Recognition of nursing qualification and credentialing pathway of Filipino nurses in Finland: A qualitative study

AIM

To understand the experiences of Filipino internationally educated nurses (FIENs) on their recognition and credentialing pathway in the recruitment process in Finland.

BACKGROUND

The nursing shortage in Finland results in the recruitment of internationally educated nurses (IENs) such as those from the Philippines. In the context of migration, IENs experience a rigorous process to become qualified nurses in the destination country.

METHODS

A thematic analysis of the secondary data from qualitative interviews was conducted. Ten FIENs (n = 10) were recruited from university hospitals in Finland through purposeful and snowball sampling. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) checklist.

RESULTS

Three main themes were identified. First, pre-migration victories and predicaments described the experiences of FIENs during the recruitment process and the pathway to acquiring a Registered Nurse qualification. Second, ambiguous integration implied integrating into the workplace while working on the top-up education programme as a prerequisite to nursing registration. Lastly, migration uncertainty discussed the interest among FIENs to continue practising as Registered Nurses (RNs) in Finland.

CONCLUSIONS

Pre-migration orientation and workplace integration experiences influenced FIENs' choice to practise as RNs in Finland. The licensure pathway for FIENs required collaboration from various stakeholders in Finnish society. It is recommended to structure the system for the recognition and qualification process of IENs by creating a national model in line with international standards and requirements in collaboration with higher education institutions.

IMPLICATION FOR NURSING POLICY

Recognition of previous education and clinical experience can facilitate the transition to becoming an RN for IENs, but the lack of a clear education model and recognition of foreign nursing qualifications leads to deskilling and hinders IENs from practising. Policies prioritising education and integration into the local healthcare system can facilitate the integration and professional growth of IENs, enabling them to contribute significantly to the healthcare system.

Mortality Associated With Occupational Exposure in Helsinki, Finland-A 24-Year Follow-up

OBJECTIVES

Our objective was to study mortality related to different obstructive lung diseases, occupational exposure, and their potential joint effect in a large, randomized population-based cohort.

METHODS

We divided the participants based on the answers to asthma and chronic obstructive pulmonary disease (COPD) diagnoses and occupational exposure and used a combined effects model and compared the results to no asthma or COPD with no occupational exposure.

RESULTS

High exposure had a hazards ratio (HR) of 1.34 (1.11-1.62) and asthma and COPD coexistence of 1.58 (1.10-2.27). The combined effects of intermediate exposure and coexistence had an HR of 2.20 (1.18-4.09), high exposure with coexistence of 1.94 (1.10-3.42) for overall mortality, and sub-HR for respiratory-related mortality of 3.21 (1.87-5.50).

CONCLUSIONS

High occupational exposure increased overall but not respiratory-related mortality hazards, while coexisting asthma and COPD overall and respiratory-related hazards of mortality.

Screen media and non-screen media habits among preschool children in Singapore, South Korea, Japan, and Finland: Insights from an unsupervised clustering approach

The main purpose of the research was to describe the daily screen media habits and non-screen media habits like indoor and outdoor play, and sleep of preschool children aged 2 to 6 years from Singapore, South Korea, Japan, and Finland using a content-validated online questionnaire (SMALLQ®) and unsupervised cluster analysis. Unsupervised cluster analysis on 5809 parent-reported weekday and weekend screen and non-screen media habits of preschool children from the four countries resulted in seven emergent clusters. Cluster 2 (n = 1288) or the Early-screen media, screen media-lite and moderate-to-vigorous physical activity-lite family made up 22.2% and Cluster 1 (n = 261) or the High-all-round activity and screen media-late family made up 4.5%, respectively represented the largest and smallest clusters among the seven clusters that were emergent from the pooled dataset. Finland was best represented by Cluster 2 and Japan was best represented by Cluster 3 (High-screen media-for-entertainment and low-engagement family). Parents from Finland and Japan displayed greater homogeneity in terms of the screen media and non-screen media habits of preschool children than the parents from South Korea and Singapore. South Korea was best represented by Clusters 6 (Screen media-physical activity-engagement hands-off family) and 7 (Screen media-lite, screen media-late and high-physical activity family). Singapore was best represented by Clusters 4, 5, 6 and 7, and these clusters ranged from Low all-round activity-high nap time family to Screen media-lite, screen media-late and high-physical activity family. Future research should explore in-depth reasons for the across-country and within-country cluster characteristics of screen media and non-screen media habits among preschool children to allow for more targeted interventions.

Changes in occupational well-being during COVID-19: the impact of age, gender, education, living alone, and telework in a Finnish four-wave population sample

OBJECTIVES

This study investigated how occupational well-being evolved across different phases, before and during the COVID-19 outbreak in the Finnish population. Whereas studies have suggested that certain demographic groups (eg, young, female) are more at risk during COVID-19, less is known whether the effects of such demographic factors may vary (i) across different phases of the unfolding viral outbreak and (ii) on different dimensions of occupational well-being. As they are predictors of changes in burnout, job boredom, and work engagement, we examined age, gender, education, living alone, and teleworking. This is the first study to provide such detailed knowledge regarding the changes in various occupational well-being dimensions before and during the COVID-19 outbreak.

METHODS

We collected randomized population panel data at the end of 2019 and conducted three follow-up surveys with 6-month intervals (N=532). The data were analyzed with latent change score models.

RESULTS

Whereas during spring 2020, occupational well-being slightly improved, in autumn 2020 well-being decreased back to pre-COVID-19 levels. There was an indication of slight increases in job boredom between before COVID-19 and summer 2021. Well-being deteriorated more for the young and those who lived alone. There was also some indication of females, those with lower education, and non-teleworkers experiencing less favorable changes in occupational well-being. Teleworking appeared to have more beneficial effects on well-being for those with lower education.

CONCLUSIONS

The study suggests that only relatively minor changes in well-being took place among the employed population. A particular focus in workplaces should be targeted at younger employees.

Gorham-Stout disease with life-threatening pleural effusion treated with a pleuro-peritoneal shunt: a case report

Summary

Gorham-Stout disease (GSD) is a rare bone disease characterized by massive osteolysis and lymphatic proliferation. The origin of the condition is unknown, and no established treatment protocol exists. Massive pleural effusion is a frequent complication of GSD in the thoracic region. We present the case of a 23-year-old male with thoracic GSD, subsequent paraparesis, and life-threatening pleural effusion. The patient was managed by a multidisciplinary team with a good recovery. The pleural effusion was successfully treated with a pleuro-peritoneal shunt. This is the first report of the use of this mini-invasive technique in the management of pleural effusion related to GSD. Further, we present the potential role of interleukin-6 and bone resorption markers in the measurement of the disease activity.

Learning points

Multidisciplinary approach is important in the management of rare and severe disorders such as Gorham-Stout disease. Pleuro-peritoneal shunting is a valuable option in the treatment of pleural effusion related to GSD. Interleukin-6 and bone resorption markers appear useful in measuring the disease activity of GSD.

Acromegaly caused by a GHRH-producing pancreatic neuroendocrine tumor: a rare manifestation of MEN1 syndrome

SUMMARY

Multiple endocrine neoplasia type 1 NM_001370259.2(MEN1):c.466G>C(p.Gly156Arg) is characterized by tumors of various endocrine organs. We report on a rare, growth hormone-releasing hormone (GHRH)-releasing pancreatic tumor in a MEN1 patient with a long-term follow-up after surgery. A 22-year-old male with MEN1 syndrome, primary hyperparathyroidism and an acromegalic habitus was observed to have a pancreatic tumor on abdominal CT scanning, growth hormone (GH) and insulin-like growth factor 1 (IGF1) were elevated and plasma GHRH was exceptionally high. GHRH and GH were measured before the treatment and were followed during the study. During octreotide treatment, IGF1 normalized and the GH curve was near normal. After surgical treatment of primary hyperparathyroidism, a pancreatic tail tumor was enucleated. The tumor cells were positive for GHRH antibody staining. After the operation, acromegaly was cured as judged by laboratory tests. No reactivation of acromegaly has been seen during a 20-year follow-up. In conclusion, an ectopic GHRH-producing, pancreatic endocrine neoplasia may represent a rare manifestation of MEN1 syndrome.

LEARNING POINTS

Clinical suspicion is in a key position in detecting acromegaly. Remember genetic disorders with young individuals having primary hyperparathyroidism. Consider multiple endocrine neoplasia type 1 syndrome when a person has several endocrine neoplasia. Acromegaly may be of ectopic origin with patients showing no abnormalities in radiological imaging of the pituitary gland.

Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

The informalization of doctor-patient relations in a Finnish setting: New social figurations and emergent possibilities

This article features data drawn from interviews with doctors working in the Finnish occupational health-care system. These are used to explore the value of an Eliasian approach towards interpreting and assessing the moral meanings and social dynamics of relationships between health practitioners and their patients. We attend to spiralling 'formalizing' and 'informalizing' processes and how these are operating to reconfigure doctor-patient relationships. We document some of the ways in which Finnish doctors are adapting to these processes. While data drawn from a British context suggest both doctor and patients are inclined to adopt positions of mutual distrust and hostility, by contrast we note that in this Finnish setting more concerted attempts are being made to renegotiate social roles, cultural meanings and individual responsibilities. We propose that this can be taken as an instance where informalization is accompanied by revitalized currents of formalization and new syntheses of moral codes and conduct.

Precarious Sovereignty in a Post-liberal Europe: The COVID-19 Emergency in Estonia and Finland

The paper addresses a puzzle resulting from the current global state of alert: the coronavirus pandemic brought us back to the world of the allegedly sovereign nation states with borders and national governments in charge, yet in fact, this retrieved sovereignty looks very vulnerable and precarious. We explain this controversy through a triad of concepts—sovereignty, governmentality, and post-liberalism—that we apply to an analysis of a corona-imposed state of emergency in Estonia and Finland. Based on comparative case study research, we posit that sovereignty is precarious in post-liberalism due to its large dependence on the technologies of responsibilization and agency. From a biopolitical perspective, a major point in the anti-crisis management is to convince people to sacrifice personal liberties for the sake of public safety. These issues of governmentality will be dealt with based on critical discourse analysis and media analysis in Estonia and Finland.

Trends in the receipt of medicines information among Finnish adults in 1999-2014: a nationwide repeated cross-sectional survey

OBJECTIVE

The aim of this study was to examine long-term trends in the receipt of medicines information (MI) among adult medicine users from 1999 to 2014.

DESIGN

Repeated cross-sectional postal survey from the years 1999, 2002, 2005 and 2008-2014.

SETTING

Each study year, a new nationally representative sample of 5000 Finns aged 15-64 years was drawn from the Population Register Centre of Finland.

PARTICIPANTS

The range of annual respondents varied from 2545 to 3371 and response rates from 53% to 67%. Of the total responses (n=29 465), 64% were from medicine users (n=18 862, ranging by year from 58% to 68%).

OUTCOME MEASURES

Receipt of information on medicines in use within 12 months prior to the survey from a given list of consumer MI sources available in Finland.

RESULTS

Physicians, community pharmacists and package leaflets were the most common MI sources throughout the study period. Receipt of MI increased most from the Internet (from 1% in 1999 to 16% in 2014), while decreased most from physicians (62% to 47%) and package leaflets (44% to 34%), and remained stable from community pharmacists (46% to 45%) and nurses (14% to 14%). In 1999, of the medicine users 4% did not report receipt of MI from any of the sources listed in the survey, while this proportion had remarkably increased to 28% in 2014.

CONCLUSIONS

Healthcare professionals and package leaflets had still a dominating importance in 2014 despite the growing number of MI sources over time, but still a minority of adult medicine users reported receiving MI via the Internet in 2014. Worrying is that the proportion of adult medicine users who did not receive MI from any of the sources became seven fold during the study period.

Cohort profile: a nationwide cohort of Finnish military recruits born in 1958 to study the impact of lifestyle factors in early adulthood on disease outcomes

PURPOSE

The cohort was set up to study the impact of lifestyle factors in early adulthood on disease outcomes, with a focus on assessing the influence of body composition and physical performance in early adulthood on subsequent cancer risk.

PARTICIPANTS

Men born in 1958 who performed their military service between the ages of 17 and 30 years were included in this study (n=31 158). They were eligible for military service if they were healthy or had only minor health problems diagnosed at the beginning of their service. Men with chronic illnesses requiring regular medication or treatment were not eligible for service. Comprehensive health data including diagnosed illnesses, anthropometric measures and health behaviour were collected at the beginning and at the end of military service, including data from medical check-ups.

FINDINGS TO DATE

During the follow-up, 1124 new cancer cases were diagnosed between baseline (ie, end of the military service for each individual) and end of the year 2014. In the end of the follow-up, 91% of the study participants were still alive. Overweight (body mass index (BMI) ≥25 kg/m2) and obesity (BMI ≥30 kg/m2) were associated with an overall increased risk of cancer. A good or excellent physical condition significantly reduced cancer risk.

FUTURE PLANS

The dataset offers the possibility of linkage with other databases, such as the Finnish Cancer Registry (eg, primary site of the tumour, morphology, time of detection, spreading and primary treatment), vital statistics (date of emigration or deaths), censuses (socioeconomic indicators), hospital discharge data (comorbidity) and population surveys (life habits).

Vegetable and fruit consumption, education and plasma vitamin C concentration in Russian and Finnish Karelia, 1992-2002

OBJECTIVE

To examine (i) whether the consumption of fresh vegetables, fruit and berries is associated with plasma vitamin C concentration and (ii) educational differences in plasma vitamin C concentration in two neighbouring areas in Russia and Finland.

DESIGN

Cross-sectional risk factor surveys in 1992, 1997 and 2002. Logistic regression analysis was applied to examine the associations of consumption of selected foods and education with plasma vitamin C concentration.

SETTING

District of Pitkäranta in the Republic of Karelia, Russia and North Karelia, Finland.

SUBJECTS

Adults aged 25-64 years: 579 men and 612 women in Pitkäranta; 974 men and 642 women in North Karelia.

RESULTS

The plasma vitamin C concentration was strikingly low in Pitkäranta, Russia across the study years. During the 10 years of monitoring, the mean plasma vitamin C concentration among men ranged from 2·5 to 8·0 μmol/l in Pitkäranta, Russia and from 27·1 to 53·9 μmol/l in North Karelia, Finland. In both areas, daily consumption of fruit was most strongly associated with plasma vitamin C, while the association of fresh vegetable consumption with plasma vitamin C was less consistent. Consumption of berries was less important in explaining plasma vitamin C. In Pitkäranta, the plasma vitamin C concentration was lower among respondents in the lowest education group.

CONCLUSIONS

Differences in the consumption of fresh vegetables and fruit resulted in notable differences in vitamin C status between Pitkäranta and North Karelia in spring. In comparative settings, knowledge of local food culture and validation pilots are important before conducting large population surveys.

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study

BACKGROUND

In many developed countries, including Finland, health care authorities customarily consider the international mobility of physicians as a means for addressing the shortage of general practitioners (GPs). This study i) examined, based on register information, the numbers of foreign-born physicians migrating to Finland and their employment sector, ii) examined, based on qualitative interviews, the foreign-born GPs' experiences of accessing employment and work in primary care in Finland, and iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors).

METHODS

Three different data sets were used: registers, theme interviews among foreign-born GPs (n = 12), and a survey for all (n = 1,292; response rate 42%) foreign-born physicians living in Finland. Methods used in the analyses were qualitative content analysis, analysis of covariance, and logistic regression analysis.

RESULTS

The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1,750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licensing process as the main obstacle to accessing work as a physician. Most licensed foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an 'active' job profile (high job demands and high levels of job control combined) according to Karasek's demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful.

CONCLUSIONS

Primary care may not be able in the long run to attract a sufficient number of foreign-born GPs to alleviate Finland's GP shortage, although speeding up the licensing process may bring in more foreign-born physicians to work, at least temporarily, in primary care. For physicians to be retained as active GPs there needs to be improvement in the psychosocial work environment within primary care.

Power discourses of fish death: case of linnunsuo peat production

This article explores the peat production impacts on Jukajoki river in Finland by implementing discourse analysis. Four discourses are explored: state truth statements; company statements that are in close proximity of state power; discourses provided by the local community Selkie, who provided counter-narratives to the official views; and finally media and related discourses. In conclusion, the discourses by the state and closely related actors (A-B) comprised implementation of their power and justifying it at the expense of those who are excluded from such power, in this case the village. The village narrative (C) contains elements that strongly contradict the statements provided by those with power. The results indicate local communities should be taken more seriously. The systematic denial of local peoples' rights should be reviewed, and local participation in environmental permit assessments implemented.

Primary care-based, targeted screening programme to promote sustained weight management

OBJECTIVE

To identify overweight and obese subjects at increased cardiovascular risk in the community, and provide them with lifestyle counselling that is possible to implement in real life.

DESIGN

Longitudinal cohort study.

SETTING

The communities of Harjavalta and Kokemäki in south-western Finland.

SUBJECTS

A tape for measurement of waist and a risk factor questionnaire was mailed to home-dwelling inhabitants aged 45-70 years (n = 6013). Of the 4421 respondents, 2752 with at least one cardiovascular risk factor were examined by a public health nurse. For the subjects with high cardiovascular risk (n = 1950), an appointment with a physician was scheduled. The main goal of lifestyle counselling for the 1608 high-risk subjects with BMI ≥ 25 kg/m(2) was weight reduction of at least 5%. Among these, 906 had completed self-administrated questionnaires at baseline and form the present study population.

MAIN OUTCOME MEASURE

Success in weight management.

RESULTS

At the three-year follow-up visit, 18% of subjects had lost ≥ 5% of their initial weight and 70% had stabilized their weight, while 12% had gained weight ≥ 5%. Newly diagnosed glucose disorder (OR 1.37 [95% CI 1.02-1.84]) predicted success in weight management, whereas depressive symptoms (OR 0.61 [95% CI 0.42-0.90]), excess alcohol use (OR 0.63 [95% CI 0.44-0.90]), and number of drugs used (OR 0.91 [95% CI 0.83-0.99]) at baseline predicted poor outcome.

CONCLUSIONS

A primary care screening programme to identify overweight or obese individuals can promote sustained weight management. Psychological factors, especially depressive symptoms, are a critical component to consider before attempts to change the lifestyle of an individual.

The prevalence of potential alcohol-drug interactions in older adults

OBJECTIVES

The aim of this study was to assess the possibility of clinically significant drug-alcohol interactions among home-dwelling older adults aged ≥ 65 years.

DESIGN

This study was a cross-sectional assessment of a stratified random sample of 2100 elderly people (≥ 65 years) in Espoo, Finland. The response rate was 71.6% from the community-dwelling sample. The drugs were coded according to their Anatomical Therapeutic Chemical (ATC) classification index (ATC DDD 2012). Significant alcohol interactive (AI) drugs were examined according to the Swedish, Finnish, INteraction X-referencing (SFINX) interaction database, as well as concomitant use of central nervous system drugs, hypoglycaemics, and warfarin with alcohol. "At-risk alcohol users" were defined consuming > 7 drinks/week, or ≥ 5 drinks on a typical drinking day, or using ≥ 3 drinks several times/week, "moderate users" as consuming at least one drink/month, but less than 7 drinks/week, and "minimal/non-users" less than one drink/month.

RESULTS

Of the total sample (n = 1395), 1142 respondents responded as using at least one drug. Of the drug users, 715 (62.6%) persons used alcohol. The mean number of medications was 4.2 (SD 2.5) among "at-risk users", 4.0 (SD 2.6) among "moderate users", and 5.4 (SD 3.4) among "minimal/non-users" (p < 0.001). The concomitant use of AI drugs was widespread. Among the "at-risk users", "moderate users", and "minimal/nonusers" 42.2%, 34.9%, and 52.7%, respectively, were on AI drugs (p < 0.001). One in 10 of "at-risk users" used warfarin, hypnotics/sedatives, or metformin.

CONCLUSIONS

Use of AI drugs is common among older adults, and this increases the potential risks related to the use of alcohol.

Clinical research in Finland in 2002 and 2007: quantity and type

BACKGROUND

Regardless of worries over clinical research and various initiatives to overcome problems, few quantitative data on the numbers and type of clinical research exist. This article aims to describe the volume and type of clinical research in 2002 and 2007 in Finland.

METHODS

The research law in Finland requires all medical research to be submitted to regional ethics committees (RECs). Data from all new projects in 2002 and 2007 were collected from REC files and the characteristics of clinical projects (76% of all submissions) were analyzed.

RESULTS

The number of clinical projects was large, but declining: 794 in 2002 and 762 in 2007. Drug research (mainly trials) represented 29% and 34% of the clinical projects; their total number had not declined, but those without a commercial sponsor had. The number of different principal investigators was large (630 and 581). Most projects were observational, while an experimental design was used in 43% of projects. Multi-center studies were common. In half of the projects, the main funder was health care or was done as unpaid work; 31% had industry funding as the main source. There was a clear difference in the type of research by sponsorship. Industry-funded research was largely drug research, international multi-center studies, with randomized controlled or other experimental design. The findings for the two years were similar, but a university hospital as the main research site became less common between 2002 and 2007.

CONCLUSIONS

Clinical research projects were common, but numbers are declining; research was largely funded by health care, with many physicians involved. Drug trials were a minority, even though most research promotion efforts and regulation concerns them.

Protected area as an indicator of ecological sustainability? A century of development in Europe's boreal forest

Protected area (PA) is an indicator linked to policies on ecological sustainability. We analyzed area, size, and categories of PAs in the European boreal forest biome in Norway, Sweden, Finland, and Russia from 1900 to 2010. The PA increased from 1.5 × 10(3) ha in 1909 to 2.3 × 10(7) ha in 2010. While the total PA in the boreal biome was 10.8 %, the figures ranged from 17.2 % in the northern, 7.9 % of the middle, and 8.7 % of the southern boreal sub-regions. The median size of PAs varied from 10 to 124 ha among countries. The categories of less strictly PAs increased over time. The proportion of area occupied by PAs is an important response indicator for conservation efforts. However, the use of PA as an indicator of ecological sustainability needs to consider ecosystem representation, functional connectivity and management categories.

Socioeconomic differences in mortality amenable to health care among Finnish adults 1992-2003: 12 year follow up using individual level linked population register data

BACKGROUND

Finland decentralised its universal healthcare system and introduced market reforms in the 1990s. Despite a commitment to equity, previous studies have identified persistent socio-economic inequities in healthcare, with patterns of service use that are more pro-rich than in most other European countries. To examine whether similar socio-economic patterning existed for mortality amenable to intervention in primary or specialist care, we investigated trends in amenable mortality by income group from 1992-2003.

METHODS

We analysed trends in all cause, total disease and mortality amenable to health care using individual level data from the National Causes of Death Register for those aged 25 to 74 years in 1992-2003. These data were linked to sociodemographic data for 1990-2002 from population registers using unique personal identifiers. We examined trends in causes of death amenable to intervention in primary or specialist healthcare by income quintiles.

RESULTS

Between 1992 and 2003, amenable mortality fell from 93 to 64 per 100,000 in men and 74 to 54 per 100,000 in women, an average annual decrease in amenable mortality of 3.6% and 3.1% respectively. Over this period, all cause mortality declined less, by 2.8% in men and 2.5% in women. By 2002-2003, amenable mortality among men in the highest income group had halved, but the socioeconomic gradient had increased as amenable mortality reduced at a significantly slower rate for men and women in the lowest income quintile. Compared to men and women in the highest income quintile, the risk ratio for mortality amenable to primary care had increased to 14.0 and 20.5 respectively, and to 8.8 and 9.36 for mortality amenable to specialist care.

CONCLUSIONS

Our findings demonstrate an increasing socioeconomic gradient in mortality amenable to intervention in primary and specialist care. This is consistent with the existing evidence of inequity in healthcare use in Finland and provides supporting evidence of changes in the socioeconomic gradient in health service use and in important outcomes. The potential adverse effect of healthcare reform on timely access to effective care for people on low incomes provides a plausible explanation that deserves further attention.

Validation of the Whooley questions and the Beck Depression Inventory in older adults

OBJECTIVE

To analyse the psychometric properties of the Whooley questions and the 21-item Beck Depression Inventory (BDI-21) in older adults with depression and chronic health problems.

DESIGN

A population-based study.

SETTING

Community.

SUBJECTS

474 adults, aged 72-73 years, living in the city of Oulu, Finland.

MAIN OUTCOME MEASURES

The screening parameters of the Whooley questions and the BDI-21 for detecting major depression.

RESULTS

The prevalence of major depression according to the DSM-IV was 5.3% (single or recurrent episode) obtained by the Mini Neuropsychiatric Interview (MINI). The BDI-21 was best able to identify a current episode of major depression with a cut-off point of 11. The sensitivity and specificity of this cut-off point were 88.0% (95% confidence interval (95% CI) 68.8-97.5) and 81.7% (95% CI 77.8-85.2), respectively. The area under the receiver operating characteristics (ROC) curve was 0.89 (95% CI 0.83-0.96). The two Whooley screening questions had a sensitivity of 62.5% (95% CI 40.6-81.2) and either screening question plus the help question had a sensitivity of 66.7% (44.7-84.4).

CONCLUSIONS

The Beck Depression Inventory is a valid instrument for the diagnosis of depression in older adults. As a screening measure, the optimal cut-off score should be 11 or higher. Our results indicate that the sensitivity of the Whooley questions is not high enough to be used as a screening scale among the elderly.

Panic disorder in primary care: comorbid psychiatric disorders and their persistence

OBJECTIVE

Although 70-80% of panic disorder patients use primary care to obtain mental health services, relatively few studies have examined panic patients in this setting. This study aimed to examine both the lifetime and current comorbid psychiatric disorders associated with panic disorder in primary care, the duration and severity of the disorder, and the sociodemographic factors associated with it.

DESIGN

Patients were screened for panic disorder. Panic disorder and the comorbid disorders were determined using the Structured Clinical Interview for DSM-IV Axis I and II.

SETTING

Eight different health care centers in primary care in the city of Espoo.

SUBJECTS

Finnish-speaking, between 18 and 65 years of age.

MAIN OUTCOME MEASURES

Comorbid psychiatric disorders, the duration and severity of the disorder, and the sociodemographic factors.

RESULTS

A sample of 49 panic disorder patients and 44 patients with no current psychiatric diagnosis were identified; 98% of panic disorder patients had at least one comorbid lifetime DSM-IV Axis I disorder. Major depressive disorder and other anxiety disorders were most common comorbid disorders. Lifetime alcohol use disorders also showed marked frequency. Interestingly, the remission rates of alcohol use disorders were notable. The panic symptoms appeared to persist for years. Panic disorder was associated with low education and relatively low probability of working full time.

CONCLUSIONS

Also in primary care panic disorder is comorbid, chronic, and disabling. It is important to recognize the comorbid disorders. High remission rates of comorbid alcohol use disorders encourage active treatment of patients also suffering from these disorders.

Young male daily smokers are nicotine dependent and experience several unsuccessful quit attempts

OBJECTIVE

Previous studies on smoking cessation have generally been conducted with adolescents or adults. Very little is known about the cessation attempts, their success, and/or use of pharmacological aids in young adult smokers who want to quit. The present study aimed to investigate quitting attempts in a group of both young male daily and occasional smokers.

DESIGN AND SUBJECTS

614 male smokers aged 18-26 years completed a standardized questionnaire about their smoking habits, quit attempts, and aids used in smoking cessation.

RESULTS

Nearly all daily smokers (95.3%, 95% CI 93.1-96.8) were nicotine addicted to some extend according to the standardized questionnaire, and the more addicted they were, the more often they had tried to quit (p = 0.025). Of the daily smokers, 55.6% (95% CI 51.3-59.9) had made quit attempts and 36.2% (95% CI 32.1-40.4) had used nicotine replacement therapy (NRT). In all, 34.1% (95% CI 25.2-44.3) of all occasional smokers reported having intended to quit but they had seldom made more than one attempt whereas 20.2% of daily smokers had made at least three attempts. The stronger the nicotine dependence in daily smokers was, the more likely the subject was to have attempted to use NRT (quite dependent 23.8% vs. totally dependent 48.9%) (p < 0.001).

CONCLUSIONS

A high proportion of young male daily smokers were nicotine addicted. Young smokers make many unsuccessful attempts to stop smoking using nicotine replacement therapy (NRT) on their own. A better availability of professional cessation services directed to young adult smokers is needed.

Epithelial salivary gland tumors in two distant geographical locations, Finland (Helsinki and Oulu) and Israel (Tel Aviv): a 10-year retrospective comparative study of 2,218 cases

Salivary gland tumors (SGTs) of epithelial origin are relatively rare, and worldwide reports show considerable variations in their epidemiology. The aim of this study was to examine, for the first time, the records of SGTs from two very distant geographical locations, Finland (two medical centers) and Israel (one medical center) between 1999 and 2008, based exclusively on the 2005 WHO classification of head and neck tumors, and to compare those data to the other available (single-center) studies that used the same classification. A total of 2,218 benign and malignant tumors diagnosed in the three centers were analyzed. Differences in classification of the tumors were found between the two geographical locations as well as between the two centers from Finland. There was a higher ratio of benign-to-malignant SGTs in the Finnish centers (5.4:1 and 7:1) compared to the Israeli center (2:1), a higher frequency of tumors of minor salivary glands in the Israeli center (34%) than in the Finnish centers (4 and 11%), and a higher frequency of malignant SGTs in the minor salivary glands in Israel (64.5%) than in Finland (10.9 and 27%). The diversity of these multicenter data are compatible with reports from different parts of the world. We conclude that conducting epidemiologic surveys based on the latest WHO classification provides clinicopathologic correlations on SGTs that seem to be characteristic even in small geographical regions.

Chromosome 9 ALS and FTD locus is probably derived from a single founder

We and others have recently reported an association between amyotrophic lateral sclerosis (ALS) and single nucleotide polymorphisms on chromosome 9p21 in several populations. Here we show that the associated haplotype is the same in all populations and that several families previously shown to have genetic linkage to this region also share this haplotype. The most parsimonious explanation of these data are that there is a single founder for this form of disease.

The challenge of bridging science and policy in the Baltic Sea eutrophication governance in Finland: the perspective of science

This article examines the views of scientists on intricacies of scientific knowledge that affect science-policy interface in the Baltic Sea eutrophication governance in Finland. The analysis demonstrates that these intricacies can be divided into five categories: (1) uncertainty of knowledge concerning ecological processes, (2) heterogeneity of knowledge, (3) societal and political call for (certain) knowledge, (4) contingency of the knowledge that ends up taken as a baseline for decision making and further research, and (5) linkages of knowledge production, processing, and communication to particular characteristics of individual researchers and research societies. By explicating these aspects, this article illustrates the ways in which scientific knowledge concerning eutrophication is human-bound and susceptible to interpretation, thus adding on to the uncertainty of the Baltic Sea environmental governance. The aim is, then, to open up perspectives on how ambiguities related to science-policy interface could be coped with.

The semiaquatic nematoceran fly assemblages of three wetland habitats and concordance with plant species composition, a case study from subalpine Fennoscandia

Semiaquatic flies (Diptera, Nematocera) are an ecologically important and species rich group of insects within the boreal and arctic biomes. Community structure, species richness and abundance of semiaquatic flies were studied in three habitat types (aapa mires, springs and headwater streams), totaling 19 study sites, within the subalpine ecoregion of northern boreal Finland. Concordance of semiaquatic fly species composition with plant assemblages (higher plants and mosses), and geographical and environmental distance matrices were also studied. The collected insect material consisted of 94 species and 9038 specimens. According to non-metric multidimensional scaling ordination (visual inspection), multi-response permutation procedure and analysis of similarity tests, fly assemblages of aapa mires were clearly different from those of springs and headwater streams, but no differences were found between spring and headwater stream assemblages. The cumulative number of species was highest in headwater streams. Alpha diversity varied within the habitat types but was generally highest among headwater streams. Semiaquatic fly communities of headwater streams were the most abundant (number of specimens) and their rank-abundance distributions were relatively skewed; assemblages of aapa mires were less abundant and rather even. Community composition of combined plant material (219 taxa), higher plants (116 taxa) and mosses (103 taxa) were all in concordance with the flies; the strongest matrix correlation was found between higher plants and flies (Mantel test). The influence of geographical distance of the study sites to species composition was statistically significant but rather weak; instead, much stronger concordance was noted with environmental variables (Mantel test). Plants, especially higher plants, may be potential surrogates for semiaquatic fly assemblage composition. However, more studies of community concordance in a larger geographic area and within one habitat type are needed.

Workshop: Virtual study trip to integrated primary health care in Finland

First a brief general introduction of the types of services usually encountered in a PHC centre in Finland, and the relationships/interfaces with specialist level services and social services.

Then a study tour of typical health centres with photographs, organizational charts, pictures of teams at their work and at meetings, perhaps videoed interviews and hopefully some representatives of staff of health centres introduced in person in the session.

Virtual study trip to community mental health services in Finland

Content

The virtual study trip to community mental health in Finland includes several examples about how the local mental health services are organised and which methods are used in the coordination and integration processes of services for people with mental illness (e.g., public services, private services, voluntary organisations and other NGOs of and for people with mental illness, psychosocial rehabilitation and the empowering clubhouse rehabilitation network in Finland).

Time division

Introduction and general overview to the workshop theme by Esko Hänninen (10’), service providing NGO’s presentation (15’), service users’ experiences about the Finnish community mental health services (2×10’), other participants of the workshop are telling about situations in their countries and discussion (45’).

Educational results

Learning to understand the welfare mix approach and how to manage the mix while organising coordinated and integrated multi-stakeholders’ community mental health services.

Finnish challenges and solutions on community mental health services

This keynote paper examines the historical developments in Finland in developing community mental health services. In particular, it describes the development and growth of the ‘clubhouse model’ in the support and management of individuals with mental health and how Finland leads the way in such an approach. The paper describes the relative success of this ‘integrated’ model of care and considers what the future for community mental health in Finland will be.

The client-centredness in the innovative rehabilitation course: the schizophrenia client's expertise in changing service system

Introduction

Aims

Theory and methods

Clubhouse model and supported employment—examples of community based (mental health) services

This keynote presentation focuses on the experiences and evidence of two examples of community based mental health services in Finland: first, supported employment services for vulnerable groups; and second, the ‘clubhouse model’ that provides comprehensive community-based services for persons with mental health problems. Both service models are based on similar principles, but aiming at a bit different goals. Supported employment, for example, has a clear goal of achieving for clients a paid job in the open labour market through professional support in the work place. The goal of the clubhouse model is more diffuse since it seeks to empower individuals and improve psychosocial well-being through peer support and the development of a ‘community’. Both are based on social support, social inclusion and care integration with other services. The paper shows how supported employment has a strong evidence-base, both from research and practice, but that there have been problems in mainstreaming such services. The paper also describes how the clubhouse model has seen rapid growth in the US and Europe, and especially in Finland and that evidence support the benefits of the approach. However, there remains a need for carefully conducted and rigorous research on its long-term impact.

Finland could become the world leader in horizontal and vertical integration—reason for enthusiasm or worry? …

This keynote paper examines how the development of integrated care in Finland has become a key aspect of health and welfare reforms in recent years. However, it poses questions as to whether future reforms to the Finnish system will continue to support care integration and outlines many of the key challenges faced in supporting such an agenda.

From controlled opioid substitution treatment to pharmacy delivery of buprenorphine-naloxone and to treatment in primary health care: the views of patients and personnel

Introduction

There are 4000–5000 opioid abusers and about 1700 patients in opioid substitution treatment in Finland. New legislation (2008) allows less restrictive treatment models than before.

Aims

To assess advantages and disadvantages of pharmacy delivery of buprenorphine-naloxone and referral of stabile patients into primary health care.

Theory and methods

The setting was five Finnish outpatient clinics involved in treatment of opioid dependence in 2008–2009. Seventy-four patients (75% males, mean age 33, ½– 8 years in treatment) were interviewed. A questionnaire regarding the patients'´ situation was filled in by the nurses (n=166 patients). The view of personnel was studied in five group interviews (n=24) and through a questionnaire (n=36). Qualitative and quantitative methods were used.

Results

Most patients were unemployed, had psychiatric problems, and had heavy history of drug abuse. Transition to pharmacy delivery and to primary health care was more difficult and time-consuming than expected. This was due to patients' insistent personal need for psychosocial treatment or concerns of the personnel. Financial and organizational factors also played an important role.

Conclusions

A variety of treatment models, careful evaluation of the patients’ situation, and training of personnel of clinics and health centres, and pharmacy staff is needed. Both patients and personnel were willing to move towards less restrictive models, if they were flexible enough.

Closing a loop: substance flow analysis of nitrogen and phosphorus in the rainbow trout production and domestic consumption system in Finland

Ongoing eutrophication is changing the Baltic Sea ecosystem. Aquaculture causes relatively small-scale nutrient emissions, but local environmental impact may be considerable. We used substance flow analysis (SFA) to identify and quantify the most significant flows and stocks of nitrogen (N) and phosphorus (P) related to rainbow trout aquaculture in Finland. In 2004-2007, the input of nutrients to the system in the form of fish feed was 829 t N year(-1) and 115 t P year(-1). Around one-fifth of these nutrients ended up as food for human consumption. Of the primary input, 70% ended up in the Baltic Sea, directly from aquaculture and indirectly through waste management. The nutrient cycle could be closed partially by using local fish instead of imported fish in rainbow trout feed, thus reducing the net load of N and P to a fraction.

Risk-taking behaviour is more frequent in teenage girls with multiple sexual partners

OBJECTIVE

To investigate associations between sexual behaviour and risk-taking health behaviour among adolescent females in our changing sexual culture.

DESIGN

A questionnaire study. Girls who had had multiple sexual partners (at least five in their lifetime or four during the last six months) were compared with those with fewer partners. Logistic regression was applied.

SETTING

The Adolescent Clinic, a primary healthcare unit in the city of Tampere, Finland.

SUBJECTS

A sample of 247 female clients aged 15-18 years who had experienced sexual intercourse.

MAIN OUTCOME MEASURES

Contraceptive practices, substance use, and sexual attitudes.

RESULTS

Girls with multiple sexual partners (n = 69) and the reference group (n = 178) did not differ from each other significantly by age, age at menarche, or educational status. In univariate analysis, age at sexual debut, contraceptive practices, and various substance uses were strongly associated with having multiple sexual partners. Ever-use of emergency contraception was marginally associated, while ever-use of conventional hormonal contraception or condoms was not. In multivariate analysis, low age at sexual debut (OR 8.75 for age 11-13), omitting contraception at the most recent intercourse (OR 3.48), ever-use of withdrawal as a contraceptive method (OR 2.34), and repeated use of drugs (OR 4.10) were associated with having multiple sexual partners.

CONCLUSION

Different types of risk-taking behaviour are still interlinked. In discussions with adolescents showing one type of risk behaviour health service providers should make an effort to identify other modes of risk-taking.

The impact of the integrated services to home care personnel's job, job satisfaction and quality of services: an intervention study

Introduction

Aim

Method

Results

Conclusions

How does a shortage of physicians impact on the job satisfaction of health centre staff?

OBJECTIVE

The aim was to determine how a shortage of physicians at Finnish health centres has affected the job satisfaction of the entire staff.

METHODS

A questionnaire was posted to 2848 employees working with patients at health centres in the Finnish provinces of Satakunta and Varsinais-Suomi. The information concerning the shortage of physicians at health centres was taken from research undertaken by the Finnish Medical Association in October 2003. The health centres were divided into four groups according to the severity of the shortage.

RESULTS

The questionnaire was returned by 1447 employees. The staff at health centres with the most severe shortage of physicians were less satisfied with the management of the organization. Employees at health centres with a minor shortage of physicians were more satisfied with the quality of services in their operational unit. The shortage of physicians had no impact on staff satisfaction regarding the operation of their work unit, the strain of dealing with issues within their work environment, feelings of stress, the strain of working under pressure that they experienced, or interest in finding a new job.

CONCLUSION

The majority of healthcare employees are satisfied and motivated in their work. The shortage of physicians has only a slightly negative impact on their satisfaction.

Use of plant stanol ester margarine among persons with and without cardiovascular disease: early phases of the adoption of a functional food in Finland

BACKGROUND

The plant stanol ester margarine Benecol is a functional food that has been shown to lower effectively serum total and LDL-cholesterol. The purpose of this post-marketing study is to characterize users of plant stanol ester margarine with and without cardiovascular disease.

METHODS

A cohort of plant stanol ester margarine users was established based on a compilation of 15 surveys conducted by the National Public Health Institute in Finland between 1996-2000. There were 29,772 subjects aged 35-84 years in the cohort. The users of plant stanol ester margarine were identified by the type of bread spread used.

RESULTS

The plant stanol ester margarine was used as bread spread by 1332 (4.5%) subjects. Almost half (46%) of the users reported a history of cardiovascular disease. Persons with cardiovascular disease were more likely to use plant stanol ester margarine (8%) than persons without cardiovascular disease (3%). Users with and without cardiovascular disease seemed to share similar characteristics. In particular, they were elderly people with otherwise healthy life-styles and diet. They were less likely smokers, more likely physically active and less likely obese than nonusers. The users reported being in good or average health in general and having used cholesterol-lowering drugs.

CONCLUSION

Plant stanol ester margarine seems to be used by persons for whom it was designed and in a way it was meant: as part of efforts for cardiovascular disease risk reduction.

Atmospheric emissions, depositions, and transformations of arsenic in natural ecosystem in Finland

For the last 2 decades, special attention has been paid to arsenic due to its high concentration in groundwater in many regions of the globe. There are not very many reports on arsenic concentration in the Finnish ecosystem, although the metal has been known to be highly toxic since ancient times. For the majority of people in Finland, the leading exposure route to arsenic is through food consumption. In this study, it has been observed that atmospheric emissions of arsenic from anthropogenic sources have decreased by 90%, which is due to better control technology and strict regulation. Aquatic discharge also was attenuated from 7.1 metric tons (t) in 1990 to 0.7 t in 1999. The concentration of arsenic aerosols in the atmosphere in Finland varies between 0.46 to 0.75 ng m(-3). Its use in pesticides and insecticides also has been phased out in Finland. There is no information available regarding arsenic species in the Finnish environment. Elevated concentrations of arsenic in groundwater has been reported for many countries. In Finland two hot spots are reported--one in the south of Finland and the second in Lapland. In these areas, arsenic concentration in well water is greater than 10 microg l(-1) (WHO recommended value: <10 microg l(-1)). It is believed that the release of arsenic into the Finnish groundwater is geogenic.

Seasonal effects on reproduction in the domestic sow in Finland--a herd record study

Seasonal effects on fertility of the domestic sow were assessed by retrospective analysis of the Finnish national computerised data management system covering 1081 herds in 1993. Multivariate analyses were used, where the reproductive parameter of interest (repeat breeding, weaning to oestrus interval, age of gilts at first farrowing, litter size, culling due to anoestrus or no conception) was designed as the response variable. The months of the year (each month compared with January) and all herds and breed were included in the models as explanatory variables. The study demonstrated clear seasonal effects on various aspects of fertility in the domestic sow. The poorest reproductive performance was consistently observed in late summer and autumn and was demonstrated in a number of ways. Firstly, the gilts born between December and April were older (> 5 days) at farrowing than those born during the rest of the year (p < 0.01). Secondly, the risk that a culled sow would be culled due to anoestrus was significantly increased during the autumn months (Odds Ratio (OR) ranged from 1.10 to 1.36). Thirdly, the risk of a repeat breeding was higher from July to November (OR = 1.16). Risk of a prolonged weaning-to-oestrus beyond day 10 was the highest from August to October (OR ranged from 1.70 to 1.77). Risk of a sow to be culled due to no conception was the highest in January and February (weaned in October-November). In addition, descriptive data gathered in a slaughterhouse in 1993 (a subpopulation of the sows included in the herd records) suggest that incidence of inactive ovaries is increased in summer-autumn (p < 0.05). In conclusion, a marked reduction in fertility of the domestic sow in Finland is reported between July and November.

A developmental behavior-genetic perspective on alcoholism risk

Although behavioral problems associated with abuse of alcohol emerge during late adolescence and adulthood, some behavioral characteristics indicative of an increased risk of alcoholism may already be obvious during early childhood. Studies in several countries have demonstrated that children with high levels of novelty-seeking behavior and low levels of harm-avoidance behavior are more likely to develop alcohol-related problems during adolescence. Moreover, as early as age 3, children at high risk of future alcoholism because of a family history are more active, more impatient, and more aggressive than matched controls of low-risk children. Causal influences on the initiation of drinking must be distinguished from those that affect patterns of consumption once drinking is initiated. Studies of adolescent twins have demonstrated that initiation of drinking is primarily influenced by the drinking status of parents, siblings, and friends and by socioregional differences in the environments within which adolescent twins reside. The influence of genetic factors is negligible. Conversely, once initiated, differences in frequency and quantity of drinking are strongly influenced by genetic factors. However, these influences, too, are modulated by sibling and peer effects and by regional environmental variation.

Immunization of cattle against rabies using inactivated cell culture vaccines

Twenty-one heads of cattle were vaccinated with Madibovin, 31 with Rabdomun and 127 with Rabisin on 4 different farms. Rabies neutralizing antibody titre (> or = 0.5 IU/ml) was detected in 80% of 163 animals tested about 1 month and in 42% of 133 animals tested about 1 year after primary vaccination. On 3 of the farms 86 animals received booster vaccination about 1 year after primary vaccination. All these animals had antibody titre (> or = 0.5 IU/ml) about 1 month after booster and antibody levels were higher than after the primary vaccination. Rabies antibody titres (> or = 0.5 IU/ml) were detected in 96% of 50 animals tested 1 year after the booster. No significant differences (p > 0.05) in antibody levels were detected between animals vaccinated with Madibovin or Rabisin (farm C) respectively with Rabisin or Rabdomun (farm D) at any collection time. Responses to rabies vaccines varied considerably between the farms. After primary vaccination of the animals on 2 farms with the same batch of Rabisin, the antibody levels clearly differed (p < 0.0001) between the farms. Our results indicate that booster is always necessary after primary vaccination to ensure that all animals are protected.

An epidemic of sylvatic rabies in Finland--descriptive epidemiology and results of oral vaccination

When rabies reappeared in Finland in April 1988, the country had been rabies free since 1959. Soon a picture of sylvatic rabies become evident, its main vector and victim being the raccoon dog (Nyctereutes procyonoides). Between 8 April 1988 and 16 February 1989, 66 virologically verified cases were recorded (48 raccoon dogs, 12 red foxes, 2 badgers, 2 cats, 1 dog and 1 dairy bull) in an area estimated at 1700 km2 in south-eastern Finland. The greatest distance between recorded cases was 67 km. A positive reaction with monoclonal antibody p-41 indicated that the virus was an arctic-type strain. A field trial on oral immunization of small predators was initiated in September 1988 using Tübingen fox baits according to the Bavarian model of bait distribution. Each bait contained 5*10(7) TCID50/ml modified live rabies virus (SAD-B19). The 6 months' surveillance indicate a seroconversion rate of 72% (N = 126) in the raccoon dog population, 67% (N = 56) in the red foxes and 13% (N = 16) in the badgers, when titers greater than or equal to 1.0 IU/ml are considered seropositive. In the whole follow-up period, no statistically significant difference could be detected between the raccoon dogs and red foxes in the rate of seroconversion or in the uptake of tetracycline from the baits. Notably high antibody levels were recorded in both raccoon dogs and red foxes within 4-5 months after vaccination. Of the seropositive animals, the proportion of animals with titers 3.0 IU/ml or greater was higher in raccoon dogs (73%) than in red foxes (51%) (x2 = 5.29, p less than 0.05). The trial shows that raccoon dogs can be immunized against rabies in the field with vaccine baits originally developed for controlling sylvatic rabies in foxes.

Experimental maedi infection in sheep. 2. Antibody response

All 4 sheep inoculated via the respiratory tract with 7×10⁶ TCID50 af maedi M88 strain developed complement fixing (CF) antibodies within 3 months after inoculation, and a gradual rise in CF titers was found during the first year. The antibody titers have been maintained, though with some fluctation, through the following year, and the titers vary from 64 to 256. Virus neutralizing activity against maedi M88 strain was detected in the sera of all intrapulmonarily inoculated sheep within 8 months after inoculation. Titers have been maintained or have slightly increased. The level of titers, ranging from 8 to 256, was clearly different between individual sheep.

One of the 4 sheep inoculated intracerebrally with 5×10⁵ TCID50 of maedi M88 strain developed CF antibodies 1 month after inoculation, but no neutralizing antibodies until death 11 months after inoculation. The rest of the intracerebrally inoculated sheep displayed no evidence of CF or neutralizing antibodies within 18 months after inoculation in spite of numerous virus isolations from peripheral blood leukocytes. The absence of antibodies might perhaps be attributed to phenomena such as differences in tropism, provirus state, immunological tolerance and size of inoculum.

One sheep hyperimmunized with repeated s.c. and i.v. injections of maedi M88 strain developed high CF antibody titers but lower neutralizing antibody titers.

The 2 uninoculated control sheep developed no CF or neutralizing antibodies within 18 months after inoculation.