Outcome studies on schizophrenic psychoses in Helsinki

This paper deals with the prognosis of schizophrenic psychoses in Helsinki in 1950-1955, 1960-1965, 1965-1970, 1970-1975, and 1975-1980. The first 4 cohorts each include a sample of 100 patients taken in 1950, 1960, 1965, and 1970. The patients were admitted for the first time to a psychiatric hospital because of schizophrenic and paranoid psychoses. The 1975 material includes all (n = 94) first admissions for schizophrenia, fulfilling the DSM-III criteria of schizophrenia or schizophreniform psychosis.     

Polysorbate 20 as a drug release regulator in ethyl cellulose film coatings

Tablet coatings of hydrophobic ethyl cellulose have been made more hydrophilic by the addition of a non-ionic surfactant, polysorbate (Tween) 20, to the film. As its content increased, so did the release of sodium salicylate from the coated tablets. With a certain content of surfactant and specific thickness of the tablet coat, zero order release kinetics were observed. Leaching of the polysorbate 20 occurred from all formulations. Scanning and transmission electron micrographs showed that the structure of the coats consisted of several layers parallel to the tablet surface. Polysorbate 20 was seen as small drops in some coats.     

A study of attempted suicides in urban versus rural areas, with a follow-up.

The group of subjects consisted of 44 patients (attempters) who were admitted to hospital for treatment because of attempted suicide during a 3-month period in Norther Savo (in Eastern Finland), another 44 patients (non-attempters) admitted to hospital in the same period for other reasons serving as controls. The number of women was the same in both groups, and so was, in consequence, the number of men. The study compared the attempters with the non-attempters and, in addition, the patients coming from urban areas with those coming from rural areas, the ratio of the urban to the rural patients being the same in both groups. The study was based on personal psychiatric interviews with the patients, which took place in each case both immediately following the patient's admission and precisely 3 months afterwards. The results showed that schizophrenia was significantly more frequent in the rural than in the urban attempter group. By contrast, alcoholism and alcohol abuse were more frequent in the urban than in the rural attempter group. Compared with the urban patients, the rural patients tended to be physically more seriously desordered. Poisoning by drugs was a significantly more frequent means of attempted suicide in the urban than in th rural group. The patients in the latter group, again, had resorted oftener to the so-called "active" methods of attempted suicide. Of the attempters, 25% attempted suicide anew during the 3-month follow-up period, the corresponding figure for the non-attempter group being only 6%. During the follow-up period, a greater number of suicidal attempts was made by the patients in the rural group than by those in the urban group, and, as regards the intent to succeed, the attempts of the former were more serious than those of the latter. The so-called "active" methods were used more often by rural than by urban patients also during the follow-up period. All in all, the self-destructive behaviour exhibited during the follow-up period was graver in the rural than in the urban group.     

Changes in bone mineral density during and after 3 years' use of tamoxifen or toremifene

OBJECTIVES: To study the effects of tamoxifen and toremifene on bone mineral density (BMD) in postmenopausal women with breast cancer. METHODS: Seventy patients with stage II-III breast cancer were randomized to start either tamoxifen (n = 36; 20 mg per day) or toremifene (n = 34; 40 mg per day) for 3 years. BMD in the lumbar spine and in the proximal femur was measured by dual-energy X-ray absorptiometry both before and during the treatment and 1 year after the discontinuation of the anti-estrogens. RESULTS: The baseline BMD measurements were comparable between the groups. In 3 years, lumbar BMD decreased by 1.7% in tamoxifen (P = 0.048) and 3.0% in toremifene (P = 0.001) users (ns between the groups), and femoral neck BMD by 0.9% (P = 0.040) and 1.3% (P = ns), respectively. The use of hormone replacement therapy (HRT) until the diagnosis of breast cancer was associated with decreases in lumbar BMD during anti-estrogen regimen (4% at 3 years) in contrast to unchanged lumbar BMD in women with no previous use of HRT. During the 1st year after the cessation of anti-estrogen, lumbar BMD did not change at all in either group whereas femoral BMD decreased in both the groups at the rate of 1.5-3.2%, as expected. CONCLUSIONS: We conclude that tamoxifen (20 mg) and toremifene (40 mg) have similar bone-sparing efficacy that in lumbar spine extends up to 1 year after the cessation of these regimens. This effect is not seen in lumbar spine BMD in those postmenopausal women who discontinue HRT at the time of breast cancer diagnosis.     

Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study

Objectives

Atherosclerosis (AS) and osteoporosis are common diseases in elderly people and may be metabolically related. The aim of this cross-sectional population-based study was to explore the association between common carotid artery intima-media thickness (cIMT), carotid artery calcification (CAC), and BMD in postmenopausal women. In addition, the association of postmenopausal hormone therapy (HT) and selected diseases with cIMT and carotid calcification was studied.

Study design

The 290 women (mean age 73.6 years) included in this Bone Brain Atherosclerosis study (OSTPRE-BBA) were randomly selected from the population-based Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort, Finland.

Main outcome measures

For this cross-sectional study, cIMT was measured with B-mode ultrasound; femoral neck and total body BMD were measured with dual-energy X-ray absorptiometry.

Results

There were no statistically significant associations between mean cIMT and femoral neck T-score (p > 0.05). However, an increased maximum cIMT was significantly associated with low femoral neck T-score. In the osteoporotic group (T-score <−2.5, n = 20), the maximum cIMT was 2.51 ± 0.88 mm (mean ± SD); in the normal BMD group (T-score >−1, n = 122), it was 1.93 ± 0.64 mm (p = 0.001). The odds of having CAC were approximately four-fold higher in the osteoporotic group compared with the group with a normal femoral neck T-score (odds ratio [OR] = 4.2, p = 0.038). The maximum cIMT was smaller in HT users (1.98 ± 0.56 mm, n = 190) than in non-users (2.16 ± 0.74 mm, n = 156, p = 0.036).

Conclusions

The results of our population-based study suggest that BMD is related to AS, at least in carotid arteries. They indirectly support the hypothesis of partially shared pathophysiological mechanisms between these two disorders.     

Does postmenopausal hormone replacement therapy affect cardiac autonomic regulation in osteoporotic women?

OBJECTIVE: Postmenopausal hormone replacement therapy (HRT) has been associated with reduced risk of cardiovascular disease; however, the mechanisms remain obscure, and it is not known whether this applies to regimens containing both estrogen and progestin. One possibility is that estrogen would act via enhancement of cardiac autonomic regulation. DESIGN: In this prospective, controlled study of 6-months duration, 22 osteoporotic, postmenopausal women in the intervention group were treated with combined estradiol hemihydrate corresponding to estradiol 2 mg and norethisterone acetate 1 mg with or without clodronate (HRT group). Nine women in the control group received clodronate only. Indices of heart rate variability (HRV) by power spectral analyses and baroreceptor sensitivity (BRS) by phenylephrine test were measured before and after 3 and 6 months of treatment. RESULTS: The total power of HRV remained identical within the groups, although it was higher at 3 and 6-month measurements in the control group than the HRT group. This was mainly due to lower very low frequency and high frequency power in the HRT group. However, no changes in the low frequency/high frequency-ratio of HRV, an index of sympathovagal balance, were observed between and within the groups. Further, during the intervention, no significant changes in BRS (baseline and 6 months: 5.0 +/- 2.1 and 5.1 +/- 2.5 ms/mmHg) within the HRT group was observed. CONCLUSIONS: The impact of estrogen and progesterone on cardiac autonomic regulation seems to be quite modest. Therefore, cardiac morbidity and mortality are probably not mediated by their effects on cardiac autonomic regulation. However, the effects of estrogen alone or more selective estrogen receptor modulators need yet to be clarified in future studies.     

Insulin sensitivity markers: predictors of accidents and suicides in Helsinki Heart Study screenees

The purpose of this study was to evaluate whether elements signifying relative insulin sensitivity (IS) were prospectively linked to accidents and suicides in 14,976 Helsinki Heart Study (HHS) screenees. The main outcome measure was hospitalizations and deaths from accidents and suicide attempts determined from Finnish registries, in aggregate; and separating out suicides (and attempts). Cox proportional hazards regression was used to determine adjusted risk ratios (RR) relating IS characteristics (extreme quartiles of high HDL-C, low BMI, and low SBP), individually and conjointly, to subsequent accidents or suicides (including attempts), adjusted for age, alcohol use, smoking, and non-HDL cholesterol. Each IS element was related to combined hospitalization and death, from accidents and from suicide attempts; increasing numbers of these characteristics were associated with increased risk, an effect that was more powerful and statistically significant for suicide. For accidents, the presence of one and two to three IS characteristics provided RRs (95% confidence intervals (CI)) of 1.08 (0.97-1.20) and 1.14 (0.98-1.31), respectively. For suicides including attempts, RRs (95%CI) were 1.61 (1.09-2.38) for one IS factor, and 1.88 (1.18-2.98) for two to three IS factors, while for completed suicides, the figures were 2.01 (1.19-3.38) and 2.24 (1.20-4.17), respectively. We speculate that insulin sensitivity may relate to these outcomes through low central serotonin activity.     

Oral Health Care Reform in Finland – aiming to reduce inequity in care provision

Background  

In Finland, dental services are provided by a public (PDS) and a private sector. In the past, children, young adults and special needs groups were entitled to care and treatment from the public dental services (PDS). A major reform in 2001 – 2002 opened the PDS and extended subsidies for private dental services to all adults. It aimed to increase equity by improving adults' access to oral health care and reducing cost barriers. The aim of this study was to assess the impacts of the reform on the utilization of publicly funded and private dental services, numbers and distribution of personnel and costs in 2000 and in 2004, before and after the oral health care reform. An evaluation was made of how the health political goals of the reform: integrating oral health care into general health care, improving adults' access to care and lowering cost barriers had been fulfilled during the study period.     

Inflammation markers are modulated by responses to diets differing in postprandial insulin responses in individuals with the metabolic syndrome

BACKGROUND: Inflammation may be a mechanism by which high postprandial insulin and glucose responses increase the risk of type 2 diabetes mellitus. OBJECTIVE: We hypothesized that dietary carbohydrates characterized by different postprandial insulin responses may differentially modify cytokine concentrations in plasma and gene expression in subcutaneous adipose tissue. DESIGN: Individuals (n = 47) with the metabolic syndrome were randomly assigned to a 12-wk diet with oat and wheat bread and potato (high postprandial insulin response) or rye bread and pasta (low postprandial insulin response). Postprandial glucose and insulin responses to the oat and wheat bread meal and to the rye bread meal were determined in 19 individuals before intervention. RESULTS: During the 12-wk diet, the change in the gene expression of interleukin (IL)-10 receptor alpha and tumor necrosis factor-alpha in subcutaneous adipose tissue differed between the groups (P = 0.002 and P = 0.083, respectively). Moreover, the change in fasting plasma concentrations of IL-1beta and IL-6 differed between the groups (P = 0.020 and P = 0.055, respectively). In the postprandial challenge, the insulin response to the rye bread meal was lower than that to the oat and wheat bread meal (P < 0.001), whereas there were no differences in the mean blood glucose response. In contrast, plasma glucose concentrations decreased more below fasting concentrations 2.5-3 h after the oat and wheat bread meal than after the rye bread meal. A late postprandial rebound of free fatty acids was detected after the oat and wheat bread meal (P = 0.048). CONCLUSIONS: Long-term intake of cereal foods with differing postprandial insulin responses may be a factor that modulates the inflammatory status in individuals with the metabolic syndrome.     

Water spin dynamics during apoptotic cell death in glioma gene therapy probed by T1rho and T2rho.

Longitudinal and transverse relaxations in the rotating frame, with characteristic time constants T1rho and T2rho, respectively, have potential to provide unique MRI contrast in vivo. On-resonance spin-lock T1rho with different spin-lock field strengths and adiabatic T2rho with different radiofrequency-modulation functions were measured in BT4C gliomas treated with Herpes Simplex Virus thymidine kinase (HVS-tk) gene therapy causing apoptotic cell death. These NMR tools were able to discriminate different treatment responses in tumor tissue from day 4 onward. An equilibrium two-site exchange model was used to calculate intrinsic parameters describing changes in water dynamics. Observed changes included increased correlation time of water associated with macromolecules and a decreased fractional population of this pool. These results are consistent with destructive intracellular processes associated with cell death and the increase of extracellular space during the treatment. Furthermore, association between longer exchange correlation time and decreased pH during apoptosis is discussed. In this study, we demonstrated that T1rho and T2rho MR imaging are useful tools to quantify early changes in water dynamics reflecting treatment response during gene therapy.