Lumbar disc syndrome in Finland.

The prevalence of lumbar disc syndrome (herniated disc or typical sciatica) and its consequences in terms of disability, handicap, and need for medical care were studied as part of the Mini-Finland Health Survey. A sample of 8000 persons representative of the Finnish population aged 30 or over was asked to come for examination, and 7217 (90%) participated. A diagnosis of lumbar disc syndrome based on medical history, symptoms, and standardised physical examination was made for 5.1% of the men and for 3.7% of the women. Half of these patients were assessed to be in need of medical care, over 80% of which was considered to be adequately met. One third of all patients with lumbar disc syndrome had been previously hospitalised for that syndrome, and one fifth of the patients had undergone lumbar surgery. At least slight disability was found in almost 60% of the patients, though severe functional limitations were rare. About 6% of the population's work disability was estimated to be attributable to lumbar disc syndrome.     

Serum cholesterol and risk of cancer in a cohort of 39,000 men and women

Serum cholesterol concentration was studied for its prediction of cancer in 39,268 men and women aged 15-99 years and initially free from cancer. During a median follow-up of 10 years 1381 cancer cases were diagnosed. Serum cholesterol level was inversely associated with cancer incidence among non-smokers. Age-adjusted relative risks of cancer in quintiles of serum cholesterol were in male non-smokers 1.0, 0.81, 0.73, 0.69, and 0.46 and in female non-smokers 1.0, 0.75, 0.84, 0.78, and 0.70. The associations were not found to be confounded by serum vitamins A or E, serum selenium or several other factors. The association between serum cholesterol level and risk of cancer varied from strongly negative to slightly positive according to subpopulation and site of cancer. The strongest negative associations were found to appear during the first years of follow-up, especially for rapidly developing cancers. Thus the increased occurrence of cancer at low cholesterol levels seems mainly to be due to preclinical cancer.     

Difficulties with tooth protectors in endotracheal intubation

The suitability of three tooth protectors for routine use during endotracheal intubation was studied in 300 consecutive patients undergoing elective operations under general anaesthesia. The main disadvantages of the protectors were lack of space and the consequent difficulty of guiding the endotracheal tube into the larynx, and poor visibility, especially when the Camo protector was used. These difficulties could be avoided in most cases by cutting off the right angle of the Camo protector. The less experienced anaesthesiologists especially had difficulties with the protectors: 20% of patients in the Camo group were considered impossible to intubate unless the protector was removed. The silicone inlay of the Camo protector melts and becomes adhesive at body temperature, which makes its prolonged use hazardous. Two patients lost a maxillary incisor despite the proper use of a protector (Denex). Thus the use of a tooth protector alone does not guarantee avoidance of dental trauma. Better results could be obtained by improving the design of the protectors and by careful pre-anaesthetic dental examination.     

Weight and mortality in Finnish men

Mortality rates of 22,995 Finnish men aged 25 and over followed up for a median of 12 years were analyzed in relation to body mass index (BMI) at the initial examination. All-cause mortality followed a "U"-shaped distribution, being greatest for the thinnest and fattest men at all ages, or about 1.5-fold for those with BMI less than 19.0 kg/m2 and BMI greater than or equal to 34.0 kg/m2, as compared with men of normal weight (BMI 22.0-24.9 kg/m2). Mortality from cardiovascular diseases (CVD) increased with increasing BMI beyond the normal range. This depended mostly on the association of BMI with the biological risk factors of CVD. Mortality rates from CVD were also elevated among thin men under age 55, which could not be explained by the effect of the biological variables. Mortality rates from non-cardiovascular diseases, including cancers were inversely related to BMI among men of all ages. The high overall mortality of thin men was partly but not entirely attributable to smoking, low social class and antecedent disease. We conclude that both thinness and overweight are detrimental to longevity, but through differing mechanisms and disease patterns.     

The relationship between job-related burnout and depressive disorders--results from the Finnish Health 2000 Study

BACKGROUND: Depression and burnout are common health problems in working populations today. They appear to be interrelated, and the need for their differential diagnosis has been highlighted in many reviews. We analysed the overlap of job-related burnout and depressive disorders, i.e., major depressive disorder, dysthymia, and minor depressive disorder. METHODS: We used the population-based 'Health 2000 Study' in Finland. Our nationally representative sample comprised 3276 employees aged 30-64 years. Burnout was assessed with the Maslach Burnout Inventory-General Survey. Diagnoses of depressive disorders were based on the Composite International Diagnostic Interview. RESULTS: Burnout and depressive disorders were clearly related. The risk of depressive disorders, especially major depressive disorder (12-month prevalence), was greater when burnout was severe. Half of the participants with severe burnout had some depressive disorder. Those with a current major depressive episode suffered from serious burnout more often than those who had suffered a major depressive episode earlier. LIMITATIONS: This study was cross-sectional. CONCLUSIONS: The concepts of burnout and depression complement each other and cover partly overlapping phenomena. Depressive disorders are related to job-related burnout, particularly when it is severe. A current major depressive episode is likely to be associated with the experience of burnout. When encountering working patients, it is recommended to assess both the occurrence of burnout and of depressive disorders.     

Weight and mortality in Finnish women

Mortality in relation to body mass index (BMI) was studied in 17,159 healthy Finnish women aged 25-79 followed up for a median of 12 years. Mortality from all cases was related to BMI only in non-smokers aged 25-64, among whom the mortality pattern was "U"-shaped, with a minimum in the second quintile of BMI (the reference range), and about 1.5 times higher in quintiles I and V. Most of the excess risk of mortality among overweight women was due to cardiovascular diseases. During the first 7 years of follow-up, and high risk (relative risk (RR) = 1.7, 95% confidence interval (CI) = 1.0-2.9 for quintile V compared to quintile II) depended on the association of BMI with the initial blood pressure level, but in the later years, the relative risk of cardiovascular death, ranging from 1.6 (95% CI = 1.0-2.5) for women in quintile III up to 2.6 (95% Ci = 1.7-4.0) for those in quintile V, was largely independent of the baseline levels of the main biological risk factors. The excess mortality among thin women under the age of 65 was mainly due to non-cardiovascular diseases (RR = 1.7, 95% CI = 1.2-2.3 for quintile I compared to quintile II) and was not attributable to antecedent disease, smoking or the biological risk factors studied. Among women aged 65 and over, overall mortality varied little with BMI, but thinness seemed to predict deaths from cancers (RR = 1.6, 95% CI = 0.9-3.0).(ABSTRACT TRUNCATED AT 250 WORDS)     

Dental fear affects adolescent perception of interaction with dental staff

The main purpose of this study was to explore whether subjective perception of interaction with dental staff is associated with dental fear in a population‐based sample of 18‐yr‐old adolescents (n = 773). The interaction was measured using the Patient Dental Staff Interaction Questionnaire (PDSIQ), validated with exploratory and confirmatory factor analyses, which yielded the factors of ‘kind atmosphere and mutual communication’, ‘roughness’, ‘insecurity’, ‘trust and safety’, and ‘shame and guilt’. Dental fear was measured using the Modified Dental Anxiety Scale (MDAS). Gender and sense of coherence (SOC) were included as potential confounding variables. Adolescents with high dental fear more often perceived their interaction with dental staff negatively and more often felt insecure than others. This difference persisted after adjustment for gender and SOC. In conclusion, adolescents with high dental fear may perceive their interaction with dental staff more positively if the staff succeed in creating a positive, trusting, approving, and supportive atmosphere with kindness, calmness, and patience. The communication and interaction skills of dental staff may play a particularly important role when encountering highly fearful dental patients.     

Inequality in oral health‐related quality of life before and after a major subsidization reform

In Finland, a dental subsidization reform, implemented in 2001–2002, abolished age restrictions on subsidized dental care. We investigated income‐related inequality in oral health‐related quality of life (OHRQoL) and its determinants among adult Finns before and after the reform. Three cross‐sectional postal surveys, focusing on perceived oral health and the use of dental services among people born before 1971, were conducted in 2001 (n = 2,046), 2004 (n = 1,728), and 2007 (n = 1,560). Five measures, based on the Oral Health Impact Profile‐14, were used as indicators of OHRQoL. Income‐related inequality and associated factors were analysed using the concentration index and its decomposition. Prevalence, extent, and severity of oral health impacts were slightly lower in 2007 than in 2001. The oral health impacts were concentrated, at all study time points, among individuals with lower income. Most of the inequality was related to self‐perceived general health, tooth loss, and income. Contributions of time since the last dental visit and satisfaction with the last treatment period to the inequality decreased from 2001 to 2007. However, the contributions of these factors were already small (10–20%) in 2001. In general, OHRQoL improved slightly; however, no clear or dramatic change in inequality in OHRQoL was seen after the reform.