11.-18.2.2008

Al-Lawati, J. A. and Jousilahti, P.

Public Health Nutrition. 2008; 11(1): 102-108. Article. IF 2.123

Background.- There are no data on optimal cut-off points to classify obesity among Omani Arabs. The existing cut-off points were obtained from studies of European populations. Objective: To determine gender-specific optimal cut-off points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WER) associated with elevated prevalent cardiovascular disease (CVD) risk among Omani Arabs. Design: A community-based cross-sectional study. Setting: The survey was conducted in the city of Nizwa in Oman in 2001. Subjects and methods: The study contained a probabilistic random sample of 1421 adults aged >= 20 years. Prevalent CVD risk was defined as the presence of at least two of the following three risk factors: hyperglycaemia, hypertension and dyslipidaemia. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI, WC and WHR in relation to the area under the curve (AUC), sensitivity and specificity. Results: Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia, 19% hypertension and 34.5% had high total cholesterol). All three indices including BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767) predicted prevalent CVD risk factors equally well. The optimal cut-off points for men and women respectively were 23.2 and 26.8kg m(-2) for BMI, 80.0 and 84.5 cm for WC, and 0.91 and 0.91 for WHR. Conclusions: To identify Omani subjects of Arab ethnicity at high risk of CVD, cutoff points lower than currently recommended for BMI, WC and WHR are needed for men while higher cut-off points are suggested for women.

Seven distinct dietary patterns identified among pregnant Finnish women - associations with nutrient intake and sociodemographic factors

Arkkola, T., Uusitalo, U., Kronberg-Kippilae, C., Maennistoe, S., Virtanen, M., Kenward, M. G., Veijola, R., Knip, M., Ovaskainen, M. L. and Virtanen, S. M.

Public Health Nutrition. 2008; 11(2): 176-182. Article. IF 2.123

Objectives: To identify and describe dietary patterns in a cohort of pregnant women and investigate whether the dietary patterns are associated with dietary intake and sociodemographic factors. Design: Mothers entering the Finnish Type I Diabetes Prediction and Prevention (DIPP) Nutrition Study in 1997-2002 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy. Principal components analysis was used to identify dietary patterns. Setting: Finland. Subjects: Subjects were 3730 women with a newborn infant carrying increased genetic susceptibility to type 1 diabetes mellitus. Results: Seven factors were identified and named. Energy intake correlated positively with 'Healthy', 'Fast food', 'Traditional bread', 'Traditional meat' and 'Coffee' patterns and inversely with the 'Alcohol and butter' pattern. Intake of dietary fibre correlated positively with 'Healthy', 'Traditional bread' and 'Low-fat foods' patterns and inversely with the 'Alcohol and butter' pattern. The seven dietary patterns seemed to account for relatively large proportions of the variance in energy and nutrient intakes except for the intake of vitamin D, vitamin C, carotenoids and calcium. Maternal age and higher level of education were associated with higher scores on 'Healthy', 'Low-fat foods' and 'Alcohol and butter' patterns. Conclusion: Principal components analysis produced seven dietary patterns which may be useful for further research concerning maternal diet and health outcomes among both mothers and their offspring.

Spousal and filial help among older people with functional limitations in England and Finland in the 2000s

Blomgren, J., Koskinen, S., Martelin, T., Martikainen, P., Sainio, P. and Breeze, E.

European Journal of Public Health. 2007; 17: 10-11. Meeting Abstract. IF 1.481

Cost-effectiveness analysis of guidelines for antihypertensive care in Finland

Booth, N., Jula, A., Aronen, P., Kaila, M., Klaukka, T., Kukkonen-Harjula, K., Reunanen, A., Rissanen, P., Sintonen, H. and Makela, M.

Bmc Health Services Research. 2007; 7. Article. IF 1.198

Background: Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario). Methods: A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole. Results: The impact of the use of the ACCG scenario in subgroups (aged 40-80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective. Conclusion: The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.

Smoking reduction predicts cessation: longitudinal evidence from the Finnish adult twin cohort

Broms, U., Korhonen, T. and Kaprio, J.

European Journal of Public Health. 2007; 17: 152-152. Meeting Abstract. IF 1.481

International Circumpolar Surveillance System for invasive pneumococcal disease, 1999-2005

Bruce, M. G., Deeks, S. L., Zulz, T., Bruden, D., Navarro, C., Lovgren, M., Jette, L., Kristinsson, K., Sigmundsdottir, G., Jensen, K. B., Lovoll, O., Nuorti, J. P., Herva, E., Nystedt, A., Sjostedt, A., Koch, A., Hennessy, T. W. and Parkinson, A. J.

Emerg Infect Dis. 2008; 14(1): 25-33. IF 5.094

The International Circumpolar Surveillance System is a population-based surveillance network for invasive bacterial disease in the Arctic. The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced for routine infant vaccination in Alaska (2001), northern Canada (2002-2006), and Norway (2006). Data for invasive pneumococcal disease (IPD) were analyzed to identify clinical findings, disease rates, serotype distribution, and antimicrobial drug susceptibility; 11,244 IPD cases were reported. Pneumonia and bacteremia were common clinical findings. Rates of IPD among indigenous persons in Alaska and northern Canada were 43 and 38 cases per 100,000 population, respectively. Rates in children <2 years of age ranged from 21 to 153 cases per 100,000 population. In Alaska and northern Canada, IPD rates in children <2 years of age caused by PCV7 serotypes decreased by >80% after routine vaccination. IPD rates are high among indigenous persons and children in Arctic countries. After vaccine introduction, IPD caused by non-PCV7 serotypes increased in Alaska.

Effect of apolipoprotein M on high density lipoprotein metabolism and atherosclerosis in low density lipoprotein receptor knock-out mice

Christoffersen, C., Jauhiainen, M., Moser, M., Porse, B., Ehnholm, C., Boesl, M., Dahlback, B. and Nielsen, L. B.

Journal of Biological Chemistry. 2008; 283(4): 1839-1847. Article. IF 5.808

To investigate the role of apoM in high density lipoprotein (HDL) metabolism and atherogenesis, we generated human apoM transgenic (apoM-Tg) and apoM-deficient ( apoM(-/-)) mice. Plasma apoM was predominantly associated with 10-12-nm alpha-migrating HDL particles. Human apoM overexpression (11-fold) increased plasma cholesterol concentration by 13-22%, whereas apoM deficiency decreased it by 17-21%. The size and charge of apoA-I-containing HDL in plasma were not changed in apoM-Tg or apoM(-/-) mice. However, in plasma incubated at 37 C, lecithin: cholesterol acyltransferase-dependent conversion of alpha- to pre-alpha-migrating HDL was delayed in apoM-Tg mice. Moreover, lecithin: cholesterol acyltransferase-independent generation of pre-beta-migrating apoA-I-containing particles in plasma was increased in apoM-Tg mice (4.2 +/- 1.1%, p = 0.06) and decreased in apoM(-/-) mice (0.5 +/- 0.3%, p = 0.03) versus controls ( 1.8 +/- 0.05%). In the setting of low density lipoprotein receptor deficiency, apoM-Tg mice with similar to 2-fold increased plasma apoM concentrations developed smaller atherosclerotic lesions than controls. The effect of apoM on atherosclerosis may be facilitated by enzymatic modulation of plasma HDL particles, increased cholesterol efflux from foam cells, and an antioxidative effect of apoM-containing HDL.

Associations of methylenetetrahydrofolate reductase C677T polymorphism with markers of subclinical atherosclerosis: The cardiovascular risk in young Finns study

Collings, A., Raitakari, O. T., Juonala, M., Rontu, R., Kahonen, M., Hutri-Kahonen, N., Ronnemaa, T., Marniemi, J., Viikari, J. S. A. and Lehtimaki, T.

Scandinavian Journal of Clinical & Laboratory Investigation. 2008; 68(1): 22-30. Article. IF 1.216

Objective. To study whether the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism or serum homocysteine concentration is associated with carotid artery intima media thickness (IMT), carotid artery compliance (CAC) or brachial artery flow mediated dilatation (FMD) in a healthy Finnish adult population. Methods. Cross-sectional data obtained in 2001 for the Cardiovascular Risk in Young Finns Study were used. Carotid artery IMT, CAC and brachial FMD were measured by ultrasound and serum homocysteine concentrations using a commercial immunoassay kit. We studied 1,440 subjects (aged 24-39 years). Genotyping was performed using the 59 nuclease TaqMan assay. Results. Homocysteine values differed between genotypes in women and men (ANOVA, p < 0.001 for both sex groups): the genotype raised values in the order of CC, CT, TT. There was a significant difference in CAC values between the MTHFR genotypes in men (ANOVA, p = 0.008), and the CC genotype had the lowest values. In multivariate linear regression analysis adjusted for other major coronary risk factors (e. g. age, smoking, body mass index, systolic blood pressure, C-reactive protein), the association remained significant (R-2 = 25.8%, beta = 0.091; p = 0.02). Homocysteine level was directly associated with CAC in the whole population (R-2 = 18.0%, beta = 0.012; p = 0.014) and in women (R-2 = 9.3%, beta = 0.02; p = 0.013), but not in men (R-2 = 15.2%, beta = 0.004; p = 0.444). We found no association between homocysteine level or the MTHFR polymorphism and carotid IMT or brachial artery FMD. Conclusions. The findings suggest that the MTHFR polymorphism does not influence IMT or FMD, but that the T allele may have an effect on CAC in men.

Favorable effects of berry consumption on platelet function, blood pressure, and HDL cholesterol

Erlund, I., Koli, R., Alfthan, G., Marniemi, J., Puukka, P., Mustonen, P., Mattila, P. and Jula, A.

Am J Clin Nutr. 2008; 87(2): 323-31. IF 6.562

BACKGROUND: Berries are a particularly rich source of polyphenols. They also contain other bioactive substances, such as vitamin C. Previous studies indicated that the consumption of polyphenol-rich foods (eg, cocoa, tea, and red wine) may induce beneficial changes in pathways related to cardiovascular health. Whether the consumption of berries has similar effects is unknown. OBJECTIVE: We aimed to investigate the effects of berry consumption on hemostatic function, serum lipids, and blood pressure (BP). DESIGN: Middle-aged unmedicated subjects (n = 72) with cardiovascular risk factors consumed moderate amounts of berry or control products for 8 wk in a single-blind, randomized, placebo-controlled intervention trial. RESULTS: Berry consumption inhibited platelet function as measured with a platelet function analyzer (using collagen and ADP as platelet activator) [changes: 11% and -1.4% in the berry and control groups, respectively; P = 0.018, analysis of covariance (ANCOVA)]. Plasma biomarkers of platelet activation, coagulation, and fibrinolysis did not change during the intervention. Serum HDL-cholesterol concentrations increased significantly more (P = 0.006, ANCOVA) in the berry than in the control group (5.2% and 0.6%, respectively), but total cholesterol and triacylglycerol remained unchanged. Systolic BP decreased significantly (P = 0.050, ANCOVA); the decrease mostly occurred in subjects with high baseline BP (7.3 mm Hg in highest tertile; P = 0.024, ANCOVA). Polyphenol and vitamin C concentrations in plasma increased, whereas other nutritional biomarkers (ie, folate, tocopherols, sodium, and potassium) were unaffected. CONCLUSION: The consumption of moderate amounts of berries resulted in favorable changes in platelet function, HDL cholesterol, and BP. The results indicate that regular consumption of berries may play a role in the prevention of cardiovascular disease.

Socioeconomic mortality differences among diabetic people in Finland 1991-2003

Forssas, E. H., Keskimaki, I. T., Koskinen, S. V., Arffman, M. E. and Reunanen, A. R.

European Journal of Public Health. 2007; 17: 220-220. Meeting Abstract. IF 1.481

Coronary heart disease among diabetic and nondiabetic people - socioeconomic differences in incidence, prognosis and mortality

Forssas, E. H., Keskimaki, I. T., Reunanen, A. R. and Koskinen, S. V.

Journal of Diabetes and Its Complications. 2008; 22(1): 10-17. Article. IF 1.526

Objective: To investigate coronary heart disease (CHD) morbidity and mortality and their patterning by socioeconomic status among diabetic and nondiabetic individuals in Finland. Methods: All diabetic persons aged 35-74 years entitled to free anti-diabetic medication were drawn from the 1991-1996 national health insurance files along with nondiabetic referents. outcome events for up to 6 years of follow-up, corresponding to 418 987 and 867 813 person-years in diabetic and nondiabetic people, respectively, were identified from national health insurance, hospital discharge and causes of death registers using personal identification codes. Results: The annual CHD incidence for diabetic women and men was 2.7% and 3.7%, respectively, corresponding to relative risks of 3.55 (95% CI: 3.43-3.67) and 2.64 (95% CI: 2.56-2.72) compared to nondiabetic persons. The impact of diabetes on CHD mortality was greater, with relative death rates of 6.04 and 3.42 for women and men, respectively. CHD mortality and incidence displayed systematic socioeconomic trends with higher rates among worse-off diabetic and nondiabetic people, although gradients were generally steeper for nondiabetics. In the diabetic population, socioeconomic differences were rather similar for sudden CHD deaths and nonfatal CHD incident cases. For both genders, socioeconomic differences in mortality after CHD diagnosis were small in both diabetic and nondiabetic persons, except for the lowest compared to the highest income quintile. Conclusions: Socioeconomic CHD mortality differences among diabetic people in Finland were mainly explained by higher CHD incidence and particularly sudden deaths without prior CHD diagnosis. No systematic socioeconomic differences were found in long-term prognosis after CHD diagnosis. (c) 2008 Elsevier Inc. All rights reserved.

Exercise habits and alcohol use affect the report of seasonal changes in mental health Sharon Grimaldi

Grimaldi, S., Perala, J., Partonen, T., Pirkola, S., Haukka, J., Aromaa, A. and Loennqvist, J.

European Journal of Public Health. 2007; 17: 203-203. Meeting Abstract. IF 1.481

Relative bone mineral density measured by metacarpal index (MCI) and chronic spinal syndromes: an epidemiological study

Haara, M. M., Arokoski, J. P. A., Kroger, H., Karkkainen, A., Manninen, P., Knekt, P., Impivaara, O. and Heliovaara, M.

Scandinavian Journal of Rheumatology. 2007; 36(6): 466-469. Article. IF 2.273

Objectives: The results of previous studies on the association between bone mineral density (BMD) and chronic spinal syndromes have been contradictory. Therefore, we studied relative BMD measured by the metacarpal index (MCI) and its associations with chronic neck and low-back syndromes and diffuse idiopathic skeletal hyperostosis (DISH). Methods: A population sample of 8000 Finns aged 30 years and over was invited to a comprehensive health examination in 1978-1980; 90% complied. In the clinical phase, a trained physician diagnosed chronic neck and low-back syndromes. Hand and chest radiographs were taken from 3568 participants to determine the MCI and to diagnose DISH. Of these, 340 subjects were re-examined clinically in 2000. Results: After adjusting for potential confounding factors, a high MCI showed a significant cross-sectional association with chronic neck syndrome and DISH. The odds ratio (OR) per increment of one standard deviation (0.1) of MCI for chronic neck syndrome was 1.33 [95% confidence interval (CI) 1.21-1.47] and for DISH 1.29 (95% Cl 1.04-1.60). No association was found between MCI and chronic low-back syndrome. In the follow-up setting, however, baseline MCI did not predict the incidence of chronic neck or low-back syndromes. Conclusions: Relative BMD is directly proportional to the prevalence of chronic neck syndrome. Further studies are needed to clarify the mechanisms of the association. The close association found between high relative BMD and DISH suggests a joint metabolic factor, which needs to be studied further to determine its effects on bones and intervertebral discs.

Socio-economic differences in the use of fresh vegetables in nine European countries

Hakala, S., Roos, E., Helmert, U., Klumbiene, J., Van Oyen, H., Regidor, E. and Kunst, A.

European Journal of Public Health. 2007; 17: 86-86. Meeting Abstract. IF 1.481

Urban Air Pollution And Asthma And Copd Hospital Emergency Room Visits

Halonen, J. I., Lanki, T., Yli-Tuomi, T., Kulmala, M., Tiittanen, P. and Pekkanen, J.

Thorax. 2008. IF 6.064

Rationale: There is little previous information of the effects of size-fractioned particulate air pollution and source-specific fine particles (PM2.5; <2.5 microm) on asthma and COPD among children, adults, and the elderly.

OBJECTIVES: To determine the effects of daily variation in levels of different particle size fractions and gaseous pollutants on asthma and COPD by age group. METHODS: We measured the levels of particulate air pollution, NO2, and CO in 1998-2004 at central outdoor monitoring sites in Helsinki, Finland. We evaluated associations between daily pollution levels and hospital emergency room visits for asthma (ICD10: J45+J46) in children <15 years old, and for asthma and COPD (ICD10: J41+J44) in adults (15-64 years) and the elderly (>/=65). Measurements and

MAIN RESULTS: We found 3 to 5 days lagged increases in the asthma visits among children in association with nucleation (<0.03microm), Aitken (0.03-0.1microm) and accumulation (0.1-0.29microm) mode particles, gaseous pollutants, and traffic-related PM2.5 (7.8% [95% CI 3.5-12.3] for 1.1microg/m3 increase in traffic-related PM2.5 at lag 4). Pooled asthma-COPD visits among elderly were associated with lag 0 of PM2.5, coarse particles, gaseous pollutants, and long-range transported and traffic-related PM2.5 (3.9% [95% CI 0.28-7.7] at lag 0). Only accumulation mode and coarse particles were associated with asthma and COPD among adults.

CONCLUSIONS: Among children traffic-related PM2.5 had delayed effects, whereas among elderly several types of particles had effects that were more immediate. These findings suggest that the mechanisms of the respiratory effects of air pollution, and responsible pollutants differ by age group.

Psychosocial changes contributing to lifestyle improvement: Are there socio-economic differences?

Hankonen, N., Absetz, P. and Uutela, A.

European Journal of Public Health. 2007; 17: 169-170. Meeting Abstract. IF 1.481

Trends in traditional risk factor levels no longer well explain changes in cardiovascular mortality and its socio-economic disparities in Finland

Harald, K., Koskinen, S., Jousilahti, P., Torppa, J., Vartiainen, E. and Salomaa, V.

European Journal of Public Health. 2007; 17: 217-218. Meeting Abstract. IF 1.481

Changes in traditional risk factors no longer explain time trends in cardiovascular mortality and its socioeconomic differences

Harald, K., Koskinen, S., Jousilahti, P., Torppa, J., Vartiainen, E. and Salomaa, V.

J Epidemiol Community Health. 2008; 62(3): 251-7. IF 2.805

AIM: To investigate to what extent the changes in traditional risk factors (total cholesterol, smoking, hypertension) explain the changes in socioeconomic (defined by occupational class and household income) differences in cardiovascular mortality in Finland during the past 20 years. DESIGN: Study population comprised 14,642 men and women aged 35-64 years who were selected from population-based FINRISK surveys in 1987, 1992, 1997 or 2002 in three areas of Finland. The 1982 and 1987 FINRISK cohorts were used to determine a model for the probability of cardiovascular death based on risk factor values at the baseline for each socioeconomic group. These predicted changes in cardiovascular mortality were then contrasted with observed mortality rates in different socioeconomic groups to determine the contribution of the changes in risk factors to changes in actual mortality. RESULTS: We found that among men during 1987-97, when risk factor levels were improving in all socioeconomic groups, the model explained 29-44% of the observed mortality decline. The risk factors explained a larger part of the decline among lower socioeconomic groups. During the period 1997-2002 the risk factor levels stopped improving in all socioeconomic groups but observed mortality rates kept declining. The predicted mortality rates were 16-34% of the observed rates during the period 1987-2002. CONCLUSIONS: Changes in traditional risk factors no longer provide a good explanation of the changes in cardiovascular mortality and its socioeconomic differences. However, risk factors did explain the cardiovascular mortality decline among lower socioeconomic groups.

L ongitudinal study of relationships between adolescents' smoking and school achievement among secondary school students in Finland

Haukkala, A. and Vartiainen, E.

European Journal of Public Health. 2007; 17: 216-216. Meeting Abstract. IF 1.481

Indoor-outdoor relationships of particle number and mass in four European cities

Hoek, G., Kos, G., Harrison, R., de Hartog, J., Meliefste, K., ten Brink, H., Katsouyanni, K., Karakatsani, A., Lianou, M., Kotronarou, A., Kavouras, I., Pekkanen, J., Vallius, M., Kulmala, M., Puustinen, A., Thomas, S., Meddings, C., Ayres, J., van Wijnen, J. and Hameri, K.

Atmospheric Environment. 2008; 42(1): 156-169. Article. IF 2.630

The number of ultrafine particles in urban air may be more health relevant than the usually measured mass of particles smaller than 2.5 or 10 mu m. Epidemiological studies typically assess exposure by measurements at a central site. Limited information is available about how well measurements at a central site reflect exposure to ultrafine particles. The goals of this paper are to assess the relationships between particle number (PN) and mass concentrations measured outdoors at a central site, right outside and inside the study homes. The study was conducted in four European cities: Amsterdam, Athens, Birmingham and Helsinki. Particle mass (PM10 and PM2.5), PN, soot and sulfate concentrations were measured at these sites. Measurements of indoors and outdoors near the home were made during 1 week in 152, mostly non-smoking, homes. In each city continuous measurements were also performed at a central site during the entire study period. The correlation between 24-h average central site outdoor and indoor concentrations was lower for PN (correlation among cities ranged from 0.18 to 0.45) than for PM2.5 (0.40-0.80), soot (0.64-0.92) and sulfate (0.91-0.99). In Athens, the indoor-central site correlation was similar for PN and PM2.5. Infiltration factors for PN and PM2.5 were lower than for sulfate and soot. Night-time hourly average PN concentrations showed higher correlations between indoor and central site, implying that indoor sources explained part of the low correlation found for 24-h average concentrations. Measurements at a central site may characterize indoor exposure to ambient particles less well for ultrafine particles than for fine particle mass, soot and sulfate. (C) 2007 Elsevier Ltd. All rights reserved.

Long-Term Outcome of Major Depressive Disorder in Psychiatric Patients Is Variable

Holma, K. M., Holma, I. A., Melartin, T. K., Rytsala, H. J. and Isometsa, E. T.

J Clin Psychiatry. 2008: e1-e10. IF 5.533

OBJECTIVE: The prevailing view of outcome of major depressive disorder (MDD), based on mostly inpatient cohorts sampled from tertiary centers, emphasizes chronicity and frequent recurrences. We investigated the long-term outcome of a regionally representative psychiatric MDD cohort comprising mainly outpatients. METHOD: The Vantaa Depression Study included 163 patients with DSM-IV MDD (71.5% of those eligible) diagnosed using structured and semistructured interviews and followed up at 6 months, 18 months, and 5 years with a life chart between February 1, 1997, and April 30, 2004. The effects of comorbid disorders and other predictors on outcome were comprehensively investigated. RESULTS: Over the 5-year follow-up, 98.8% of patients achieved a symptom state below major depressive episode (MDE) criteria, and 88.4% reached full remission, with the median time to full remission being 11.0 months. Nearly one third (29.3%) had no recurrences, whereas 30.0% experienced 1, 12.9% experienced 2, and 27.9% experienced 3 or more recurrences. Preceding dysthymic disorder (p = .028), cluster C personality disorder (p = .041), and longer MDE duration prior to entry (p = .011) were the most significant predictors of longer time in achieving full remission. Severity of MDD and comorbidity, especially social phobia, predicted probability of, shorter time to, and number of recurrences. CONCLUSION: Previous literature on mostly inpatient MDD may have, by generalizing from patients with the most severe psychopathology, overemphasized chronicity of MDD. The long-term outcome of MDD in psychiatric care is variable, with about one tenth of patients having poor, one third having intermediate, and one half having favorable outcomes. In addition to known predictors, cluster C personality disorders and social phobia warrant further attention as predictors of MDD outcome among outpatients.

Cost-effectiveness of strategies to prevent perinatal streptococcal infection in Finland in 2006

Hovil, S. L., Lyytikainen, O., Autti-Ramo, I., Salonen, R. and Makela, M.

European Journal of Public Health. 2007; 17: 32-32. Meeting Abstract. IF 1.481

Waist to hip ratio as a supplement to body mass index - Reply

Hu, G., Tuomilehto, J., Silventoinen, K. and Jousilahti, P.

Archives of Internal Medicine. 2008; 168(2): 238-238. Letter. IF 7.920

Adolescent risk factors for hazardous alcohol use at age 32 years: a 16-year follow-up study of Finnish adolescents

Huurre, T., Lintonen, T., Pelkonen, M., Marttunen, M. and Aro, H.

European Journal of Public Health. 2007; 17: 222-223. Meeting Abstract. IF 1.481

Predictors for switch from major depressive disorder to bipolar type I or II disorders: A 5-year prospective study

Isometsa, E. T., Holma, K. M., Melartin, T. K. and Holma, I.

Bipolar Disorders. 2008; 10: 9-9. Meeting Abstract. IF 3.494

A population-specific diabetogenic haplotype HLA-A2,Cw1,B56,DR4,DQ8 is associated with high birthweight in Finnish diabetic families

Jarvinen, T. M., Harjutsalo, V., Kinnunen, L., Miettinen, M. E., Tuomilehto-Wolf, E. and Tuomilehto, J.

Genes Immun. 2008. IF 4.533

Children with type 1 diabetes (T1D) susceptibility HLA genotypes are shown to have an increased birthweight. We investigated to what extent T1D-predisposing HLA haplotypes were associated with increased birthweight. A total of 1255 Finnish children comprising those with T1D and their non-diabetic siblings were investigated. A total of 342 children and their non-diabetic parents were HLA genotyped. Birthweight data were obtained from the national Medical Birth Registry. The population-specific diabetogenic haplotype HLA-A2,Cw1,B56,DR4,DQ8 was associated with high birthweight (P=0.0280) in families with a diabetic offspring. Other T1D-predisposing HLA haplotypes showed nonsignificant tendency with high birthweight. More infants with a birthweight >/=4000 g were born in families with a T1D offspring than in the general Finnish population (P=0.0139). The previously observed direct association between birthweight and T1D risk may be mediated through the modulating effects that T1D susceptibility HLA genes have on weight. High birthweight and subsequent weight gain may accelerate the ongoing pancreatic autoimmune process in genetically susceptible individuals. The high proportion of infants having a birthweight >/=4000 g in families with a diabetic offspring raises a concern of potential adverse health outcomes that high birthweight can have.Genes and Immunity advance online publication, 14 February 2008; doi:10.1038/gene.2008.3.

EuroGentest: DNA-based testing for heritable disorders in Europe

Javahera, P., Kaariainen, H., Kristoffersson, U., Nippert, I., Sequeiros, J., Zirnmern, R. and Schmidtke, J.

Community Genetics. 2008; 11(2): 75-120. Article. IF 0.984

Objectives: Regarding the recent attention to develop policies regarding the provision of clinical genetic testing services, access to, acceptance, utilisation and regulation of genetic services was investigated in selected European countries as well as one non-European country. Methods: Data were collected on the basis of relevant international reports and sources accessible via the internet, from self-designed, internationally administered surveys and with the help of a panel of experts from European countries participating in several workshops as well as from National European Societies of Human Genetics. Results: A selection of divergent health care systems was reviewed and compared (e.g. Finland, Germany, Portugal, Sweden, UK, France, Italy, Spain, Czech Republic, Lithuania and Serbia/Montenegro). For the evaluation of clinical validity and utility of genetic testing, background information was provided focussing on DNA-based testing for heritable disorders with a strong genetic component (usually due to the action of a single gene). Conclusions: There is great heterogeneity in genetic testing services among the countries surveyed. It is premature to mandate that genetic testing provided by clinical services meets professional standards regarding clinical validity and utility, because there is to date no consensus within the scientific community and among health care providers to what extent clinical validity and utility can and need to be assessed. Points to consider in the process of developing such standards are proposed. Copyright (c) 2008 S. Karger AG, Basel.

The contribution of physical and psychosocial working conditions on socioeconomic inequalities in health

Kaikkonen, R., Rahkonen, O., Lallukka, T. and Lahelma, E.

European Journal of Public Health. 2007; 17: 85-85. Meeting Abstract. IF 1.481

Growth before 2 years of age and serum lipids 60 years later: the Helsinki Birth Cohort Study

Kajantie, E., Barker, D. J., Osmond, C., Forsen, T. and Eriksson, J. G.

Int J Epidemiol. 2008. IF 4.517

Background Small body size at birth and slow growth during the first 2 years after birth, leading to low body mass index (BMI) at 2 years, are associated with coronary heart disease and stroke in adult life. We tested the hypothesis that this path of growth is associated with an atherogenic lipid profile in later life. Methods We measured serum lipid concentrations at age 57-70 years in 1999 members of the Helsinki Birth Cohort. They were randomly selected from an original cohort of 8760 people and had on average 11 measurements of height and weight between birth and 2 years of age. Results The 18% of subjects who used lipid-lowering medication had a lower BMI at birth and at 2 years. These subjects were excluded from the analyses of lipid profiles. A 1 kg/m(2) lower BMI at birth was associated with 0.051 mmol/l (95% CI -0.001 to 0.103; P = 0.05) higher non-HDL cholesterol and 0.018 g/l higher (0.005-0.031; P = 0.006) apolipoprotein B concentrations. A slower increase in BMI during the first 6 months after birth was associated with lower HDL and higher non-HDL cholesterol concentrations. A 1 kg/m(2) lower BMI at 2 years was associated with 0.020 mmol/l lower (0.004-0.036; P = 0.02) HDL cholesterol and 0.059 mmol/l (0.020-0.099; P = 0.003) higher non-HDL cholesterol and 0.018 mmol/l higher (0.008-0.028; P < 0.001) apolipoprotein B concentrations. The age at weaning off breast milk was not associated with lipid profile in later life. Conclusion Small body size at birth and slow weight gain during infancy are associated with an atherogenic lipid profile in adult life.

Functional disabilities do not prevent the elderly in Finland from eating regular meals

Kallio, M. K., Koskinen, S. V. and Prattala, R. S.

Appetite. 2007. IF 1.727

The aim of this study was to depict the prevalence of different meal patterns of the elderly in Finland and to analyse the role of socio-demographic factors, functional capacity and help received as the determinants of following a conventional meal pattern. A nationally representative sample of elderly people aged 65 years and over and living at home (n=1697) in 2000-2001 was obtained. A structured (personal) interview was used for data collection. Regular hot meals are common among the elderly. Functional disability affecting the carrying out of food-related activities does not have an independent effect on the regularity of meals. The conventional meal pattern, which consists of breakfast, a hot lunch and a hot dinner, is more seldom followed by the elderly who have a low socio-economic status than by those whose educational level and monthly income are higher. The help received in carrying out food-related activities contributes to the ability to maintain a conventional meal pattern. In order to allow elderly people to live independently at home for as long as possible, special attention should be paid to the problems regarding meals in the lower socio-economic groups.

Six new loci associated with blood low-density lipoprotein cholesterol, high-density lipoprotein cholesterol or triglycerides in humans

Kathiresan, S., Melander, O., Guiducci, C., Surti, A., Burtt, N. P., Rieder, M. J., Cooper, G. M., Roos, C., Voight, B. F., Havulinna, A. S., Wahlstrand, B., Hedner, T., Corella, D., Tai, E. S., Ordovas, J. M., Berglund, G., Vartiainen, E., Jousilahti, P., Hedblad, B., Taskinen, M. R., Newton-Cheh, C., Salomaa, V., Peltonen, L., Groop, L., Altshuler, D. M. and Orho-Melander, M.

Nature Genetics. 2008; 40(2): 189-197. Article. IF 24.176

Blood concentrations of lipoproteins and lipids are heritable(1) risk factors for cardiovascular disease(2,3). Using genome-wide association data from three studies (n = 8,816 that included 2,758 individuals from the Diabetes Genetics Initiative specific to the current paper as well as 1,874 individuals from the FUSION study of type 2 diabetes and 4,184 individuals from the SardiNIA study of aging-associated variables reported in a companion paper in this issue(4)) and targeted replication association analyses in up to 18,554 independent participants, we show that common SNPs at 18 loci are reproducibly associated with concentrations of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and/or triglycerides. Six of these loci are new (P < 5 x 10(-8) for each new locus). Of the six newly identified chromosomal regions, two were associated with LDL cholesterol (1p13 near CELSR2, PSRC1 and SORT1 and 19p13 near CILP2 and PBX4), one with HDL cholesterol (1q42 in GALNT2) and five with triglycerides (7q11 near TBL2 and MLXIPL, 8q24 near TRIB1, 1q42 in GALNT2, 19p13 near CILP2 and PBX4 and 1p31 near ANGPTL3). At 1p13, the LDL-associated SNP was also strongly correlated with CELSR2, PSRC1, and SORT1 transcript levels in human liver, and a proxy for this SNP was recently shown to affect risk for coronary artery disease(5). Understanding the molecular, cellular and clinical consequences of the newly identified loci may inform therapy and clinical care.

Childhood and current determinants of heavy drinking in early adulthood

Kestila, L., Martelin, T., Rahkonen, O., Joutsenniemi, K., Pirkola, S., Poikolainen, K. and Koskinen, S.

European Journal of Public Health. 2007; 17: 214-214. Meeting Abstract. IF 1.481

Psychological well-being and psychosocial resources among chronically ill young Finnish adults

Kiviruusu, O., Huurre, T. and Aro, H.

European Journal of Public Health. 2007; 17: 221-221. Meeting Abstract. IF 1.481

Reproductive health in general health surveys

Koponen, P., Luoto, R., Hakulinen, K. and Aromaa, A.

European Journal of Public Health. 2007; 17: 182-182. Meeting Abstract. IF 1.481

Sleep quality and life satisfaction: testing alternative causal hypotheses among Finnish twins

Korhonen, T., Paunio, T., Hublin, C., Partinen, M., Kivimaki, M., Koskenvuo, M. and Kaprio, J.

European Journal of Public Health. 2007; 17: 163-163. Meeting Abstract. IF 1.481

Association Analysis of Allelic Variants of USF1 in Coronary Atherosclerosis

Kristiansson, K., Ilveskoski, E., Lehtimaki, T., Peltonen, L., Perola, M. and Karhunen, P. J.

Arterioscler Thromb Vasc Biol. 2008. IF 6.883

OBJECTIVE: USF1 regulates the transcription of more than 40 cardiovascular related genes and is well established as a gene associated with familial combined hyperlipidemia, a condition increasing the risk for coronary heart disease. No detailed data, however, exists on the impact of this gene to the critical outcome at the tissue level: different types of atherosclerotic lesions. METHODS AND RESULTS: We analyzed the USF1 in 2 autopsy series of altogether 700 middle-aged men (the Helsinki Sudden Death Study) with quantitative morphometric measurements of coronary atherosclerosis. SNP rs2516839, tagging common USF1 haplotypes, associated with the presence of several types of atherosclerotic lesions, particularly with the proportion of advanced atherosclerotic plaques (P=0.02) and area of calcified lesions (P<0.001) of the coronary arteries. Importantly, carriers of risk alleles of rs2516839 also showed a 2-fold risk for sudden cardiac death (genotype TT versus CC; OR 2.10, 95% CI 1.17 to 3.75, P=0.04). The risk effect of rs2516839 was present also in aorta samples of the men. CONCLUSIONS: Our findings in this unique study sample suggest that USF1 contributes to atherosclerosis, the pathological arterial wall phenotype resulting in coronary heart disease and in its most dramatic consequence-sudden cardiac death.

Trends in self-reported sleep duration and insomnia-related symptoms in Finland from 1972 to 2005: a comparative review and re-analysis of Finnish population samples

Kronholm, E., Partonen, T., Laatikainen, T., Peltonen, M., Harma, M., Hublin, C., Kaprio, J., Aro, A. R., Partinen, M., Fogelholm, M., Valve, R., Vahtera, J., Oksanen, T., Kivimaki, M., Koskenvuo, M. and Sutela, H.

J Sleep Res. 2008; 17(1): 54-62. IF 3.458

A hypothesis concerning habitual sleep reduction and its adverse consequences among general population in modern societies has received wide publicity in the mass media, although scientific evidence supporting the hypothesis is scarce. Similarly, there is an extensively distributed belief, at least in Finland, that the prevalence of insomnia-related symptoms is increasing, but evidence for this is even sparser. These issues are important because of the known increased risk of mortality and health risks associated with sleep duration deviating from 7 to 8 h. To reveal possible trends in self-reported sleep duration and insomnia-related symptoms, we reanalyzed all available data from surveys carried out in Finland from 1972 to 2005. The main results were that a minor decrease of self-reported sleep duration has taken place in Finland, especially among working aged men. However, the size of the reduction (about 4%) was relatively small, approximately 5.5 min per each 10 years during the 33 years' time interval under study. The proportion of 7 h sleepers has increased and, correspondingly, the proportion of 8 h sleepers has decreased, but the extreme ends of the sleep duration distribution remained unchanged. Tentative evidence suggesting an increase in insomnia-related symptoms among working aged population during the last 10 years was found. In conclusion, the Finnish data during the past 33 years indicate a general decrease in self-reported sleep duration of about 18 min and an increase of sleep complaints, especially among the employed middle-aged population.

Sindbis virus infection in resident birds, migratory birds, and humans, Finland

Kurkela, S., Ratti, O., Huhtamo, E., Uzcategui, N. Y., Nuorti, J. P., Laakkonen, J., Manni, T., Helle, P., Vaheri, A. and Vapalahti, O.

Emerg Infect Dis. 2008; 14(1): 41-7. IF 5.094

Sindbis virus (SINV), a mosquito-borne virus that causes rash and arthritis, has been causing outbreaks in humans every seventh year in northern Europe. To gain a better understanding of SINV epidemiology in Finland, we searched for SINV antibodies in 621 resident grouse, whose population declines have coincided with human SINV outbreaks, and in 836 migratory birds. We used hemagglutination-inhibition and neutralization tests for the bird samples and enzyme immunoassays and hemagglutination-inhibition for the human samples. SINV antibodies were first found in 3 birds (red-backed shrike, robin, song thrush) during their spring migration to northern Europe. Of the grouse, 27.4% were seropositive in 2003 (1 year after a human outbreak), but only 1.4% were seropositive in 2004. Among 2,529 persons, the age-standardized seroprevalence (1999-2003) was 5.2%; seroprevalence and incidence (1995-2003) were highest in North Karelia (eastern Finland). Grouse may contribute to the epidemiology of SINV in humans.

Sub-chronic nandrolone treatment modifies neurochemical and behavioral effects of amphetamine and 3,4-methylenedioxymethamphetamine (MDMA) in rats

Kurling, S., Kankaanpaa, A. and Seppala, T.

Behav Brain Res. 2008. IF 14.964

Misuse of anabolic-androgenic steroids (AASs) is increasing, and appears to have much in common with the use of substances known to induce drug dependence. Moreover, persons who abuse AASs also tend to abuse other psychotropic drugs such as amphetamine or 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy"). The aim of this study was to investigate whether nandrolone (5x5 or 5x20mg/kg) pre-exposure modulates the acute neurochemical and behavioral effects of amphetamine (1mg/kg) and MDMA (5mg/kg) in rats. Dopamine (DA), 5-hydroxytryptamine (5-HT) and their metabolites were measured from samples collected from the nucleus accumbens (NAc) by in vivo microdialysis. The behavior of the animals was recorded on videotapes, from which it was later rated. Our results demonstrate that sub-chronic treatments with supraphysiological doses of nandrolone attenuate dose-dependently the increase in extracellular DA concentration evoked by amphetamine or MDMA. The lower dose of nandrolone attenuated MDMA-induced increase in 5-HT-levels, while the higher dose potentiated it. Analysis of the behavioral data suggests that effects of the amphetamine and MDMA are dose-dependently attenuated by AAS-treatment, paralleling DA results. In conclusion, the results of this study show that AAS-pre-treatment is able to modulate the reward-related neurochemical and behavioral effects of amphetamine and MDMA.

Feasibility of health examination surveys in Europe

Kuulasmaa, K., Aromaa, A., Koponen, P., Kulmala, I., Conti, S., Graff-Iversen, S., Verschuren, M. and Primatesta, P.

European Journal of Public Health. 2007; 17: 46-46. Meeting Abstract. IF 1.481

Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60000 men and women over 23 years

Laaksonen, M., Talala, K., Martelin, T., Rahkonen, O., Roos, E., Helakorpi, S., Laatikainen, T. and Prattala, R.

European Journal of Public Health. 2008; 18(1): 38-43. Article. IF 1.481

Background: Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical avtivity, can account for relative differences in cardiovascular and all-cause mortality by educational level. Methods: Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29065 men and 31543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied. Results: Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small. Conclusions: Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.

Severe Streptococcus pyogenes Infections, United Kingdom, 2003-2004

Lamagni, T. L., Neal, S., Keshishian, C., Alhaddad, N., George, R., Duckworth, G., Vuopio-Varkila, J. and Efstratiou, A.

Emerg Infect Dis. 2008; 14(2): 201-9. IF 5.094

The Centers for Disease Control and Prevention is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The Centers for Disease Control and Prevention designates this educational activity for a maximum of 1 AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. This activity for 1 contact hour is provided by the Centers for Disease Control and Prevention, which is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditations. The Centers for Disease Control and Prevention is a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is a designated event for the CHES to receive 1 Category I contact hour in health education, CDC provider number GA0082 CDC has been reviewed and approved as an Authorized Provider by the International Association for Continuing Education and Training (IACET), 8405 Greensboro Drive, Suite 800, McLean, VA 22102, USA. CDC has awarded 0.1 of CEUs to participants who successfully complete this program. CDC, our planners, and our presenters wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters with the exception of Dr. George, and he wishes to disclose that he has received honorarium as a speaker for GlaxoSmithKline. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use. Origination Date: January 14, 2008, Expiration Date: January 14, 2011.

Stress-induced expression of a novel variant of human fumarate hydratase (FH)

Lehtonen, H. J., Ylisaukko-Oja, S. K., Kiuru, M., Karhu, A., Lehtonen, R., Vanharanta, S., Jalanko, A., Aaltonen, L. A. and Launonen, V.

Gene Expression. 2007; 14(2): 59-69. Article. IF 1.156

Fumarate hydratase (FH) is an enzyme of the mitochondrial tricarboxylic acid cycle (TCAC). Here we report the characterization of a novel FH variant (FHv) that contains an alternative exon 1b, thus lacking the mitochondrial signal sequence. Distinct from mitochondrial FH, FHv localized to cytosol and nucleus and lacked FH enzyme activity. FHv was expressed ubiquitously in human fetal and adult tissues. Heat shock and prolonged hypoxia increased FHv expression in a cell line (HTB115) by nine- and fourfold, respectively. These results suggest that FHv has an alternative function outside the TCAC related to cellular stress response.

Work against HIV/AIDS epidemic in the Northern Dimension area

Leinikki, P., Karvonen, O. and Milen, A.

European Journal of Public Health. 2007; 17: 69-69. Meeting Abstract. IF 1.481

Finnish guidelines for workplace drug testing

Lillsunde, P., Haavanlammi, K., Partinen, R., Mukala, K. and Lamberg, M.

Forensic Sci Int. 2008; 174(2-3): 99-102. IF 1.397

The Finnish guidelines for workplace drug testing outlined here represent what is considered the best practice for workplace drug testing to be followed in Finland. The guidelines are based on the act on the protection of privacy in working life (759/2004), the occupational health care act (1383/2001) and the decree on workplace drug testing (218/2005). They start by defining situations in which workplace testing is allowed and continue up to the point where the certificate is submitted to the employer. The role of the occupational health care system is crucial in the procedure. The guidelines include the best practice procedures to be followed by laboratories providing workplace drug testing services. The laboratory recommendations are based on general principles established internationally. In the Finnish guidelines, accreditation is an absolute prerequisite for a laboratory functioning as a workplace drug testing laboratory. The laboratory section of the guidelines includes specimen collection, laboratory organisation, analysis procedure, quality assurance and quality control measures. These largely conform to the European laboratory guidelines for legally defensible workplace drug testing published by the European workplace drug testing society (EWDTS), but there are differences. In addition to using urine as a specimen, the Finnish guidelines also encompass blood.

Role of occupational health services in workplace drug testing

Lillsunde, P., Mukala, K., Partinen, R. and Lamberg, M.

Forensic Sci Int. 2008; 174(2-3): 103-6. IF 1.397

In Finland, workplace drug testing is mainly performed in accordance with the Act on the Protection of Privacy in Working Life (759/2004), (http://www.finlex.fi/en/laki/kaannokset/2004/20040759) [1], the Occupational Health Care Act (1383/2001), (http://www.finlex.fi/en/laki/kaannokset/2001/20011383) [2] and the Decree on Workplace Drug Testing (218/2005) [3]. The role of occupational health services is stated in the Occupational Health Care Act. All workplace drug tests are carried out by health services according to good occupational health care practice. A referral for a drug test is given by a physician or a nurse working in health care services. When giving the referral, the physician or nurse should inform the person to be tested of the purpose and content of the test, record any medication they may be using, and make sure they are aware that they can later dispute the result of the test. The identity of the person should be checked before taking a sample. The analysis laboratory sends the result of the drug test to the health care service unit that has given the referral. If the test result is positive, the laboratory gives a detailed analysis of the test result. The health care service personnel provide the testee with the result. If it is negative, it may be given by a nurse. When the test result is positive, a Medical Review Officer (MRO) should interpret the answer and evaluate whether the positive result is due to medication, or another reasonable explanation offered by the person tested. The MRO informs the person of the options of rehabilitation treatment available to drug abusers stated in the written drug testing policy/programme of the employer/company. The testee takes the test result report to his/her employer personally.

Determinants for the effectiveness of lifestyle intervention in the Finnish Diabetes Prevention Study

Lindstrom, J., Peltonen, M., Eriksson, J. G., Aunola, S., Hamalainen, H., Ilanne-Parikka, P., Keinanen-Kiukaanniemi, S., Uusitupa, M. and Tuomilehto, J.

Diabetes Care. 2008. IF 7.912

Objective: Intensive lifestyle intervention reduced significantly diabetes incidence among the participants of the Finnish Diabetes Prevention Study. We investigated whether and to what extent risk factors for type 2 diabetes and other baseline characteristics of the study participants modified the effectiveness of the lifestyle intervention. Research Design and Methods: Overweight, middle-aged volunteers with impaired glucose tolerance were randomized to intensive lifestyle intervention (n=265) or control group (n=257) for a median of 4 years. Diabetes status was ascertained annually with repeated oral glucose tolerance testing. Incidence rates of diabetes and hazard ratios (HR) comparing the intervention group with the control group were calculated by sex and baseline tertiles of age, BMI, waist circumference, plasma glucose concentration at fasting and 2 hours after a glucose load, fasting serum insulin and insulin resistance index, and categories of composite baseline Finnish Diabetes Risk Score (FINDRISC). Interactions between the intervention assignment and baseline risk factors on diabetes risk were analyzed. Results: The intervention was most effective among the oldest individuals (HRs 0.77, 0.49, and 0.36 by increasing age tertiles, respectively; p for interaction = 0.0130) and those with a high baseline FINDRISC (HRs 1.09, 0.84, 0.34, and 0.22 by increasing risk score category, respectively; p for interaction = 0.0400). The effect of the intervention on diabetes risk was not modified by other baseline characteristics or risk factors. Conclusions: The FINDRISC may be useful in identifying high risk groups most likely to benefit from intensive lifestyle intervention to prevent type 2 diabetes.

Personality characteristics of research volunteers

Lonnqvist, J. E., Paunonen, S., Verkasalo, M., Leikas, S., Tuulio-Henriksson, A. and Lonnqvist, J.

European Journal of Personality. 2007; 21(8): 1017-1030. Article. IF 1.864

We evaluated Big Five personality factor differences between research volunteers and nonvolunteers. In the first study, 158 military officers were asked to participate in a mail survey. The personality scores of the officers were available from an archival data set. In our second study, adult siblings from large families were invited to participate in extensive clinical epidemiological evaluations. The personality scores of volunteers (N = 55) and nonvolunteers from the same families (N = 29) were estimated from sibling ratings made by those who participated in the study. In both studies, respondents, compared to nonrespondents, were found to be significantly lower in Neuroticism and higher in Conscientiousness. The second study further indicated respondents as being higher in Extraversion and Agreeableness. Copyright (C) 2007 John Wiley & Sons, Ltd.

Community action on Adolescents and Injury risk (AdRisk)

Lowe, U., Mensunza, M., Benyi, M., Paavola, M. and Meijer, C.

European Journal of Public Health. 2007; 17: 201-201. Meeting Abstract. IF 1.481

Deficiency of the INCL protein Ppt1 (palmitoyl protein thioesterase 1) results in changes in ectopic F1-ATP synthase and altered cholesterol metabolism

Lyly, A., Marjavaara, S. K., Kyttala, A., Uusi-Rauva, K., Luiro, K., Kopra, O., Martinez, L. O., Tanhuanpaa, K., Kalkkinen, N., Suomalainen, A., Jauhiainen, M. and Jalanko, A.

Hum Mol Genet. 2008. IF 8.099

Infantile neuronal ceroid lipofuscinosis (INCL) is a severe neurodegenerative disease caused by deficiency of palmitoyl protein thioesterase 1 (PPT1). INCL results in dramatic loss of thalamocortical neurons, but the disease mechanism has remained elusive. In the present work we describe the first interaction partner of PPT1, the F(1)-complex of the mitochondrial ATP synthase, by co-purification and in vitro-binding assays. In addition to mitochondria, subunits of F(1)-complex have been reported to localize in the plasma membrane, and to be capable of acting as receptors for various ligands such as apolipoprotein A-1. We verified here the plasma membrane localization of F(1)-subunits on mouse primary neurons and fibroblasts by cell surface biotinylation and TIRF-microscopy. To gain further insight into the Ppt1-mediated properties of the F(1)-complex, we utilized the Ppt1-deficient Ppt1(Deltaex4) mice. While no changes in the mitochondrial function could be detected in the brain of the Ppt1(Deltaex4) mice, the levels of F(1)-subunits alpha and beta on the plasma membrane were specifically increased in the Ppt1(Deltaex4) neurons. Significant changes were also detected in the apolipoprotein A-I uptake by the Ppt1(Deltaex4) neurons and the serum lipid composition in the Ppt1(Deltaex4) mice. These data indicate neuron-specific changes for F(1)-complex in the Ppt1-deficient cells and give clues for a possible link between lipid metabolism and neurodegeneration in INCL.

Chlamydia trachomatis seroprevalence atlas of Finland 1983-2003

Lyytikainen, E., Kaasila, M., Koskela, P., Lehtinen, M., Patama, T., Pukkala, E., Tasanen, K., Surcel, H. M. and Paavonen, J.

Sexually Transmitted Infections. 2007; 84(1): 19-22. Article. IF 3.395

Objectives: To study Chlamydia trachomatis seroprevalence trends and geographical distribution over time in Finland. Materials and methods: First pregnancy serum samples were retrieved from the Finnish Maternity Cohort serum bank for the subcohort of 8000 women stratified by calendar years (1983-1989, 1990-1996, 1997-2003) and age at time of sample withdrawal (14-22 and 23-28 years). C trachomatis antibodies were determined using standard major outer membrane protein peptide ELISA. The spatiotemporal variation of C trachomatis seroprevalence rates was visualised by a series of maps. Results: A decreasing C trachomatis seroprevalence trend from 1983 to 2003 was seen for both women under 23 years of age (20.8% to 10.6%) and 23-28-year-old women (19.1% to 12.5%). Constant clusters were seen around the largest cities and in eastern Finland although seroprevalence rates were generally decreasing throughout the country. Conclusions: Only a few population-based serological studies have been undertaken on C trachomatis epidemiology over time. In Finland the seroprevalence of C trachomatis is decreasing all over the country, albeit with small clusters remaining.

Population-based register of acute myocardial infarction: manual of operations

Madsen, M., Gudnason, V., Pajak, A., Palmieri, L., Rocha, E. C., Salomaa, V., Sans, S., Steinbach, K. and Vanuzzo, D.

European Journal of Cardiovascular Prevention & Rehabilitation. 2007; 14: S3-S22. Article. IF 1.979

Cardiovascular disease is the leading cause of death and hospitalization in both sexes in nearly all countries of Europe. The main forms of cardiovascular disease are ischaemic heart disease and stroke. The magnitude of the problem contrasts with the shortage, weak quality and comparability of data available in most European countries. Innovations in medical, invasive and biological treatments have substantially contributed to the escalating costs of health services. It is therefore urgent to obtain reliable information on the magnitude and distribution of the disease for both adequate health planning (including preventive strategies) and clinical decision making with correct cost-benefit assessments. A stepwise surveillance procedure based on standardized data collection, appropriate record linkage and validation methods was set up by the EUROCISS Project (EUROpean Cardiovascular Indicators Surveillance Set) to build up comparable and reliable indicators (attack rate and case fatality) for the surveillance of acute myocardial infarction/acute coronary syndrome at population level. This manual of operations is intended for health professionals and policy makers and provides a standardized and simple model for the implementation of a population-based register. It recommends to start from a minimum data set and then follow a stepwise procedure. Before implementing a population-based register, it is important to identify the target population under surveillance which should preferably cover a well-defined geographical and administrative area or region representative of the whole country for which population data and vital statistics (mortality and hospital discharge records at minimum) are routinely collected and easily available each year. All cases among residents should be recorded even if the case occurs outside the area. Validation of a sample of fatal and nonfatal events is mandatory. Eur J Cardiovasc Prev Rehabil 14 (Suppl 3):S3-S22 (c) 2007 The European Society of Cardiology

Twenty-five year socioeconomic trends in leisure-time and commuting physical activity among employed Finns

Makinen, T., Borodulin, K., Laatikainen, T., Fogelholm, M. and Prattala, R.

Scand J Med Sci Sports. 2008.

The trend of socioeconomic differences in physical activity is largely unknown in Finland. In this study, we examined socioeconomic trends in leisure-time and commuting physical activity among Finns in 1978-2002. Nationwide data were derived from an annually repeated cross-sectional Finnish Adult Health Behavior Survey. People under the age of 25, students, the unemployed, and retirees were excluded from the analysis. The final data set included 25 513 women and 25 302 men. Socioeconomic variables included education, occupation, and household income. Odds ratios for being physically active and 95% confidence intervals were calculated. People with the lowest income were less leisure-time and commuting physically active. Among women, low occupational status was associated with high commuting physical activity whereas among men such an association was not found. No educational differences among men in leisure-time and commuting physical activity over time were found. Some indications were found that educational differences in leisure-time physical activity among women might have been reversed. Our data suggest that socioeconomic differences in leisure-time and commuting physical activity are quite small and have remained similar between 1978 and 2002.

Educational differences in leisure time physical activity among adult Finns in 2000: the contribution of socio-economic and life-style factors

Makinen, T., Kestila, L., Borodulin, K., Martelin, T., Rahkonen, O. and Prattala, R.

European Journal of Public Health. 2007; 17: 205-205. Meeting Abstract. IF 1.481

The effect of freezing and long-term storage on serum thyrotropin, thyroid hormones and autoantibodies

Mannisto, T., Surcel, H., Bloigu, A., Ruokonen, A., Hartikainen, A. L., Jarvelin, M. R., Pouta, A., Vaarasmaki, M. and Suvanto-Luukkonen, E.

Hormone Research. 2007; 68: 43-43. Meeting Abstract. IF 1.385

Clinical predictors of unrecognized bipolar I and II disorders

Mantere, O., Suominen, K., Arvilommi, P., Valtonen, H., Leppamaki, S. and Isometsa, E.

Bipolar Disord. 2008; 10(2): 238-44. IF 3.494

Objectives: Bipolar disorder (BD) is correctly diagnosed in only 40-50% of patients. No previous study has investigated the characteristics of bipolar patients in psychiatric care with or without clinical diagnoses of BD. We investigated the demographic and clinical predictors of the absence of a clinical diagnosis of BD I and II among psychiatric patients. Methods: In the Jorvi Bipolar Study, 1,630 psychiatric in- and outpatients were screened with the Mood Disorder Questionnaire. Suspected cases were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient version (SCID-I/P) for BD. Patients with no preceding clinical diagnosis of BD, despite previous manic, hypomanic or mixed phases and treatment in psychiatric care, were classified as undiagnosed. The clinical characteristics of unrecognized BD I patients (23 of 90 BD I patients) and BD II patients (47 of 93 BD II patients) were compared to those of patients who had been correctly diagnosed. Results: No previous hospitalizations [odds ratio (OR) = 10.6, p = 0.001] or psychotic symptoms (OR = 4.4, p = 0.045), and the presence of rapid cycling (OR = 11.6, p = 0.001) predicted lack of BD I diagnosis. No psychotic symptoms (OR = 3.3, p = 0.01), female gender (OR = 3.0, p = 0.03), and shorter time in treatment (OR = 1.1, p = 0.03) predicted the lack of a BD II diagnosis. Conclusions: Correct diagnosis of BD I is related to the severe phases of illness leading to hospitalizations. In BD II, the illness factors may not be as important as time elapsed in treatment, a factor that often leads to a delay in diagnosis or none at all. Excessive reliance on typical and cross-sectional presentations of illness likely explain the non-recognition of BD. The challenge for correctly diagnosing bipolar patients is in outpatient settings.

The effects of migration on the relationship between area socioeconomic structure and mortality

Martikainen, P., Sipila, P., Blomgren, J. and van Lenthe, F. J.

Health & Place. 2008; 14(2): 361-366. Article. IF 1.828

We studied whether migration influences the relationship between area socioeconomic structure and mortality. We used data on Finns aged 25-64 that are linked to information on proportions of manual workers in 85 functional regions in 1987 and 1997, and on deaths in 1998-2004. Participants aged 25-44 moving to areas with a lower proportion of manual workers had lower mortality and those moving to areas with a higher proportion of manual workers had mortality similar to those residing in these areas at both time points. Among the 45-64-year-olds, all migrants between areas had increased mortality. However, because these mortality differences and the migratory flows were relatively small, their effects on area socioeconomic differences in mortality were also small. (C) 2007 Elsevier Ltd. All rights reserved.

Social contact and mixing patterns relevant to the spread of infectious diseases: a multi-country population-based survey

Mossong, J., Jit, M., Hens, N., Beutels, P., Auranen, K., Mikolajczyk, R., Massari, M., Scalia-Tomba, G. P., Wallinga, J., Sadkowska-Todys, M., Rosinska, M. and Edmunds, W. J.

European Journal of Public Health. 2007; 17: 57-58. Meeting Abstract. IF 1.481

Social capital as the determinant of self-rated health and psychological well-being

Nieminen, T., Martelin, T., Koskinen, S., Aro, H., Alanen, E. and Hyyppa, M. T.

European Journal of Public Health. 2007; 17: 229-229. Meeting Abstract. IF 1.481

Mutations in mRNA export mediator GLE1 result in a fetal motoneuron disease

Nousiainen, H. O., Kestila, M., Pakkasjarvi, N., Honkala, H., Kuure, S., Tallila, J., Vuopala, K., Ignatius, J., Herva, R. and Peltonen, L.

Nature Genetics. 2008; 40(2): 155-157. Article. IF 24.176

The most severe forms of motoneuron disease manifest in utero are characterized by marked atrophy of spinal cord motoneurons and fetal immobility. Here, we report that the defective gene underlying lethal motoneuron syndrome LCCS1 is the mRNA export mediator GLE1. Our finding of mutated GLE1 exposes a common pathway connecting the genes implicated in LCCS1, LCCS2 and LCCS3 and elucidates mRNA processing as a critical molecular mechanism in motoneuron development and maturation.

Social participation, trust and self-rated health: A study among ageing people in urban, semi-urban and rural settings

Nummela, O., Sulander, T., Rahkonen, O., Karisto, A. and Uutela, A.

Health & Place. 2008; 14(2): 243-253. Article. IF 1.828

This study examined associations between self-rated health and combinations of social participation and trust among ageing people in three living areas of Finland (N = 2815, 66% response rate). Social participation and trust combinations were: low social capital (low participation/low trust), traditionalism (low/high), "the miniaturisation of community" (high/ low) and high social capital (high/high). The highest rate of good self-rated health was found among the high social capital group, but after adjusting for background variables, statistical significance remained only in the urban area. High social capital measured at an individual level may thus promote health among ageing people. (C) 2007 Elsevier Ltd. All rights reserved.

The effect of social capital on health: The case of two language groups in Finland

Nyqvist, F., Finnas, F., Jakobsson, G. and Koskinen, S.

Health & Place. 2008; 14(2): 347-360. Article. IF 1.828

The aim of this study was to examine the association between individual-level social capital and two aspects of self-reported health-self-rated health and psychological health-in Finland. Data were taken from a nationwide survey conducted in year 2000/2001. Two language groups, the Swedish-speakers and the Finnish-speakers in Finland were used as examples to illustrate ethnic differences in social capital. Moreover, social capital was used to explore the reasons behind health inequalities between the language groups. The results of the study demonstrated a positive association between individual-level cognitive social capital and the health outcomes. We further found that Swedish-speakers possess more structural and cognitive social capital compared to Finnish-speakers. Social capital explains to some extent health differences between the language groups. The results indicate the importance of considering ethnic differences in social determinants of health. (C) 2007 Elsevier Ltd. All rights reserved.

Dietary habits of socio-economically disadvantaged adults in Finland

Ovaskainen, M. L. and Paturi, M.

European Journal of Public Health. 2007; 17: 172-172. Meeting Abstract. IF 1.481

Injuries among Finnish young men

Paavola, M., Kumpula, H., Lounamaa, A., Lunetta, P. and Impinen, A.

European Journal of Public Health. 2007; 17: 160-160. Meeting Abstract. IF 1.481

Enclophenotypes in schizophrenia: implications for diagnosis, treatment and etiological research

Paunio, T.

European Neuropsychopharmacology. 2007; 17: S221-S221. Meeting Abstract. IF 3.794

Labelling the salt content in foods is a useful tool in reducing sodium intake

Pietinen, P., Valsta, L. M., Hirvonen, T. and Sinkko, H.

European Journal of Public Health. 2007; 17: 17-17. Meeting Abstract. IF 1.481

Blame the patients or blame the politicians?

Puska, P.

International Journal of Public Health. 2007; 52(6): 331-332. Editorial Material.

Future challenges and solutions of health promotion

Puska, P.

European Journal of Public Health. 2007; 17: 6-6. Meeting Abstract. IF 1.481

National immunization program in Finland

Rapola, S.

Int J Circumpolar Health. 2007; 66(5): 382-9.

In the national immunization program, all Finnish children are vaccinated against 9 infectious diseases: diphtheria, tetanus, pertussis, polio, severe infections due to Haemophilus influenzae type b, measles, mumps, rubella and influenza. In addition, vaccination against tuberculosis, hepatitis A- and B-, influenza or tick-borne encephalitis are given to those at risk of contracting the diseases. More than 95% of children are vaccinated according the optimal schedule. Vaccine preventable diseases are rare in Finland. In Finland, all vaccines are imported. The decisions regarding the vaccination program are made by the Ministry of Social Affairs and Health. The National Public Health Institute is responsible for the control of the communicable diseases and the implementation of the vaccination program in practice. Evaluation of the implementation of new vaccines in the vaccination program is ongoing.

Eating habits of Finnish school children during school day

Raulio, S., Pietikainen, M. and Prattala, R.

European Journal of Public Health. 2007; 17: 103-103. Meeting Abstract. IF 1.481

Changes in alcohol consumption among Pitkarantas's adolescents in North-West of Russia in 1995 and 2004

Rogacheva, A., Laatikainen, T., Vartiainen, E. and Tossavainen, K.

European Journal of Public Health. 2007; 17: 143-144. Meeting Abstract. IF 1.481

Receptor stimulation overrides sympathetic vasoconstrictor activity in human skeletal muscle

Rosenmeier, J., Yegutkin, G. G. and Gonzalez-Alonso, J.

Circulation. 2007; 116(16): 159-159. Meeting Abstract. IF 10.940

Alcohol Consumption, Abstaining, Health Utility, and Quality of Life - A General Population Survey in Finland

Saarni, S. I., Joutsenniemi, K., Koskinen, S., Suvisaari, J., Pirkola, S., Sintonen, H., Poikolainen, K. and Lonnqvist, J.

Alcohol Alcohol. 2008. IF 2.061

AIMS: To examine the associations between alcohol consumption and utility-based health-related quality of life (HRQoL), subjective quality of life (QoL), self-rated health (SRH), and mental distress. METHODS: Representative general population survey in Finland, with 5871 persons aged 30-64 years. HRQoL was measured with two health utility instruments (15D and EQ-5D), QoL and SRH were measured with RATING scales, and mental distress with a General Health Questionnaire (GHQ-12). Past alcohol problems were diagnosed with a structured psychiatric interview known as the composite international diagnostic interview (CIDI). Alcohol consumption was examined with a self-report questionnaire. RESULTS: Negative associations between alcohol and well-being were observed on several measures for women consuming more than 173 g and men more than 229 g per week. Former drinkers scored worst on most measures, even in comparison to the highest drinking decile. For men, all statistically significant associations between moderate drinking and well-being disappeared when sociodemographic factors and former drinkers were controlled for. For women, moderate alcohol use associated with better SRH and EQ-5D as compared to abstainers. However, the possible health utility benefits associated with moderate alcohol consumption were of clinically insignificant magnitude. CONCLUSIONS: Failure to separate former drinkers and other abstainers produces a significant bias favoring moderate drinkers. As the possible health utility benefits of moderate alcohol use were clinically insignificant, it suffices to investigate mortality, when estimating the public health impact of moderate alcohol consumption using quality-adjusted life years.

Ethically problematic treatment decisions: a physician survey

Saarni, S. I., Parmanne, P. and Halila, R.

Bioethics. 2008; 22(2): 121-9. IF 1.672

Background: Experiencing ethical problems requires both ethically problematic situations and ethical sensitivity. Ethically problematic treatment decisions are distressing and might reflect health care quality problems. Whether all physicians actually experience ethical problems, what these problems are and how they vary according to physician age, gender and work sector are largely unknown. Methods: A mail survey of all non-retired physicians licensed in Finland (n = 17,172, response rate 75.6%). Results: The proportion of physicians reporting having made ethically problematic treatment decisions decreased in linear fashion from 60% at ages below 30 years to 21% at ages over 63 years. The only problem that did not decrease in frequency with age was having withdrawn necessary treatments. Women and primary care physicians reported problematic decisions most often, although gender differences were small. Primary care physicians most often reported having performed too many investigations or having pressured patients, whereas hospital physicians emphasized having withdrawn necessary treatments. Performing unnecessary treatments or investigations was explained by pressure from patients or relatives, and performing too few treatments or investigations was explained by inadequate resources. Conclusions: In general, young physicians felt pressured to do too much, whereas older physicians felt they could not do enough due to inadequate resources. Older physicians might be less exposed to ethically problematic situations, be more able to handle them or have lower ethical sensitivity. Young physicians could benefit from support in resisting pressure to perform unnecessary treatments, whereas older physicians might benefit from training in recognizing ethical issues.

Quality of life, work ability, and self employment: a population survey of entrepreneurs, farmers, and salary earners

Saarni, S. I., Saarni, E. S. and Saarni, H.

Occupational and Environmental Medicine. 2008; 65(2): 98-103. Article. IF 2.255

Objectives: Self employment is increasing but it is not yet known how its different forms affect health, quality of life, and work ability. We compared the work ability, subjective quality of life (QoL), and health-related quality of life (HRQoL) of entrepreneurs both with and without personnel, farmers, and salaried workers. We investigated which domains of HRQoL are associated with work status. Methods: A nationally representative general population sample comprising 5834 Finns aged between 30 and 64. Work ability was measured using the work ability index (WAI), HRQoL using 15D and EQ-5D, and QoL with self reported global quality of life. Results: Entrepreneurs with personnel had better work ability than salary earners, but there were no differences in QoL or HRQoL between the entrepreneurs and salary earners. Farmers scored lowest on all measures; this finding remained even after adjusting for age, sex, marital status, education, and chronic conditions. The low WAI score of farmers was mainly explained by poor subjective work ability, while their low 15D score was mainly the result of poor functioning in the psychosocial domains of HRQoL. The low EQ-5D score of farmers was explained by problems with mobility, usual activities, and with pain or discomfort. Conclusions: Farmers have poorer work ability, QoL, and HRQoL than other working groups, but this does not appear to be caused by physical health problems. From a research point of view, farmers should be categorised separately from other forms of entrepreneurship. From a public health point of view, improving farmers' wellbeing may require psychosocial interventions exceeding traditional health promotion.

Economic evaluation of rotavirus vaccination in Finland

Salo, H., Ollgren, J., Linna, M., Sintonen, H. and Kilpi, T.

European Journal of Public Health. 2007; 17: 210-211. Meeting Abstract. IF 1.481

Health risk assessment of indoor air pollution in Finnish ice arenas

Salonen, R. O., Pennanen, A. S., Vahteristo, M., Korkeila, P., Alm, S. and Randell, J. T.

Environment International. 2008; 34(1): 51-57. Article. IF 2.626

Poor indoor air quality and epidemic carbon monoxide (CO) and nitrogen dioxide (NO2) poisonings due to exhaust emissions from ice resurfacers have been continuously reported from enclosed ice arenas for over 30 years. The health risks in users of Finnish ice arenas were analysed in three ways: (1) evaluation of four cases of epidemic CO poisonings, (2) modelling the association between NO2 exposure and respiratory symptoms among junior ice hockey players, and (3) estimation of the number of arena users at risk of breathing poor quality air due to non-compliance of ice arenas with recommended abatement measures. The common causes for the CO poisonings involving over 300 subjects were large emissions from propane-fuelled ice resurfacer, small arena volume, negligible ventilation, and very recent opening of the arena. Rhinitis (prevalence 18.3%) and cough (13.7%) during or after training or game were significantly associated with the estimated personal NO2 exposure of young hockey players (n = 793) to average concentrations ranging from 21 to 1176 mu g/m(3) in their home arena. During a 6-year follow-up of an intensive information campaign the portion of electric resurfacers increased from 9% to 27%, and that of emission control technology on propane-fuelled resurfacers increased from 13% to 84%. The portion of inadequately ventilated arenas decreased from 34% to 25%. However, 48% of the investigated Finnish ice arenas (n = 125) did not fully comply with the non-regulatory recommendations. Consequently, 20 000 daily users of ice arenas were estimated to remain in 2001 at risk of breathing poor quality air. Modem small and inadequately ventilated ice arenas pose their users (mostly children and young adults) at risk of breathing poor quality air and suffering from acute adverse health effects. Governmental regulations are needed worldwide to ensure safe sports in enclosed ice arenas. (C) 2007 Elsevier Ltd. All rights reserved.

Common variants in the GDF5-UQCC region are associated with variation in human height

Sanna, S., Jackson, A. U., Nagaraja, R., Willer, C. J., Chen, W. M., Bonnycastle, L. L., Shen, H. Q., Timpson, N., Lettre, G., Usala, G., Chines, P. S., Stringham, H. M., Scott, L. J., Dei, M., Lai, S., Albai, G., Crisponi, L., Naitza, S., Doheny, K. F., Pugh, E. W., Ben-Shlomo, Y., Ebrahim, S., Lawlor, D. A., Bergman, R. N., Watanabe, R. M., Uda, M., Tuomilehto, J., Coresh, J., Hirschhorn, J. N., Shuldiner, A. R., Schlessinger, D., Collins, F. S., Smith, G. D., Boerwinkle, E., Cao, A., Boehnke, M., Abecasis, G. R. and Mohlke, K. L.

Nature Genetics. 2008; 40(2): 198-203. Article. IF 24.176

Identifying genetic variants that influence human height will advance our understanding of skeletal growth and development. Several rare genetic variants have been convincingly and reproducibly associated with height in mendelian syndromes, and common variants in the transcription factor gene HMGA2 are associated with variation in height in the general population(1). Here we report genome-wide association analyses, using genotyped and imputed markers, of 6,669 individuals from Finland and Sardinia, and follow-up analyses in an additional 28,801 individuals. We show that common variants in the osteoarthritis-associated locus(2) GDF5-UQCC contribute to variation in height with an estimated additive effect of 0.44 cm (overall P < 10(-15)). Our results indicate that there may be a link between the genetic basis of height and osteoarthritis, potentially mediated through alterations in bone growth and development.

Availability and comparability of information for European community health indicators

Sihvonen, A. P., Tuomi-Nikula, A., Thelen, J., Scafato, E., Hakulinen, K., Koponen, P., Koskinen, S. and Aromaa, A.

European Journal of Public Health. 2007; 17: 107-108. Meeting Abstract. IF 1.481

Tomato juice decreases LDL cholesterol levels and increases LDL resistance to oxidation

Silaste, M. L., Alfthan, G., Aro, A., Kesaniemi, Y. A. and Horkko, S.

British Journal of Nutrition. 2007; 98(6): 1251-1258. Article. IF 2.708

High dietary intakes of tomato products are often associated with a reduced risk of CVD, but the atheroprotective mechanisms have not been established. This study was conducted to investigate the effects of increased dietary intake of tomato products on plasma lipids and LDL oxidation. The diet intervention included a baseline period, a 3-week low tomato diet (no tomato products allowed) and a 3-week high tomato diet (400 ml tomato juice and 30 mg tomato ketchup daily). Twenty-one healthy study subjects participated in the study. Total cholesterol concentration was reduced by 5.9 (So 10) % (P=0.002) and LDL cholesterol concentration by 12.9 (So 17.0) % (P=0.0002) with the high tomato diet compared to the low tomato diet. The changes in total and LDL cholesterol concentrations correlated significantly with the changes in serum lycopene (r 0.56, P=0.009; r 0.60, P=0.004, total and LDL, respectively), P-carotene (r 0.58, P=0.005; r 0.70, P<0.001) and gamma-carotene concentrations (r 0.64. P=0.002; r 0.64, P=0.002). The level of circulating LDL to resist formation of oxidized phospholipids increased 13 % (P=0.02) in response to the high tomato diet. In conclusion, a high dietary intake of tomato products had atheroprotective effects, it significantly reduced LDL cholesterol levels, and increased LDL resistance to oxidation in healthy normocholesterolaemic adults. These atheroprotective features associated with changes in serum lycopene, P-carotene and gamma-carotene levels.

Acute bacterial, nonnecrotizing cellulitis in Finland: microbiological findings

Siljander, T., Karppelin, M., Vahakuopus, S., Syrjanen, J., Toropainen, M., Kere, J., Vuento, R., Jussila, T. and Vuopio-Varkila, J.

Clin Infect Dis. 2008; 46(6): 855-61. IF 6.186

BACKGROUND: Bacterial, nonnecrotizing cellulitis is a localized and often recurrent infection of the skin. The aim of this study was to identify the beta-hemolytic streptococci that cause acute nonnecrotizing cellulitis infection in Finland.

METHODS: A case-control study of 90 patients hospitalized for acute cellulitis and 90 control subjects was conducted during the period of April 2004-March 2005. Bacterial swab samples were obtained from skin lesions or any abrasion or fissured toe web. Blood culture samples were taken for detection of bacteremia. The patients, their household members, and control subjects were assessed for pharyngeal carrier status. beta-Hemolytic streptococci and Staphylococcus aureus were isolated and identified, and group A and G streptococcal isolates were further analyzed by T serotyping and emm and pulsed-field gel electrophoresis typing.

RESULTS: beta-Hemolytic streptococci were isolated from 26 (29%) of 90 patients, 2 isolates of which were blood-culture positive for group G streptococci, and 24 patients had culture-positive skin lesions. Group G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) was found most often and was isolated from 22% of patient samples of either skin lesions or blood, followed by group A Streptococcus, which was found in 7% of patients. Group G streptococci were also carried in the pharynx of 7% of patients and 13% of household members but was missing from control subjects. Several emm and pulsed-field gel electrophoresis types were present among the isolates. Six patients (7%) had recurrent infections during the study. In 2 patients, the group G streptococcal isolates recovered from skin lesions during 2 consecutive episodes had identical emm and pulsed-field gel electrophoresis types. CONCLUSIONS: Group G streptococci, instead of group A streptococci, predominated in bacterial cellulitis. No clear predominance of a specific emm type was seen. The recurrent nature of cellulitis became evident during this study.

Costs of brain disorders in Finland

Sillanpaa, M., Andlin-Sobocki, P. and Lonnqvist, J.

Acta Neurologica Scandinavica. 2008; 117(3): 167-172. Article. IF 1.833

Objective - To calculate the costs of brain disorders on the national level. Methods - Electronic data bases, national registers and internet data. Results - Any brain disorder was estimated to affect a fifth of the Finnish population. The three most common disorders were migraine, anxiety disorder and affective disorder. The total costs of brain disorders constituted 3% of the national gross product, or 45% of all the health- care costs. However, this is likely a conservative estimate, because not all chronic brain disorders and not all costs were included. Of the total costs of brain disorders, 32% were for direct health care, 23% for indirect medical care and 45% for indirect costs. Dementia was the most costly individual brain disorder followed by addiction and affective disorders. Most costly per case were brain tumours and multiple sclerosis. Conclusion - Brain disorders constitute a costly part of the population's health costs. Directed preventive measures are needed to counteract the population morbidity and to control the increasing cost pressure in health care.

Antibody response to 7-valent conjugated pneumococcal vaccine in patients with chronic lymphocytic leukaemia

Sinisalo, M., Vilpo, J., Itala, M., Vakevainen, M., Taurio, J. and Aittoniemi, J.

Vaccine. 2007; 26(1): 82-87. Article. IF 3.159

Chronic lymphocytic Leukaemia (CLL) is a common adulthood mature B-cell neoplasm. Infections are the most important cause of mortality in this condition, and Streptococcus pneumoniae has been considered the most important single pathogen. We investigated the immunogenicity of 7-valent pneumococcal conjugate vaccine in patients with CLL. The study material comprised 52 patients with CLL and 25 age- and sex-matched controls. The subjects were vaccinated with Prevenar (R) pneumococcal conjugate vaccine. Serum samples were taken for antibody determinations before and four weeks after vaccination. Antibody response rates to vaccine antigens were Lower in patients with CLL compared to controls. However, if the vaccine had been administered at an early stage of the disease, i.e. before commencement of chemotherapy and the development of hypogammaglobulinaemia, a significant vaccination response to at least six antigens was obtained in almost 40% of the CLL patients. Our results indicate that early administration of conjugate vaccine may be beneficial in CLL. (c) 2007 Elsevier Ltd. All rights reserved.

Early age at onset of bipolar disorder is associated with more severe clinical features but delayed treatment seeking

Suominen, K., Mantere, O., Valtonen, H., Arvilommi, P., Leppamaki, S., Paunio, T. and Isometsa, E.

Bipolar Disorders. 2008; 10: 56-56. Meeting Abstract. IF 3.494

Attitudes of general hospital emergency room personnel towards attempted suicide patients

Suominen, K., Suokas, J. and Lonnqvist, J.

Nord J Psychiatry. 2007; 61(5): 387-92. IF 0.789

The aim of this study was to compare the attitudes of emergency room staff towards patients who have attempted suicide between two general hospitals, one with psychiatric consultation available and the other without. The Understanding Suicidal Patients (USP) Questionnaire was given to all staff in the emergency rooms of Jorvi Hospital (in the city of Espoo, with routine psychiatric consultation) and Malmi Hospital (in the city of Helsinki, without routine psychiatric consultation) (n=115). There were clear differences in staff attitudes between the hospitals. Female gender, older age and working in Malmi Hospital without routine psychiatric consultation were associated with more positive attitudes towards attempted suicide patients. Surprisingly, only working in Jorvi Hospital was associated with more negative attitudes. Differences in attitudes towards suicide attempters between personnel working in the different hospitals were found. Further investigation is needed to find the ideal psychiatric consultation arrangement for suicide attempters in good cooperation with emergency room staff.

Is self-reported thyroid dysfunction an obstetrical risk factor?

Suvanto-Luukkonen, E., Mannisto, T., Hartikoinen, A. L., Vaarasmaki, M., Ruokonen, A., Jaervelin, M. R. and Pouta, A.

Hormone Research. 2007; 68: 70-70. Meeting Abstract. IF 1.385

Trends in socioeconomic differences in self-reported depressiveness during 1979-2002 in Finland

Talata, K., Huurre, T., Aro, H., Martelin, T. and Prattala, R.

European Journal of Public Health. 2007; 17: 35-35. Meeting Abstract. IF 1.481

Safety assessment of common foods enriched with natural nonesterified plant sterols

Tuomilehto, J., Tikkanen, M. J., Hogstrom, P., Keinanen-Kiukaanniemi, S., Piironen, V., Toivo, J., Salonen, J. T., Nyyssonen, K., Stenman, U. H., Alfthan, H. and Karppanen, H.

Eur J Clin Nutr. 2008. IF 2.116

Background/Objectives: To assess safety during a diet based on low-fat foods enriched with nonesterified wood-derived plant sterols and mineral nutrients related to serum phytosterol, sex hormone and fat-soluble vitamin metabolism.Subjects/Methods: Seventy-one study participants (52 women, 19 men) with mild-to-moderate hypercholesterolemia completed the double-blind, placebo-controlled feeding trial lasting for 15 weeks. The subjects were randomly allocated to the sterol group receiving food items enriched with mineral nutrients as well as with a total of 1.25, 2.5 and 5.0 g per day of plant sterols during the first, second and third 5-week periods, respectively, or to the placebo group receiving similar food items without plant sterols. This outpatient clinical trial with free-living subjects was carried out at two hospital clinics.Results: Two significant findings were observed. Serum sitosterol concentrations increased from 2.84 to 5.35 mg l(-1) (P<0.004 vs placebo) but those of serum total plant sterols did not because of compensatory changes in other phytosterols. The highest plant sterol levels did not exceed 0.6% of total serum sterols. Serum alpha-tocopherol concentrations decreased in the sterol group by 10% (P<0.0002), but the between-group difference disappeared after adjusting for the change in the carrier (LDL cholesterol).Conclusions: Fifteen-week consumption of natural nonesterified plant sterol-enriched food does not cause any serious adverse effects during such a period. However, serum alpha-tocopherol levels were somewhat reduced in the sterol group suggesting that long-term effects of plant sterols on serum fat-soluble vitamin concentrations should be further explored, especially in relation to very low-fat diets.European Journal of Clinical Nutrition advance online 13 February 2008; doi:10.1038/ejcn.2008.11.

Clonality of epidemic methicillin-resistant Staphylococcus aureus strains in Finland as defined by several molecular methods

Vainio, A., Karden-Lilja, M., Ibrahem, S., Kerttula, A. M., Salmenlinna, S., Virolainen, A. and Vuopio-Varkila, J.

Eur J Clin Microbiol Infect Dis. 2008. IF 2.330

In Finland, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) strains has increased ten fold within the last decade. In order to follow the changing epidemiology of MRSA, accurate typing of S. aureus strains is important. The purpose of this study was to reanalyse 44 previously recognised Finnish epidemic MRSA strains (EMRSA) by several molecular typing methods and to revise their nomenclature. The 44 EMRSA strains were grouped into 26 pulsed-field gel electrophoresis (PFGE) clusters, 20 multi locus sequence typing (MLST) sequence types (ST) belonging to 12 clonal complexes (CC) of which CC8 was the most prevalent, and 27 spa types belonging to four clonal complexes. The staphylococcal cassette chromosome mec (SCCmec) type IV was predominant, and 48% of the strains were nonmultiresistant to antibiotics. The discriminatory power of PFGE clusters, MLST, and spa typing was high. The overall concordance values of typing methods differed when assessed by two different methods. Adjusted Rand coefficient provided fairly low correlations for all comparisons. However, spa type was able to efficiently predict types and clonal complexes of most of the other methods with high probability (>/=80%).

Differences in incidence of suicide attempts during phases of bipolar I and II disorders

Valtonen, H. M., Suominen, K. H., Haukka, J., Mantere, O., Leppamaki, S., Arvilommi, P. and Isometsa, E. T.

Bipolar Disorders. 2008; 10: 88-89. Meeting Abstract. IF 3.494

Streptococcus pyogenes activates human plasmacytoid and myeloid dendritic cells

Veckman, V. and Julkunen, I.

Journal of Leukocyte Biology. 2008; 83(2): 296-304. Article. IF 4.572

Human peripheral blood contains two major dendritic cell (DC) populations, namely CD11c(-)CD123(+) plasmacytoid DCs (PDCs) and CD11c(+) CD123(-) myeloid DCs (MDCs). Although the activation of these DC types by various TLR ligands has been relatively well-characterized, less is known about the ability of whole live bacteria to induce PDC and MDC activation. In the present report, we have compared the activation of human PDCs and MDCs in response to major human bacterial pathogen Streptococcus pyogenes (group A streptococci) and influenza A virus. S. pyogenes stimulation resulted in the maturation of both DC types, as evidenced by enhanced expression of costimulatory molecules and production of proinflammatory cytokines and chemokines. Furthermore, S. pyogenes-stimulated PDCs and MDCs activated naive CD4+ T cells and enhanced their Th1 cytokine production. Influenza A virus infection induced rapid PDC activation, whereas MDCs were extremely sensitive to influenza A virus-induced cell death. The most significant differences between DC types were seen in the production of IL-10 and IL-12, which were only produced by S. pyogenes- stimulated MDCs. Although S. pyogenes was able to induce PDC activation, only influenza A virus infection resulted in detectable IFN-alpha production. Our results show that depending on the infecting microbe, the functions of PDCs and MDCs may be partially overlapping, suggesting a considerable flexibility of the human DC system.

Health behaviour among Finnish patients with coronary heart disease - do they differ according to socioeconomic or health care related factors?

Vehko, T., Arffman, M., Keskimaki, I., Manderbacka, K. and Reunanen, A.

European Journal of Public Health. 2007; 17: 151-152. Meeting Abstract. IF 1.481

Work for promoting healthy lifestyles (fight against alcohol, tobacco, obesity and other public health threatening lifestyle trends) in the Northern Dimension area (EG on social inclusion, healthy lifestyles and work ability 'SIHLWA')

Vienonen, M., Laatikainen, T. and Paaso, K.

European Journal of Public Health. 2007; 17: 70-70. Meeting Abstract. IF 1.481

Visual impairment in persons with psychotic disorder

Viertio, S., Laitinen, A., Perala, J., Saarni, S. I., Koskinen, S., Lonnqvist, J. and Suvisaari, J.

Soc Psychiatry Psychiatr Epidemiol. 2007; 42(11): 902-8. IF 1.577

BACKGROUND: Persons with psychotic disorder may have poorer visual acuity (VA). The aim of the study is to investigate in a general population the prevalence of impaired habitual VA and self-reported difficulties in vision among persons with different psychotic disorders.

METHOD: A nationally representative sample of 6,663 persons aged 30 or older whose binocular VA for distance and for near vision was measured with current spectacles, if any. Diagnostic assessment of DSM-IV psychotic disorders used both SCID interview and case note data. Life-time ever diagnoses of psychotic disorders were classified into schizophrenia, other non-affective psychotic disorders and affective psychoses.

RESULTS: After adjusting for age and sex, schizophrenia was associated with significantly increased odds of having visual impairment for distance (OR 5.04, P < 0.0001) and for near vision (OR 6.22, P < 0.0001), while other psychotic disorders were not. Self-reported problems in VA were more common in persons with schizophrenia and other non-affective psychotic disorders than in the remaining study sample. Only 43.9% of persons with schizophrenia, compared with 69.7% in the total sample (chi(2) = 13.79, d.f. 1, P = 0.0002), had had their vision examined during the 5 years before the VA measurement.

CONCLUSIONS: Because persons with schizophrenia attend vision examinations substantially less frequently than others, and their vision is notably weaker, regular ocular evaluations should be included in physical health monitoring in psychotic disorders.

Newly identified loci that influence lipid concentrations and risk of coronary artery disease

Willer, C. J., Sanna, S., Jackson, A. U., Scuteri, A., Bonnycastle, L. L., Clarke, R., Heath, S. C., Timpson, N. J., Najjar, S. S., Stringham, H. M., Strait, J., Duren, W. L., Maschio, A., Busonero, F., Mulas, A., Albai, G., Swift, A. J., Morken, M. A., Narisu, N., Bennett, D., Parish, S., Shen, H. Q., Galan, P., Meneton, P., Hercberg, S., Zelenika, D., Chen, W. M., Li, Y., Scott, L. J., Scheet, P. A., Sundvall, J., Watanabe, R. M., Nagaraja, R., Ebrahim, S., Lawlor, D. A., Ben-Shlomo, Y., Davey-Smith, G., Shuldiner, A. R., Collins, R., Bergman, R. N., Uda, M., Tuomilehto, J., Cao, A., Collins, F. S., Lakatta, E., Lathrop, G. M., Boehnke, M., Schlessinger, D., Mohlke, K. L. and Abecasis, G. R.

Nature Genetics. 2008; 40(2): 161-169. Article. IF 24.176

To identify genetic variants influencing plasma lipid concentrations, we first used genotype imputation and meta-analysis to combine three genome-wide scans totaling 8,816 individuals and comprising 6,068 individuals specific to our study (1,874 individuals from the FUSION study of type 2 diabetes and 4,184 individuals from the SardiNIA study of aging-associated variables) and 2,758 individuals from the Diabetes Genetics Initiative, reported in a companion study in this issue. We subsequently examined promising signals in 11,569 additional individuals. Overall, we identify strongly associated variants in eleven loci previously implicated in lipid metabolism (ABCA1, the APOA5-APOA4-APOC3-APOA1 and APOE-APOC clusters, APOB, CETP, GCKR, LDLR, LPL, LIPC, LIPG and PCSK9) and also in several newly identified loci (near MVK-MMAB and GALNT2, with variants primarily associated with high-density lipoprotein (HDL) cholesterol; near SORT1, with variants primarily associated with low-density lipoprotein (LDL) cholesterol; near TRIB1, MLXIPL and ANGPTL3, with variants primarily associated with triglycerides; and a locus encompassing several genes near NCAN, with variants strongly associated with both triglycerides and LDL cholesterol). Notably, the 11 independent variants associated with increased LDL cholesterol concentrations in our study also showed increased frequency in a sample of coronary artery disease cases versus controls.

Characteristics of oxysterol binding proteins

Yan, D. and Olkkonen, V. M.

Int Rev Cytol. 2008; 265: 253-85. IF 5.988

Protein families characterized by a ligand binding domain related to that of oxysterol binding protein (OSBP) have been identified in eukaryotic species from yeast to humans. These proteins, designated OSBP-related (ORP) or OSBP-like (OSBPL) proteins, have been implicated in various cellular functions. However, the detailed mechanisms of their action have remained elusive. Data from our and other laboratories suggest that binding of sterol ligands may be a unifying theme. Work with Saccharomyces cerevisiae ORPs suggests a function of these proteins in the nonvesicular intracellular transport of sterols, in secretory vesicle transport from the Golgi complex, and in the establishment of cell polarity. Mammals have more ORP genes, and differential splicing substantially increases the complexity of the encoded protein family. Functional studies on mammalian ORPs point in different directions: integration of sterol and sphingomyelin metabolism, sterol transport, regulation of neutral lipid metabolism, control of the microtubule-dependent motility of endosomes/lysosomes, and regulation of signaling cascades. We envision that during evolution, the functions of ORPs have diverged from an ancestral one in sterol transport, to meet the increasing demand of the regulatory potential in multicellular organisms. Our working hypothesis is that mammalian ORPs mainly act as sterol sensors that relay information to a spectrum of different cellular processes.