Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989–2008

Aims/hypothesis  

Our objective was to examine the trends in prepregnancy BMI and glycaemic control among Finnish type 1 diabetic patients and their relation to delivery mode and perinatal outcome.     

Social factors of sickness absences and ways of coping: a qualitative study of men and women with mental and musculoskeletal diagnoses,Norway

The rate of sickness absence is a serious problem in Norway and Scandinavia as a whole. Musculoskeletal problems are a heterogeneous category, covering a spectrum from a broken back and diffuse muscle pains. Mental diagnoses constitute generally about 25–30% of the total number of the long-term sickness absences. It is thus important to document scientifically how and why participation in nature–culture–health (NaCuHeal) activities may prove beneficial for individuals with long-term illnesses. The purpose of our project is to focus on and to discuss how social factors influence sickness absence. There were two aims of this study: (a) to explore and reveal the absentees' own experiences and perceptions of sickness absence in daily life and (b) to explore and reveal the absentees' own perceptions and experiences of various coping strategies while being on sickness absence. Qualitative method through a pragmatic synthesis of elements of ethnography and grounded theory were used. The sample from the county of Oppland, Norway (n = 30), had a mental or a musculoskeletal diagnosis in accordance with the ICPC-2 medical classification system. In this study, men and women understand and interpret their health situation differently; most men in this sample have become ill due to work-related factors, and for women it seems to be the combined impact of domestic responsibilities and job strain, the so-called double exposure. Health-promoting nature and culture activities refuel their energy levels, which in turn help them to sustain their social network. A combination of various social activities seemed also to be beneficial as long as these activities could be personally chosen within their own time and space. This notion highlights the importance of a lay perspective on the illness experience and its connections to coping strategies. Combined with discussion of sickness absence as a phenomenon, we believe that our findings can contribute to a wider understanding of sickness absence, the complexity behind the outbreak of long-term illnesses and ways of coping in everyday life. This research may add important knowledge and insight, hence increase awareness and understanding of NaCuHeal benefits among health personnel and rehabilitation.     

Growth hormone and cortisol in serum and saliva

Salivary diagnosis is a developing area in clinical chemistry and dentistry. Cortisol analyses from saliva have been used in pediatric practice and as doping tests. Growth hormone (hGH), also a stress hormone, has not been analyzed from saliva. We studied the serum and saliva of 51 healthy subjects. The samples were taken at 8:00 in the morning after 12 h fasting. Cortisol concentrations were analyzed using RIA. An immunoradiometric assay was applied for analyzing serum and salivary hGH. The validity of this method developed in our laboratory was found to be good. The results showed correlation of salivary cortisol with that of serum (r = 0.47, P < 0.001). Salivary hGH concentrations were 1000-fold lower than the respective values in serum, but a clear correlation was found between salivary and serum hGH levels (r = 0.59, P < 0.001).     

Oral and salivary parameters in patients with rheumatic diseases

We studied the presence of secondary Sjögren's syndrome (SS) and the composition of saliva, prevalence of oral pathogens, periodontitis, mouth mucosa, and teeth in patients with various rheumatic diseases and in healthy controls. The hypothesis was that different rheumatic diseases might cause differences in oral health characteristics because of the liability of secondary SS in the patients. The study involved 77 patients and 77 age-matched and sex-matched controls. Twenty patients were suffering from spondylarthropathy (SPA), 18 from ankylosing spondylitis (AS), 24 from rheumatoid arthritis (RA), and 15 from mixed connective tissue disease (MCTD). Clinical and radiographic oral health status was recorded and salivary flow rates were measured. Selected salivary proteins and immunoglobulins were analysed by routine methods. Minor salivary gland biopsy samples were taken from the patients for assessment of inflammatory focus scores. Differences between patients and controls and in between the different rheumatic diseases were analysed statistically. Secondary SS was diagnosed in 39% (30/77) of the patients. A severe periodontal condition (community periodontal index of treatment needs score 3 or 4) occurred in 58% (45/77) of the rheumatic patients compared with only 26% (20/77) of the controls (p<0.0001). The severity of focal sialadenitis (focus score) correlated significant with salivary IgA, IgG, and IgM concentrations. Salivary albumin, total protein, IgG, and IgM concentrations were higher in all patient groups than in the controls. The number of patients with low salivary flow rates was higher in all patient groups compared to controls. Oral yeast counts were significantly higher in the patients than in the controls (p<0.001). In a subgroup analysis, patients with SS had higher values for salivary IgA and IgM than patients without SS. Dental caries and oral lactobacilli were more frequent in patients with SS, but SS was not associated with periodontitis. No major differences were noted in other salivary biochemical parameters between these two groups. Patients with rheumatic diseases, irrespective of specific diagnosis, thus had various alterations in salivary flow and composition and oral health. The findings may reflect the autoimmune inflammation of the salivary glands frequently observed in these patients.     

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle‐sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12‐ and 15‐year‐old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12‐year‐olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six‐ and 12‐year‐olds who had experienced caries were more likely to report dental fear than were caries‐free children. Among 6‐year‐olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.     

Lack of CD44 variant 6 expression in rectal cancer invasive front associates with early recurrence

AIM: To investigate the prognostic value of CD44 variant 6 (CD44v6), a membranous adhesion molecule, in rectal cancer.METHODS: Altogether, 210 rectal cancer samples from 214 patients treated with short-course radiotherapy (RT, n = 90), long-course (chemo) RT (n = 53) or surgery alone (n = 71) were studied with immunohistochemistry for CD44v6. The extent and intensity of membranous and cytoplasmic CD44v6 staining, and the intratumoral membranous staining pattern, were analyzed.RESULTS: Membranous CD44v6 expression was seen in 84% and cytoplasmic expression in 81% of the cases. In 59% of the tumors with membranous CD44v6 expression, the staining pattern in the invasive front was determined as “front-positive” and in 41% as “front-negative”. The latter pattern was associated with narrower circumferential margin (P = 0.01), infiltrative growth pattern (P < 0.001), and shorter disease-free survival in univariate survival analysis (P = 0.022) when compared to the “front-positive” tumors.CONCLUSION: The lack of membranous CD44v6 in the rectal cancer invasive front could be used as a method to identify patients at increased risk for recurrent disease.     

Laminarthrectomy as a surgical approach for decompressing the spinal canal: assessment of preoperative versus postoperative dural sac cross-sectional areal (DSCSA)

Introduction

Surgery for lumbar spinal stenosis (LSS) is today the most frequently performed procedure in the adult lumbar spine. Long-term benefit of surgery for LSS is well documented both in randomized and in non-randomized trials. In this paper, we present the results from laminarthrectomy as an alternative surgical approach, which have theoretical advantages over other approaches. In this study, we wanted to study the clinical and radiological results of laminarthrectomy. Dural sac cross-sectional areal (DSCSA) is an objective method to quantify the degree of central stenosis in the spinal canal, and was used to measure whether we were able to achieve an adequate decompression of the spinal canal with laminarthrectomy as a surgical approach.

Materials and methods

All patients operated on with this approach consecutively in the period 1 January 2008 to 31 March 2009 were included in the study. All perioperative complications were noted. Clinical results were measured by means of a questionnaire. The patients that agreed to attend the study had an MRI taken of the operated level. DSCSA before and after surgery of the actual level were measured by three observers. We then performed a correlation test between increase of area and clinical results. We also tested for inter- and intra-observer reability.

Results

Fifty-six laminarthrectomy were performed. There were 17 % complications, none of them were life-threatening or disabling. 46 patients attended the study and answered the questionnaire. Thirty-four patients (83 %) reported clinical improvement, whereas six (13 %) patients reported no improvement, and two (4 %) patients reported that they were worse. Mean ODI was 23.0. Mean EQ-5D was 0.77. Mean VAS-score for back-pain was 3.1 and mean VAS-score for leg-pain was 2.8. Mean DSCSA were measured to 80 mm² before surgery and 161 mm² after surgery. That gave an increase of DSCSA of 81 mm² (101 %). We found a significant positive correlation between increase of area and clinical results. We also found consistent inter- and intra-observer reability.

Discussion

In this study, the clinical results of laminarthrectomy were good, and comparable with other reports for LSS. The rates of complications are also comparable with other reports in spinal surgery. A significant increase in the spinal canal diameter was achieved. Within the limitations a retrospective study gives, we conclude that laminarthrectomy seems to be a safe and effective surgical approach for significant decompressing the adult central spinal canal, and measurement of DSCSA, before and after surgery seems to be a good way to quantify the degree of decompression.     

Too tight to give birth? Assessment of pelvic floor muscle function in 277 nulliparous pregnant women

Introduction and hypothesis

Theoretically, tight or strong pelvic floor muscles may impair the progress of labor and lead to instrumental deliveries. We aimed to investigate whether vaginal resting pressure, pelvic floor muscle strength, or endurance at midpregnancy affect delivery outcome.

Methods

This was a prospective cohort study of women giving birth at a university hospital. Vaginal resting pressure, pelvic floor muscle strength, and endurance in 300 nulliparous pregnant women were assessed at mean gestational week 20.8 (±1.4) using a high precision pressure transducer connected to a vaginal balloon. Delivery outcome measures [acute cesarean section, prolonged second stage of labor (> 2 h), instrumental vaginal delivery (vacuum and forceps), episiotomy, and third- and fourth-degree perineal tear) were retrieved from the hospital’s electronic birth records.

Results

Twenty-three women were lost to follow-up, mostly because they gave birth at another hospital. Women with prolonged second stage had significantly higher resting pressure than women with second stage less than 2 h; the mean difference was 4.4 cmH₂O [95 % confidence interval (CI) 1.2–7.6], p?<?0.01, adjusted odds ratio 1.049 (95 % CI 1.011–1.089, p?=?0.012). Vaginal resting pressure did not affect other delivery outcomes. Pelvic floor muscle strength and endurance similarly were not associated with any delivery outcomes.

Conclusions

While midpregnancy vaginal resting pressure is associated with prolonged second stage of labor, neither vaginal resting pressure nor pelvic floor muscle strength or endurance are associated with operative delivery or perineal tears. Strong pelvic floor muscles are not disadvantageous for vaginal delivery.