Prevention of non-communicable diseases: Risk factors in youth: The North Karelia Youth Project (1984-88)

The North Karelia Youth Project is based on the results of previouspilot studies in North Karelia and forms part of the North Kareliaintegrated programme for non-communicable diseases prevention,co-ordinated by the WHO and conducted by the Finnish NationalPublic Health Institute. The project is designed to test thefeasibility and effects of a largescale health programme among12–16 year old schoolchildren. The educational programmeaims to prevent cigarette smoking and alcohol use mainly bytraining pupils to resist social pressures and by modifyingperceived social norms which may lead to smoking and alcoholuse. The dietary intervention aims to improve dietary habitsto decrease serum cholesterol and blood pressure level. Theprogramme also aims to promote positive decision-making andcoping skills and to increase social support for coping withstress. The study, which began in the autumn of 1984 provides a comprehensivethree-year programme for all seventh graders (ages 12–13)and succeeding age cohorts in North Karelia (24 schools) andin selected schools in the county of Kuopio (eight schools),including approximately 4 000 students in the first year and12 000 over the entire study period. Simultaneously successivemeasurements are implemented in all the intervention schoolsand in eight randomized reference schools, which will allowus to evaluate the programme and to test a number of hypothesesabout programme effects. The preventive programme is designedto make the best possible use of existing resources (teachers,parents, community) and will require only relatively modestnew expenditure so that, if proved effective, it can be continuedon a permanent basis. A baseline survey of the schools was carried out in the springof 1984 among ninth-graders. Twenty-four per cent of the boysand 18% of the girls reported smoking daily and 13% and 9% respectivelywere occasional smokers. About 20% had used alcohol during thepast week, 7% reported "passing out" because of drinking duringthe last year and 12% had been deeply drunk. The mean serumcholestrol level was 4.7 mmol/l and the mean blood pressure130/66 mmHg. At this baseline survey, the levels of these variableswere generally comparable in the different randomly assignedstudy groups, although there was a trend towards less smokingand alcohol use at baseline in the schools in North Kareliathan in those in the county of Kuopio.     

Dental maturity in hypopituitarism, and dental response to substitution treatment

abstract — In 25 patients with hypopituitarism the relation of skeletal and dental maturity and the effects on it of substitution therapy for 2–4 years were analyzed. Dental age was retarded less regularly and to a lesser degree than skeletal age and statural growth. In most patients dental age was within the range of 0–2 s.d. All components of dental development seemed equally retarded. Changes in dental delay during GH treatment were variable, but in most cases parallel to the changes in statural and skeletal delay. When treatment was discontinued the lag in dental age increased, showing a response similar to that of skeletal age.     

Morbid Obesity,Gastric Plication and a Severe Neurological Deficit

ABSTRACT. SomerH, BergstrÖm L, Mustajoki P, Rovamo L. (Department of Neurology, Third Department of Internal Medicine and Children's Hospital, University of Helsinki, Helsinki, Finland.) Morbid obesity, gastric plication and a severe neurological deficit. A 39-year-old man had protracted vomiting after gastric plication for morbid obesity. Within three months he lost 53 kg in weight and developed neuromuscular weakness, especially in the lower extremities. Clinical and laboratory studies suggested both radicular and peripheral neuropathy. One year later the condition was only marginally improved: he took only few steps unsupported. The apparent etiology is malnutrition but the primary cause remained unknown.     

Frequency of initial caries lesions as predictor of future caries increment in children

Abstract — The aim of this study was to evaluate the predictive power of the frequency of initial caries lesions in selecting persons at high risk for caries. The subjects ( n = 124) were 11–13 yr old at the beginning of the follow-up. Caries was registered initially and after 5 yr. Evaluation of the predictions was based on cross-tabulations of the subjects according to their predicted caries risk and the actual 5-yr caries increment. Logistic regression analyses were used to produce the individual risk scores. In addition to the caries scores, age of the subjects, was included in the prediction function. In bivariate analyses the total initial caries score at baseline correlated better with caries increment than FS and DS scores did (r = 0.40, 0.13, and 0.31, respectively). When past caries experience was used as predictor, 69% of the children were classified correctly into the low and high risk groups. Surprisingly, only two more subjects (2%) were classified correctly when initial caries score was included in the function. These results suggest that inclusion of initial caries score adds little to the predictive power of the conventional DS and FS scores.     

Hospital Experience of Total Parenteral Nutrition with 3-litre Containers (Big Bags)

A system for total parenteral nutrition (TPN) with a 3-litre container (big bag) has been developed. The bag is filled by a pharmacist in the hospital pharmacy. One of four standard nutritional regimes can be chosen depending on the patients weight and estimated metabolic condition. The bags contain aminoacids, electrolytes, trace elements and energy in the form of glucose. Lipids with vitamins are given separately via a side port and not mixed into the bags.
During one year 61 patients have been given a total of 846 bags. All patients, except for two, maintained or increased their body weight during TPN with the big bag system. However, almost all patients lost weight when TPN was exchanged for enteral or oral feeding. S-phosphate was initially low but normalized within one week in all patients. S-magnesium was low in 1/3 of the patients and remained low in 50% of those for the entire treatment period. S-calcium increased beyond the normal upper limit in 25% of the cases. S-albumin increased in all patients, except for those with metastasizing cancers. Fifteen positive cultures were obtained from big bags. Only in one patient, however, the same bacteria could be cultured from both the patient and the big bag. Some increase in infections related to central venous catheters was noticed. Better utilization due to increased amount of potassium, magnesium, phosphate and zinc compared to routine may be beneficial.     

Finnish Healthy Village Study: impact and outcomes of a low-cost local health promotion programme

Please note that in the above article, published in Volume 11Number 2: June 1996, pages 105-115, the public resources inFinland for health care are not increasing but decreasing. Inrespect of this the ‘Conclusions’ should read asfollows: A village-level health promotion programme based on local participation,a population approach and inter-sectoral collaboration betweenvillage boards, local primary health care centres and adulteducation institutes was shown to work and to have significantimpacts on individuals' health. Inter-sectoral collaborationproved to be the key element for outcomes and cost-effectiveness.In countries such as Finland where public resources for healthcare in the near future are decreasing, this approach offersa valuable channel for health promotion.     

Turner Syndrome: Effect of Hormone Therapies on Height Velocity and Adult Height

ABSTRACT. 76 patients with Turner syndrome received estrogen alone, androgen and estrogen started simultaneously or, after preceding androgen therapy, estrogen with or without androgen. Six patients had spontaneous pubertal development and received no estrogen. Two patients received human growth hormone with androgen during >2.0 years. Height velocity increased during all therapies to mean SD scores of 7.6 during androgen-estrogen started simultaneously, 4.6 during androgen alone, 4.2 during androgen-estrogen after preceding androgen, 2.7 during estrogen alone, and 0.6 during estrogen after preceding androgen. Adult height was measured in all cases, it was 145.5±5.7 (mean ± SD) for the whole series without significant differences between the groups. It correlated strongly with midparent height, and was greater for patients with the 45,X karyotype than for the others combined.     

Client and information: a literature review

Summary

• ? This paper gives a brief review of existing research studies concerning patient information.
• ? The paper outlines two relevant perspectives on information giving and on the meaning of information to the individual patient: ideological and practical.
• ? From these two perspectives the knowledge structures of four patient groups: surgical patients, cancer patients, dialysis patients and psychiatric patients are looked at more closely.

     

The activation of the inflammatory cytokines in overweight patients with mild obstructive sleep apnoea

It is widely accepted that obstructive sleep apnoea (OSA) is linked with cardiovascular diseases. The relationship is complex and remains still poorly understood. The presence of chronic systemic inflammation has been connected with pathogenesis of both OSA and cardiovascular diseases. While atherogenesis is believed to be a process of many years, little is known about the potential impact of the largest OSA subgroup, mild OSA, on the development of cardiovascular diseases. The aim of the present study was to assess whether untreated mild OSA is associated with an activation of inflammatory cytokine system. The adult study population consisted of two groups: 84 patients with mild OSA [apnoea–hypopnoea index (AHI) 5–15 h^?1] and 40 controls (AHI <5 h^?1). Serum concentrations of pro‐ and anti‐inflammatory cytokines were measured before any interventions. After adjustments for age, sex, body mass index, fat percentage, most important cardiometabolic and inflammatory diseases, and non‐steroidal anti‐inflammatory medication, the mean level of tumour necrosis factor‐α was significantly elevated (1.54 versus 1.17 pg mL^?1, P = 0.004), whereas the level of interleukin‐1β (IL‐1β) was reduced (0.19 versus 0.23 pg mL^?1, P = 0.004) in patients with mild OSA compared with controls. The concentrations of the protective anti‐inflammatory cytokines, interleukin‐10 (1.28 versus 0.70 pg mL^?1, P < 0.001) and interleukin‐1 receptor antagonist (478 versus 330 pg mL^?1, P = 0.003) were elevated in the OSA group. The concentrations of C‐reactive protein increased, but IL‐1β decreased along with the increase of AHI. Mild OSA was found to be associated not only with the activation of the pro‐inflammatory, but also with the anti‐inflammatory systems.