Nutrition in patients receiving home care in Finland: tackling the multifactorial problem

This study describes the nutritional status of Finnish home care patients (n=178), their problems related to eating, digestion, and diet; their use of Meals on Wheels services; and informal caregivers' role in nutritional support. Half of the patients were at risk for malnutrition and 3% were malnourished according to Mini Nutritional Assessment (MNA) results. Most patients had problems with food intake, which were related to lower MNA scores. One-third of the participants had an unbalanced diet, and approximately half received assistance with shopping and food preparation from an informal caregiver. Home care patients' nutritional status, including all related aspects, such as shopping, food preparation, eating, and digestion, must be evaluated regularly and comprehensively.     

Professional cleaning and asthma

PURPOSE OF REVIEW: The purpose of this review is to summarize the recent evidence on the effect of cleaning jobs on asthma, based on case reports and series of occupational asthma among cleaners, and epidemiological studies on the relationship between different characteristics of cleaning and asthma risk, as well as to elaborate the evidence on potential occupational exposures responsible for the increased asthma risk observed in cleaners. RECENT FINDINGS: Six recent epidemiologic studies strengthen the evidence that domestic and industrial cleaners are at higher risk of asthma compared with professional employees in Europe and the United States. These studies take into account individual confounders, such as age and cigarette smoking. This finding is supported by case reports and registry-based studies of occupational asthma. The studies and reports have identified some chemicals, such as bleach, as specific causes of asthma. Increased risk of asthma has also been related to some specific job tasks, such as cleaning windows and washing dishes. SUMMARY: Recent studies strengthen the evidence of an increased asthma risk among cleaners or individuals in other jobs in which they are involved in cleaning. Further research should be directed to elaborate how much of asthma is related to specific sensitization to certain chemicals and how much to airway inflammation induced by exposure to a mixture of irritants.     

Serum antibodies to pneumococcal neuraminidase NanA in relation to pneumococcal carriage and acute otitis media

Pneumococcal neuraminidase, NanA, is a pneumococcal vaccine candidate. Prior culture-confirmed pneumococcal contacts were shown to induce serum anti-NanA antibodies during the first 2 years of life. The antibody concentrations at neither 12 nor 18 months were significantly associated with the risk of subsequent pneumococcal carriage or acute otitis media.     

Tick-borne encephalitis (TBE) in Skåne, southern Sweden: A new TBE endemic region?

No case of tick-borne encephalitis (TBE) has previously, to our knowledge, been reported from the region of north-eastern Sk?ne in southern Sweden. However, since the y 2001 we have identified 6 cases of TBE in this region occurring in a limited geographical area covering about 100 km2. Sera from 393 patients living in the vicinity of those TBE cases were analysed for the presence of TBE virus-specific IgG by use of ELISA. TBE virus IgG titres >126 VIEU (Vienna Units) were detected in 28 (7.1%) of the patients' sera. However, in only 3 of the ELISA TBE virus IgG positive sera were neutralizing antibodies against TBE virus demonstrated. Those 3 sera all had IgG titres of >380 VIEU. The TBE seroprevalence rate in this non-randomized population sample in north-eastern Sk?ne was calculated at 0.8%.     

Sub-acute neuropathy in patients with African tick bite fever

African tick bite fever (ATBF) caused by Rickettsia africae is an emerging health problem in travellers to sub-Saharan Africa. We here present 6 patients with evidence of long-lasting sub-acute neuropathy following ATBF contracted during safari trips to southern Africa. Three patients developed radiating pain, paresthaesia and/or motor weakness of extremities, 2 had hemi-facial pain and paresthaesia, and 1 developed unilateral sensorineural hearing loss. When evaluated 3-26 months after symptom onset, cerebrospinal fluid samples from 5 patients were negative for R. africae PCR and serology, but revealed elevated protein content in 3 and mild pleocytosis in 1 case. Despite extensive investigations, no plausible alternative causes of neuropathy could be identified. Treatment with doxycycline in 2 patients had no clinical effect. Given the current increase of international safari tourism to sub-Saharan Africa, more cases of sub-acute neuropathy following ATBF may well be encountered in Europe and elsewhere in the y to come.     

Bacteriophages fEV-1 and fD1 Infect Yersinia pestis

Bacteriophages vB_YpeM_fEV-1 (fEV-1) and vB_YpeM_fD1 (fD1) were isolated from incoming sewage water samples in Turku, Finland, using Yersinia pestis strains EV76 and KIM D27 as enrichment hosts, respectively. Genomic analysis and transmission electron microscopy established that fEV-1 is a novel type of dwarf myovirus, while fD1 is a T4-like myovirus. The genome sizes are 38 and 167 kb, respectively. To date, the morphology and genome sequences of some dwarf myoviruses have been described; however, a proteome characterization such as the one presented here, has currently been lacking for this group of viruses. Notably, fEV-1 is the first dwarf myovirus described for Y. pestis. The host range of fEV-1 was restricted strictly to Y. pestis strains, while that of fD1 also included other members of Enterobacterales such as Escherichia coli and Yersinia pseudotuberculosis. In this study, we present the life cycles, genomes, and proteomes of two Yersinia myoviruses, fEV-1 and fD1.     

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.Key Words: Depression, elderly, Finland, general practice, screening instruments, validation studiesCurrent guidelines recommend use of screening tests in patient populations where the prevalence of depression is high, such as older adults or patients with chronic physical illnesses.

• Based on our results, the Beck Depression Inventory is a valid instrument for the diagnosis of depression among older adults. As a screening measure, the optimal cut-off score would be 11 or higher. The sensitivity of the Whooley questions seems not to be high enough to use it as a screening scale among elderly.

     

Circulating metabolite predictors of glycemia in middle-aged men and women

OBJECTIVE

Metabolite predictors of deteriorating glucose tolerance may elucidate the pathogenesis of type 2 diabetes. We investigated associations of circulating metabolites from high-throughput profiling with fasting and postload glycemia cross-sectionally and prospectively on the population level.

RESEARCH DESIGN AND METHODS

Oral glucose tolerance was assessed in two Finnish, population-based studies consisting of 1,873 individuals (mean age 52 years, 58% women) and reexamined after 6.5 years for 618 individuals in one of the cohorts. Metabolites were quantified by nuclear magnetic resonance spectroscopy from fasting serum samples. Associations were studied by linear regression models adjusted for established risk factors.

RESULTS

Nineteen circulating metabolites, including amino acids, gluconeogenic substrates, and fatty acid measures, were cross-sectionally associated with fasting and/or postload glucose (P < 0.001). Among these metabolic intermediates, branched-chain amino acids, phenylalanine, and α1-acid glycoprotein were predictors of both fasting and 2-h glucose at 6.5-year follow-up (P < 0.05), whereas alanine, lactate, pyruvate, and tyrosine were uniquely associated with 6.5-year postload glucose (P = 0.003–0.04). None of the fatty acid measures were prospectively associated with glycemia. Changes in fatty acid concentrations were associated with changes in fasting and postload glycemia during follow-up; however, changes in branched-chain amino acids did not follow glucose dynamics, and gluconeogenic substrates only paralleled changes in fasting glucose.

CONCLUSIONS

Alterations in branched-chain and aromatic amino acid metabolism precede hyperglycemia in the general population. Further, alanine, lactate, and pyruvate were predictive of postchallenge glucose exclusively. These gluconeogenic precursors are potential markers of long-term impaired insulin sensitivity that may relate to attenuated glucose tolerance later in life.Type 2 diabetes is characterized by a long progression period before overt disease onset (1,2). Metabolic perturbations characterizing and contributing to the disease development may be observed already in the prediabetic state (3,4). Knowledge on systemic metabolites associated with deteriorating glucose tolerance may elucidate the pathogenesis of diabetes and holds potential for prevention. Comprehensive metabolic profiling is therefore increasingly used to provide hypotheses implicating novel pathways in the disease etiology (5).Using high-throughput metabolite quantification, we have demonstrated metabolic signatures of insulin resistance in young adults beyond the traditional characteristics of the metabolic syndrome (6). Further, metabolite profiling in the Framingham Heart Study recently linked five branched-chain (leucine, isoleucine, and valine) and aromatic (phenylalanine and tyrosine) amino acids with the risk for future diabetes (7). A lipid signature of triacylglycerols with lower carbon number and double-bond content was also associated with increased risk for diabetes (8). Nonetheless, it remains unknown whether these metabolites are associated with the development of hyperglycemia in nondiabetic individuals and whether the effects would be more specific to fasting or postload glycemia.Elevated fasting and postchallenge glucose both increase the risk for diabetes; however the mechanisms regulating fasting and stimulated glycemia are partly distinct and the glucose measures have different consequences in terms of risk for cardiovascular mortality (9–11). Pathophysiological differences related to insulin sensitivity and secretion have been suggested to underpin the dissimilarities in glucose tolerance (1,3,11,12). Here, we studied metabolite profiles of glycemia in the general population. The aim was to investigate associations of circulating metabolites from high-throughput profiling separately for fasting and 2-h glucose cross-sectionally and prospectively in middle-aged Finnish men and women. We further assessed whether changes in metabolite levels paralleled changes in glycemia during the 6.5-year follow-up period.     

Air pollution and stillbirth: a population-based case-control study in Taiwan

Background: There is limited evidence suggesting that prenatal exposure to ambient air pollutants may increase the risk of stillbirth, but previous epidemiological studies have not elaborated the most susceptible gestational period for the effects of air pollution exposure on stillbirth.Objectives: We estimated associations between exposure to ambient air pollutants and stillbirth, with special reference to the assessment of gestational periods when the fetus is most susceptible.Methods: We conducted a population-based case–control study in Taiwan. The case group consisted of 9,325 stillbirths, and the control group included 93,250 births randomly selected from 1,510,064 Taiwanese singleton newborns in 2001–2007. Adjusted logistic regression models were used to estimate odds ratios (ORs) per 10-ppb change for ozone and nitrogen dioxide, 1-ppb change for sulfur dioxide (SO₂), 10-μg/m³ change for particulate matter with aerodynamic diameter ≤ 10 μm (PM₁₀), and 100-ppb change for carbon monoxide during different gestational periods and according to term or preterm (< 37 weeks) birth status.Results: Stillbirth increased in association with a 1-ppb increase in first-trimester SO₂ [adjusted OR = 1.02; 95% confidence interval (CI), 1.00–1.04], particularly among preterm births (adjusted OR = 1.04; 95% CI, 1.01–1.07). Stillbirth was also associated with a 10-μg/m³ increase in PM₁₀ during the first (adjusted OR = 1.02; 95% CI, 1.00–1.05) and second (adjusted OR = 1.02; 95% CI, 1.00–1.04) month of gestation, and, as with SO₂, associations appeared to be restricted to preterm births (first-trimester adjusted OR = 1.03; 95% CI, 1.00–1.07).Conclusion: The study provides evidence that exposure to outdoor air SO₂ and PM₁₀ may increase the risk of stillbirth, especially among preterm births, and that the most susceptible time periods for exposure are during the first trimester of gestation.