological studies in patients with Campylobacter fetus ssp. jejuni infection: II. Serological findings

The serological responses of 53 patients with Campylobacter fetus ssp. jejuni enteritis were determined with formalinized, boiled and autoclaved antigen suspensions of four reference strains and the autologous isolate. Agglutinin titres of 400 or greater were found against both formalinized and boiled reference antigens in 64% of the patients. Using boiled reference antigens five seropositive patients were found who had not been detected with the formalinized reference antigens, and vice versa. Autoclaved antigens were less useful. The use of paired sera permitted the demonstration of a serological response in some additional patients, although their maximal titre did not exceed 200. The total number of patients with serological responses to reference antigens was thus 48 (91%). The use of autologous antigens detected only one further patient.

Arthritis associated with Campylobacter jejuni enteritis

Among 342 patients with infection due to Campylobacter fetus ss. jejuni, 8 cases (2.3%) of arthritis were found. Three patients had monoarthritis and 5 oligoor polyarthritis. The arthritis began 4 days - 4 weeks after the onset of diarrhoea; this interval and the synovial fluid findings suggest that the arthritis was reactive. The histocompatibility antigen HLA-B 27 was identified in 5 of the 7 patients tested.

Furuncular myiasis

Two cases of cutaneous myiasis are described. The first, acquired in West Africa, consisting of 36 furuncle-like lesions, was caused by the larvae of Cordylobia anthropophaga. An adult fly was raised from one larva. In the second patient, the infestation was caused by five larvae of Dermatobia hominis acquired in Central America. Neither patient was aware of any infestation, but the clinical presentation, although also suggestive of bacterial skin infection, showed a typical course and symptoms of cutaneous myiasis in both patients.