Tuberculosis,Airway Obstruction and Mortality in a Finnish Population

There is little long-term follow-up data concerning the association between past pulmonary tuberculosis (TB), airway obstruction and mortality. We aimed to analyse a national health examination survey data from 6701 adult Finns undergoing spirometry between 1978 and 1980 (follow-up through 2013). We identified TB either through a disease history or by a TB-indicative scar on a chest x-ray. We specified obstruction using the lower limit of normal (LLN) and classified severity using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 1–4. After adjusting for smoking and other confounders, past TB associated with obstruction. Compared to non-TB patients, the adjusted odds ratio (OR; 95% CI) of obstruction reached 2.21 (1.52–3.21) among patients with a scar recorded by one radiologist, 2.48 (1.63–3.78) when recorded by both radiologists and 4.59 (2.86–7.37) among patients with a disease history. Among those with neither past TB nor obstruction, with past TB only, with an obstruction only and with both, we found hazard ratios (HRs; 95% CIs) for subsequent mortality of 1.00 (reference), 1.11 (1.03–1.20), 1.62 (1.31–2.00) and 1.77 (1.45–2.16), adjusted for age, gender, smoking, body mass index (BMI), physical activity, education and general health. In conclusion, past TB strongly determines obstruction, although on its own quite weakly predicts premature death. TB and obstruction combined predict an additive mortality pattern.     

防护剂量监测质量控制的初步工作

为了加强防护剂量监测中的质量控制工作,我们建立了一个用于此目的的剂量学实验室.在X线防护监划、医用诊断X线工作人员剂量与效应研究及医疗照射研究等项工作中,已用这个实验室的条件开展了X线防护仪器的统一刻度,以及个人剂量监测方法比对等项实验工作.本文主要介绍这个实验室的基本条件以及第～次X线防护仪器统一刻度和个人剂量监测方法比对的主要结果.     

Effects of the implementation of the web‐based patient support system on staff’s attitudes towards computers and IT use: a randomised controlled trial

Scand J Caring Sci; 2010; 24; 592–599
Effects of the implementation of the web‐based patient support system on staff’s attitudes towards computers and IT use: a randomised controlled trial Utilisation of information technology (IT) in the treatment of people with severe mental health problems is an unknown area in Europe. Use of IT and guiding patients to relevant sources of health information requires that nursing staff have positive attitudes toward computers and accept IT use as a part of daily practises. The aim of the study was to assess the effects of the implementation of a web‐based patient support system on staff’s attitudes towards computers and IT use on psychiatric wards. Hundred and forty‐nine nurses in two psychiatric hospitals in Finland were randomised to two groups to deliver patient education for patients with schizophrenia and psychosis with a web‐based system (n = 76) or leaflets (n = 73). After baseline nurses were followed‐up for 18 months after the introduction of the system. The primary outcome was nurses’ motivation to utilise computers, and the secondary outcomes were nurses’ beliefs in and satisfaction with computers, and use of computer and internet. There were no statistically significant differences between study groups in attitudes towards computers (motivation p = 0.936, beliefs p = 0.270, satisfaction p = 0.462) and internet use (p = 0.276). However, nurses’ general computer use (p = 0.029) increased more in the leaflet group than in the IT intervention group. We can conclude that IT has promise as an alternative method in patient education, as the implementation of the web‐based patient support system in daily basis did not have a negative effect on nurses’ attitudes towards IT.     

Lactase persistence, dietary intake of milk, and the risk for prostate cancer in Sweden and Finland.

Prostate carcinoma is the most common cancer in men. Its primary pathogenesis is mostly unknown. Dairy products containing lactose have been suggested to be risk factors for prostate cancer. Digestion of lactose is dependent on lactase activity in the intestinal wall. A single nucleotide polymorphism C to T residing 13,910 bp upstream of the lactase gene has been shown to associate with the developmental down-regulation of lactase activity underlying persistence/nonpersistence trait. To find out whether lactase persistence is related to the risk for prostate cancer, we genotyped 1,229 Finnish and 2,924 Swedish patients and their 473 Finnish and 1,842 Swedish controls using solid-phase minisequencing. To explore if dairy products have an association with prostate cancer, we analyzed the milk consumption in the Swedish study consisting of 1,499 prostate cancer patients and 1,130 controls (Cancer Prostate in Sweden I study) using a questionnaire. Only the consumption of low-fat milk was found to be associated with increased risk of prostate cancer [odds ratio (OR), 1.73; 95% confidence interval (95% CI), 1.16-2.39]. A statistically significantly higher (P < 0.01) lactose intake was observed among subjects with high lactase activity (C/T and T/T genotypes) compared with those with low lactase activity (C/C genotype). Lactase persistence did not associate with increased risk for prostate carcinoma in the Finnish (OR, 1.11; 95% CI, 0.83-1.47; P = 0.488) or in the Swedish populations (OR, 1.16; 95% CI, 0.91-1.46; P = 0.23). In conclusion, lactase persistence/nonpersistence contains no risk for prostate cancer. Analysis of different milk products showed some evidence for low-fat milk as a potential risk factor for prostate cancer.     

Thrombosis in a mechanical aortic valve prosthesis during subcutaneous heparin therapy in pregnancy; a case report

Maternal death due to thrombosis in a mechanical aortic valve prosthesis during heparin therapy is described. The patient had a normal pregnancy during warfarin therapy. In this pregnancy, warfarin therapy was replaced by subcutaneous heparin injections, and the patient died of massive thrombosis in the valvuloprosthesis at 20 weeks of pregnancy. The effectiveness of heparin therapy and difficulties in the follow-up of heparin treatment during pregnancy are discussed.     

Hypergonadotropic hypogonadism in newborn males with primary testicular failure

Four infants with genital ambiguity but with apparent testes were given a gonadotropin-releasing hormone (GnRH) test and a human chorionic gonadotropin (hCG) test at age 3-12 days. The results were compared with those from 16 newborn males (aged 2 to 6 days) with minor genital anomalies; 9 with unilateral and 3 with bilateral incomplete testicular descent, 2 with surgically insignificant glandular hypospadias and 2 with penis length less than (means-2 SD) for gestational age. Treatment with testosterone resulted in clear phallus growth in all four patients. All four patients had elevated basal luteinizing hormone (LH) concentrations as well as an exaggerated LH response to GnRH; three of them also had an exaggerated follicle stimulating hormone (FSH) response. Thus in all patients the etiology of genital ambiguity was considered to be testicular. The testosterone response to hCG was normal in two of the patients but impaired in the other two. The steroidogenic response did not show any specific enzyme defect. We conclude that newborn boys with Leydig cell failure are clearly hypergonadotropic, the GnRH test is a more sensitive indicator of Leydig cell failure neonatally than the hCG test and normal testes greatly inhibit the secretion of both LH and FSH during the first week of life.     

Long-term effect of pharyngeal flap surgery on craniofacial and nasopharyngeal morphology in patients with cleft palate

The craniofacial morphology of 48 consecutive adult males with isolated cleft palate was studied by means of lateral cephalograms at the mean age of 18.8 years. Twelve of the patients had received pharyngeal flap surgery between 4 and 12 years of age (mean age 6 years) to improve speech. No significant differences were noticed in craniofacial cephalometric relations between the patients who had not had velopharyngeal flap surgery (VPF-) and those who had (VPF+), although the latter showed a tendency toward a more vertical growth direction. In the pharynx, the VPF+ group showed larger sagittal depths of nasopharyngeal airway but smaller depths of oropharyngeal airway. The differences were significant at the levels of the upper nasopharynx and lower oropharynx. According to the hospital records, none of the patients demonstrated persistent airway obstruction. Cephalometry may be useful in evaluating the changes in pharyngeal airway dimensions that may be related to velopharyngeal flap surgery.     

Effect on body weight of replacing dietary fat with olestra for two or ten weeks in healthy men and women

OBJECTIVE: To examine in two separate studies the effects of replacing dietary fat with Olestra on body composition and weight change in healthy young men and women. METHODS: Ten healthy, lean young men participated in Study One that was a 22-day single blind, within-subject design. After a control diet (40% fat) for eight days Study One subjects received an Olestra-substituted diet (31% metabolizable fat) for 14 days. Study Two was a randomized parallel-arm clinical trial with 15 healthy, lean and overweight young women. These subjects were randomly assigned to receive a control diet (40% fat), an Olestra-containing diet (31% metabolizable fat) or a reduced-fat diet (31% fat) for 10 weeks. All foods were provided to the subjects, and energy intakes were not restricted. The primary endpoint in both studies was change from baseline in body weight. In Study Two, body composition was measured by dual energy x-ray absorptiometry. In both studies, food intake and nutrient compensation were assessed. RESULTS: In Study One fat substitution by Olestra resulted in a significant 1.7 kg weight loss from baseline. In Study Two, change in body weight and body fat from baseline were statistically significant in all groups, but the group with Olestra lost significantly more weight from baseline (-5.0 kg) than the other two groups. In Study One there was partial compensation for the decreased energy intake, while in Study Two, compensation was seen only for those on the reduced-fat diet. CONCLUSION: Replacement of 1/3 of dietary fat with Olestra in periods of up to 10 weeks results in weight loss in men and women.     

Clinical applicability of heart rate variability analysis by methods based on nonlinear dynamics

Analysis of heart rate (HR) variability has become an important widely used method for assessingcardiac autonomic regulation. Conventionally, HR variability has been analyzed with time and frequency domainmethods. Analysis of HR dynamics by methods based on nonlinear systems theory has opened a novel approach forstudying the abnormalities in HR behavior. Recent studies have shown that these measures, particularly scalinganalysis methods of HR dynamics, are altered among various patients populations with cardiovascular diseases, andthey provide prognostic information. Altered long-term scaling properties of HR dynamics and more random short-termHR fluctuation has been observed, e.g., among patients with previous myocardial infarction, and these alterationshave been shown to be associated with increased mortality rate. A relatively large body of data indicate thataltered scaling properties of R-R intervals are physiologically deleterious. These findings support the notion thatsome nonlinear methods, such as scaling and complexity measures, give clinically valuable information for riskstratification among various patient populations. This article provides a review of our current knowledge of theusefulness of dynamical measures of HR fluctuation.