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Do primary care physicians' own AUDIT scores predict their use of
brief alcohol intervention? A cross-sectional survey
Aalto, M., Hyvönen, S. and Seppä, K. Drug Alcohol Depend. 2006; 83(2): 169-73. IF 2.969 BACKGROUND: To define whether the Alcohol Use Disorders Identification Test (AUDIT) scores of primary care physicians themselves predict their willingness to use brief alcohol intervention. METHODS: Cross-sectional self-administered questionnaire survey to all 3193 physicians providing primary health care in Finland. The response rate was 1909 (59.8%). Odds ratios from multinomial regression analysis were calculated for self-reported frequency (never, occasionally or regularly) of conducting brief interventions by physicians with AUDIT scores of 0-1, 2, 3, 4, 5-7 or >or=8. RESULTS: The prevalence of heavy drinkers based on AUDIT score (>or=8) was 14.5% among all physicians, 7.0% among females and 27.0% among males. Of the respondents 9.4% reported doing brief intervention regularly and 50.0% occasionally. AUDIT scores did not significantly predict either regular or occasional use of brief intervention. Instead, some other independent predictors for more frequent use of brief intervention were found. These included having a specialist licence in general practice or occupational health care and the location of the practice, but not gender or age. CONCLUSIONS: The present results indicate that in general heavy drinking among primary care physicians do not explain the low frequency with which brief intervention is used in primary health care. Effectiveness of structured questionnaires for screening heavy drinking in middle-aged women Aalto, M., Tuunanen, M., Sillanaukee, P. and Seppä, K. Alcoholism-Clinical and Experimental Research. 2006; 30(11): 1884-1888. Article. IF 2.636 Background: There is a need for an effective and feasible alcohol screening instrument. The aim of the study was to evaluate how the abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire perform in comparison with the original AUDIT and what the optimal cutoffs are when screening for heavy drinking among women. Methods: All the 40-year-old women in the city of Tampere, Finland, are invited yearly for a health screening. From 1 year, data from 894 women (response rate 68.2%) invited for a health screening were utilized in the study. The original 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, AUDIT-3, AUDIT-QF, and CAGE were evaluated against the Timeline Followback. Consumption of at least 140 g of absolute ethanol per week on average during the past month was considered heavy drinking. Results: In the Timeline Followback, the mean +/- SD weekly reported alcohol consumption was 45 +/- 67 g (range 0-936 g) of absolute ethanol. Of the women, 6.2% (55/894) were heavy drinkers. The optimal combination of sensitivity and specificity was reached for the AUDIT with cutoff >= 6, for the AUDIT-C with cutoff >= 5, for the Five Shot with cutoff >= 2.0, for the AUDIT-PC with cutoff >= 4, and for the AUDIT-QF with cutoff >= 4. When choosing the optimal cutoffs, the AUDIT-C, the Five Shot, the AUDIT-PC, and the AUDIT-QF performed as well as the 10-item AUDIT. With these cutoffs, sensitivities were 0.84 to 0.93 and specificities were 0.83 to 0.90. The AUDIT-3 and the CAGE did not perform as well as the other questionnaires. Conclusions: The 10-item AUDIT, AUDIT-C, Five Shot, AUDIT-PC, and AUDIT-QF seem to be equally effective tools in screening for heavy drinking among middle-aged women. However, their applicability is achieved only if the cutoffs are tailored according to gender. Åkerblom, H. K., Honkanen, J., Ilonen, J., and Vaarala, O. Diabetologia. 2006; 49: 13-14. Meeting Abstract. IF 5.337 Arkkola, T., Uusitalo, U., Pietikäinen, M., Metsälä, J., Kronberg-Kippilä, C., Erkkola, M., Veijola, R., Knip, M., Virtanen, S. M. and Ovaskainen, M. L. Br J Nutr. 2006; 96(5): 913-20. IF 2.967 Proper nutrition during pregnancy may be important for maternal health and fetal growth and development. In Finland, targeted recommendations are given to guide pregnant women in their food choice and dietary supplement use so that they may obtain adequate nutritional status and meet the increased need for nutrients. The aims of the present study were to examine food choices, nutrient intake and dietary supplement use of pregnant Finnish women in association with demographic variables. One thousand and seventy-five families were invited to a birth cohort study during 1998-9. Mothers of 797 newborns completed a validated 181-item food-frequency questionnaire from which the food and nutrient intakes were calculated. The information about supplement use was collected concerning the whole pregnancy. The results of the present study suggest that healthy food choices are rather common among pregnant Finnish women and the choices are positively correlated with age and education. Nutrient supplements were used by 85 % of the women. Supplements were favoured by the older and well-educated women and by those who had normal weight before pregnancy. Of the women in the present study, 31 % received vitamin A-containing supplements, although it is not recommended during pregnancy. Taking food and supplementation into account, the intake of vitamin D did not meet the dietary recommendation and folic acid intake was below recommendation in 44 % of the women. Therefore there seemed to be unnecessary nutrient supplementation and at the same time lack of relevant supplementation among these pregnant women. Mold damage in homes and wheezing in infants Cho, S. H., Reponen, T., LeMasters, G., Levin, L., Huang, J., Meklin, T., Ryan, P., Villareal, M. and Bernstein, D. Annals of Allergy Asthma & Immunology. 2006; 97(4): 539-545. Article. IF 1.987 Background: In most studies that investigate the association of mold or water damage and respiratory disorders in infants, the analysis is not adjusted for exposure to house dust mite (HDM), which is also a known cause of respiratory illnesses. Objective: To investigate the relationship between visually observable mold or water damage and HDM (Der f 1) levels and the prevalence of lower respiratory tract symptoms and allergen sensitization in infants of atopic parents as part of a prospective birth cohort study. Methods: On-site home visits (at the infants' age of 8 months) were performed to evaluate observable mold or water damage and HDM exposure. At a clinic visit near the infant's first birthday, medical histories, including parent-reported wheezing episodes, and a skin prick test to food and 15 common aeroallergens were conducted in 640 infants. Results: More than half of the homes were found to have mold or water damage, and 5% had major mold or water damage with visible mold at 0.2 m(2) or more. Only 16% of homes had a HDM allergen (Der f 1) concentration of more than 2 mu g/g. Major mold or water damage increased the risk of recurrent wheezing nearly 2 times in infants, 5 times in food or aeroallergen-sensitized infants, and 6 times in aeroallergen-sensitized infants. Neither visible mold or water damage nor HDM exposure was associated with sensitization to either mold or aeroallergens. Conclusions: Visible mold was shown to be a significant risk factor for recurrent wheezing in infants at high risk of developing atopic disorders, whereas HDM exposure did not significantly increase the risk. Mediastinitis after more than 10,000 cardiac surgical procedures Eklund, A. M., Lyytikäinen, O., Klemets, P., Huotari, K., Anttila, V. J., Werkkala, K. A. and Valtonen, M. Annals of Thoracic Surgery. 2006; 82(5): 1784-1789. Article. IF 2.229 Background. Poststemotomy mediastinitis as a complication is rare but disastrous. We assessed incidence, predisposing factors for, and outcome from, mediastinitis after cardiac surgery. Methods. We studied 10,713 consecutive patients who underwent open-heart surgery from 1990 to 1999 in a tertiary care university hospital using data prospectively recorded in the hospital discharge register, operating room log, and the hospital's cardiothoracic surgery unit register. Those cases with possible mediastinitis were identified from the hospital infection register and discharge register. Patients' charts were reviewed and cases of mediastinitis confirmed based on criteria of the Centers for Disease Control and Prevention. Results. The overall rate of mediastinitis was 1.1% ( 120 cases), and higher in coronary artery bypass surgery than in valvular surgery (1.2 vs 0.8%). No trend in incidence was detectable, although surgical patients became progressively older (mean age, 59 to 65 years, p < 0.01), and the proportion of women (from 25% to 31%; p < 0.01) and of patients with American Society of Anesthesiologists score over 3 (from 10% to 81%, p < 0.01) both increased. The rate of mediastinitis was almost twice as high in men (1.2% vs 0.7%, p < 0.01). In three body mass index (BMI) categories (< 25, 25 to 30, and > 30 kg/ m(2)), rates of mediastinitis were 0.5%, 1.0%, and 1.8%. In multivariate analysis adjusted for age, sex, year, operation type, and perfusion time, the only predictor for mediastinitis was BMI. Conclusions. Mediastinitis is not diminishing. Larger populations at risk, for example proportions of overweight patients, reinforce the importance of surveillance and pose a challenge in focusing preventive measures. Patterns of growth among children who later develop type 2 diabetes or its risk factors Eriksson, J. G., Osmond, C., Kajantie, E., Forsen, T. J. and Barker, D. J. Diabetologia. 2006; 49(12): 2853-2858. IF 5.337 AIMS/HYPOTHESIS: We studied fetal and childhood growth patterns that are associated with IGT and type 2 diabetes in adult life. METHODS: We examined clinically 2,003 subjects born in Helsinki between 1934 and 1944. They had on average 11 measurements of height and weight between birth and 2 years of age, and seven measurements between 2 and 11 years of age. Glucose tolerance in adult life was assessed by a 75-g oral glucose tolerance test. RESULTS: We identified 311 subjects with type 2 diabetes and 496 with IGT. Both IGT and type 2 diabetes were associated with low birthweight (p < 0.0001 adjusting for current BMI). The risk of these conditions was increased by low weight gain between birth and 2 years. A 1 SD increase in weight at 2 years was associated with an odds ratio for either type 2 diabetes or IGT of 0.76 (95% CI 0.69-0.84). This effect was greatest in people who had low birthweight. Low growth in the first 6 months after birth was a critical period for the development of insulin resistance in later life; other critical periods were associated with slow fetal growth and rapid increase in BMI between age 2 and 11 years. CONCLUSIONS/INTERPRETATION: Low weight gain during infancy increases the risk of IGT and type 2 diabetes. The effect is greater in people who had low birthweight. The first 6 months after birth may be the most critical period for growth, in relation to development of glucose intolerance. Hatonen, K. A., Similä, M. E., Virtamo, J. R., Eriksson, J. G., Hannila, M. L., Sinkko, H. K., Sundvall, J. E., Mykkänen, H. M. and Valsta, L. M. Am J Clin Nutr. 2006; 84(5): 1055-61. IF 5.853 BACKGROUND: Methodologic choices affect measures of the glycemic index (GI). The effects on GI values of blood sampling site, reference food type, and the number of repeat tests have been insufficiently determined. OBJECTIVE: The objective was to study the effect of methodologic choices on GI values. Comparisons were made between venous and capillary blood sampling and between glucose and white bread as the reference food. The number of tests needed for the reference food was assessed. Rye bread, oatmeal porridge, and instant mashed potato were used as the test foods. DESIGN: Twelve healthy volunteers were served each test food once and both reference foods 3 times at 1-wk intervals in a random order after they had fasted overnight. Capillary and venous blood samples were drawn at intervals for 3 h after each study meal. RESULTS: GIs and their CVs based on capillary samples were lower than those based on venous samples. Two tests of glucose solution as the reference provided stable capillary GIs for the test foods. The capillary GIs did not differ significantly when white bread was used as the reference 1, 2, or 3 times, but the variation was lower when tests were performed 2 and 3 times. Capillary GIs with white bread as the reference were 1.3 times as high as those with glucose as the reference. The capillary GIs of rye bread, oatmeal porridge, and mashed potato were 77, 74, and 80, respectively, with glucose as the reference. CONCLUSIONS: Capillary blood sampling should be used in the measurement of GI, and reference tests with glucose or white bread should be performed at least twice. Holmberg, H., Vaarala, O., Ilonen, J. and Ludvigsson, J. Diabetologia. 2006; 49: 178-179. Meeting Abstract. IF 5.337 Huovinen, E., Harkanen, T., Martelin, T., Koskinen, S. and Aromaa, A. International Journal of Epidemiology. 2006; 35(5): 1246-1252. Article. IF 4.045 Background Predictions concerning people and their health are influenced by many factors and have many sources of uncertainty. Even so predictions can give useful guidelines for health care planning. We present a Bayesian model based on past observations and prior knowledge to predict coronary heart disease (CHD) mortality in selected areas of Finland until the year 2030. Methods CHD mortality data are based on official statistics. The study area consists of one western and two eastern parts of Finland. The modelling of the probability of death follows a Bayesian age-period-cohort model. Two models are used, one assuming that the trend from 1970 to 2002 will continue and the other that mortality will stay at the attained level. Results If the observed trend in CHD mortality were to continue, death probabilities would decrease significantly among men aged 50-69 and women aged 50-59. In the older age groups (men aged 70 and women 60 years or more) the changes were found to be negligible. If the trend continues, the number of CHD deaths will decrease from 2002 to 2030 significantly among men [81% decrease; 95% credible interval (95% CI) 54-96%] and women (90%; 67-100%) aged 50-59. In the age group 60-79 the changes will be smaller and non-significant. In the oldest age group (80-99 years) the predicted increase in the number of deaths will be great, from 284 to 1297 (95% CI 474-2620) in men and from 722 to 1970 (717-4017) in women. Conclusions Our predictions emphasize the significance of maintaining the recent decline of CHD mortality among middle-aged adults. Special attention should be paid to CHD mortality among men and women aged 80 and over. Considerable improvements in prevention and treatment are needed to compensate for the effects of ageing of the population. Jalava, K., Hakkinen, M., Valkonen, M., Nakari, U. M., Palo, T., Hallanvuo, S., Ollgren, J., Siitonen, A. and Nuorti, J. P. Journal of Infectious Diseases. 2006; 194(9): 1209-1216. Article. IF 4.953 Background. Outbreaks of Yersinia pseudotuberculosis infection have been epidemiologically linked to fresh produce, but the bacterium has not been recovered from the food items implicated. In May 2003, a cluster of gastrointestinal illness and erythema nodosum was detected among schoolchildren who had eaten lunches prepared by the same institutional kitchen. Methods. We conducted a case-control study and trace-back, environmental, and laboratory investigations. Case patients had culture-confirmed Y pseudotuberculosis O:l infection, erythema nodosum, or reactive arthritis. Bacterial isolates from clinical and environmental samples were compared using pulsed-field gel electrophoresis (PFGE). Results. Of 7392 persons at risk, 111 (1.5%) met the case definition; 76 case patients and 172 healthy control subjects were enrolled in the case-control study. Only raw grated carrots were significantly associated with illness in a logistic-regression model (multivariable odds ratio, 5.7 [95% confidence interval, 1.7-19.5]); a dose response was found for increasing amount of consumption. Y pseudotuberculosis O:l isolates from 39 stool specimens and from 5 (42%) of 12 soil samples that contained carrot residue and were obtained from peeling and washing equipment at the production farm were indistinguishable by PFGE. Conclusions. Carrots contaminated early in the production process caused a large point-source outbreak. Our findings enable the development of evidence-based strategies to prevent outbreaks of this emerging foodborne pathogen. Jalava, P. I., Salonen, R. O., Halinen, A. I., Penttinen, P., Pennanen, A. S., Sillanpää, M., Sandell, E., Hillamo, R. and Hirvonen, M. R. Toxicol Appl Pharmacol. 2006; 215(3): 341-53. IF 3.148 The impact of long-range transport (LRT) episodes of wildfire smoke on the inflammogenic and cytotoxic activity of urban air particles was investigated in the mouse RAW 264.7 macrophages. The particles were sampled in four size ranges using a modified Harvard high-volume cascade impactor, and the samples were chemically characterized for identification of different emission sources. The particulate mass concentration in the accumulation size range (PM(1-0.2)) was highly increased during two LRT episodes, but the contents of total and genotoxic polycyclic aromatic hydrocarbons (PAH) in collected particulate samples were only 10-25% of those in the seasonal average sample. The ability of coarse (PM(10-2.5)), intermodal size range (PM(2.5-1)), PM(1-0.2) and ultrafine (PM(0.2)) particles to cause cytokine production (TNFalpha, IL-6, MIP-2) reduced along with smaller particle size, but the size range had a much smaller impact on induced nitric oxide (NO) production and cytotoxicity or apoptosis. The aerosol particles collected during LRT episodes had a substantially lower activity in cytokine production than the corresponding particles of the seasonal average period, which is suggested to be due to chemical transformation of the organic fraction during aging. However, the episode events were associated with enhanced inflammogenic and cytotoxic activities per inhaled cubic meter of air due to the greatly increased particulate mass concentration in the accumulation size range, which may have public health implications. Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders Karlsson, L., Pelkonen, M., Ruuttu, T., Kiviruusu, O., Heila, H., Holi, M., Kettunen, K., Tuisku, V., Tuulio-Henriksson, A., Törrönen, J. and Marttunen, M. Eur Child Adolesc Psychiatry. 2006; 15(4): 220-31. IF 1.367 OBJECTIVE: To compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression. METHOD: A sample of 218 consecutive adolescent (13-19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses. RESULTS: Current comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF <or=60) was associated with current comorbidity (OR 3.13; 95% CI 1.53, 6.45), while severity of depression and lifetime age of onset for depression were not. CONCLUSIONS: Adolescent depression presents with age- and sex-dependent patterns of multiple co-occurring problem areas. While many clinical characteristics of adolescent depression are not affected by comorbidity, comorbidity associates with increased impairment. Does parity affect mortality among parous women? Koski-Rahikkala, H., Pouta, A., Pietiläinen, K. and Hartikainen, A. L. Journal of Epidemiology and Community Health. 2006; 60(11): 968-973. Article. IF 3.003 Objective: To find out whether there is an association between parity and mortality. Design: Prospective cohort study. Setting: Northern Finland, 1966-2001. Participants and methods: 12 055 women in the two northernmost provinces of Finland were followed up from pregnancy in 1966-2001, the coverage percentage being 96%. The data on age, smoking, body mass index, socioeconomic position, age at menarche and age at first birth were collected during pregnancy, and data on deaths were obtained from the National Cause of Death Statistics, maintained by Statistics Finland. The Cox proportional hazard model was used to estimate relative mortality between parity groups. Results: Total mortality was lowest among the women with 2-4 children (reference group). High parity was associated with an up to twofold risk of mortality from vascular complications, but after adjustment for all background factors, this significance disappeared. Mortality from haemorrhagic stroke was fourfold higher among the women with >= 10 births compared with those of the reference group. No differences in cerebral infarction or total cancer mortality were seen between the groups. Primiparity was associated with increased mortality from accidental death (relative risk 2.6, 95% confidence interval 1.6 to 4.4). Conclusions: High parity was associated with an increased risk of mortality from vascular complications, especially haemorrhagic stroke, and primiparity with an increased risk of accidental death. Leskelä, U., Rytsälä, H., Komulainen, E., Melartin, T., Sokero, P., Lestelä-Mielonen, P. and Isometsä, E. Psychol Med. 2006; 36(6): 779-88. IF 3.476 BACKGROUND: Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD: In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS: The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS: Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission. Cost-effectiveness of a lifestyle intervention for hypertension: An open randomised controlled trial Martikainen, J. A., Kastarinen, M., Puska, P. and Nissinen, A. Value in Health. 2006; 9(6): A340-A340. Meeting Abstract. IF 1.306 Vascular amine oxidases are needed for leukocyte extravasation into inflamed joints in vivo Marttila-Ichihara, F., Smith, D. J., Stolen, C., Yegutkin, G. G., Elima, K., Mercier, N., Kiviranta, R., Pihlavisto, M., Alaranta, S., Pentikäinen, U., Pentikäinen, O., Fulop, F., Jalkanen, S. and Salmi, M. Arthritis Rheum. 2006; 54(9): 2852-62. IF 7.421 OBJECTIVE: Leukocyte traffic from the blood to the joints is crucial in the pathogenesis of arthritis. A bifunctional endothelial cell-surface glycoprotein, AOC3 (amine oxidase, copper-containing 3; also known as vascular adhesion protein 1), has both adhesive and enzymatic properties. We undertook this study to determine the contribution of AOC3 and its oxidase activity to leukocyte trafficking into inflamed joints in vivo. METHODS: We used gene-modified animals, molecular modeling, an AOC3 enzyme inhibitor, oxidase assays, and arthritis models (adjuvant-induced arthritis [AIA] in rats and anti-type II collagen antibody-induced arthritis in mice) to dissect the importance of AOC3 in vivo. RESULTS: The AOC3 inhibitor fitted well with a covalent binding mode into the active site of the AOC3 crystal structure. It selectively blocked the oxidase activity of AOC3 in enzyme assays. Intraperitoneal and oral administration of the AOC3 inhibitor significantly ameliorated rat AIA. In anti-type II collagen antibody-induced arthritis in mice, the AOC3 inhibitor also improved the outcome of the joint inflammation. The acute semicarbazide-sensitive amine oxidase blockade by the inhibitor had even more pronounced effects than genetic deletion of AOC3. Enzymatic analyses showed that the inhibitor also blocked 2 other structurally very closely related AOCs, but not any of more than 100 other enzymes tested. CONCLUSION: These are the first data to demonstrate that the enzymatic activity of the atypical endothelial adhesion molecule AOC3, and possibly that of other closely related ecto-oxidases, is crucial for leukocyte exit from the vessels in inflamed joints in vivo. Penttinen, P., Pelkonen, J., Huttunen, K. and Hirvonen, M. R. Toxicol Appl Pharmacol. 2006. IF 3.148 We have recently shown that the actinobacterium Streptomyces californicus and the fungus Stachybotrys chartarum originating from moisture damaged buildings possess both immunotoxic and immunostimulatory characteristics, which are synergistically potentiated by microbial interaction. In the search for the causative agent(s) behind the immunotoxicity, the cytostatic effects of the co-cultivated spores of S. californicus and S. chartarum were compared to those caused by widely used cytostatic agents produced by streptomycetes. The RAW264.7 macrophages were exposed to four doses of doxorubicin (DOX), actinomycin D (AMD), mitomycin C (MMC) or phleomycin (PHLEO) for 24 h. Kinetics of the spores of the co-cultivated and the separately cultivated microbes (1x10(6) spores/ml) was compared to DOX (0.15 muM). Apoptotic responses were analyzed by measuring DNA content and mitochondria membrane depolarization with flow cytometer, and by the fluorometric caspase-3 assay. The present data indicate that interactions during co-cultivation of S. californicus and S. chartarum stimulate the production of an unidentified cytostatic compound(s) capable of inducing mitochondria mediated apoptosis and cell cycle arrest at S-G(2)/M. The spores of co-cultivated microbes caused a 4-fold collapse of mitochondrial membrane potential and an almost 6-fold caspase-3 activation and DNA fragmentation when compared to control. Similar responses were induced by DNA cleaving compounds, especially DOX and AMD, at the relatively low concentrations, but not the spores of the same microbes when they were grown separately. These data suggest that when growing in the same habitat, interactions between S. californicus and S. chartarum stimulates the production of an unknown cytostatic compound(s) which evoke immunotoxic effects similar to those by chemotherapeutic drugs. Pirkola, S. P., Poikolainen, K. and Lönnqvist, J. K. Alcohol Alcohol. 2006; 41(3): 315-20. IF 2.040 AIMS: To study the factors relating to remission from alcohol dependence in the general population. METHODS: Within a representative, cross-sectional general population sample aged 30 years or more, the characteristics of subjects remitted from alcohol dependence were examined by comparisons with actively alcohol-dependent subjects. RESULTS: The overall lifetime prevalence of alcohol dependence was 7.9%. Comorbid depressive and anxiety disorders were diagnosed in 22% of the actively alcohol-dependent and in 19% of the remitted subjects. There were few sociodemographic, clinical or childhood-related factors differentiating the two groups of subjects. Of comorbid mental disorders, social phobia (6% vs 1%) and dysthymia (7% vs 3%) were more common among the actively alcohol-dependent, whereas other common disorders were equally common for both active and remitted alcohol dependence. Health care or other service use for alcohol problems within the previous 12 months was more frequent among the actively dependent (16% vs 4%), and the same was true for health care use for mental health problems (17% vs 8%). Any service use in the previous year for either type of problem was more common among the actively dependent than the remitted (26% vs 13%). CONCLUSIONS: In an unselected setting, only comorbid social phobia and dysthymia differentiated active alcohol dependence from a remitted state, suggesting either that they are obstacles to remission from an active state, explaining why some alcohol-dependent individuals are unable to recover, or that their symptoms are maintained by excessive alcohol use. The actively alcohol-dependent used both substance use services and mental health services more often than the remitted subjects, possibly due to needs generated by their alcohol problem. Comorbid psychopathology should be considered when developing treatment options for alcohol dependence. Maternal gestational diabetes and the manifestations of metabolic syndrome in adolescent offspring Pouta, A., Vaarasmäki, M., Tapanainen, P., Hartikainen, A. L., Sovio, U., Ruokonen, A., Elliott, P., McCarthy, M. I. and Järvelin, M. R. Diabetologia. 2006; 49: 574-575. Meeting Abstract. IF 5.337 Söderberg, S., Shaw, J., Zimmet, P., Reklamaite, R., Tamosiunas, A., Alberti, K. and Tuomilehto, J. Diabetologia. 2006; 49: 707-707. Meeting Abstract. IF 5.337 Sokero, P., Eerola, M., Rytsälä, H., Melartin, T., Leskelä, U., Lestelä-Mielonen, P. and Isometsä, E. Journal of Affective Disorders. 2006; 95(1-3): 95-102. Article. IF 3.078 Background: Suicidal ideation is likely to represent a phase preceding suicidal acts among most suicidal patients with major depressive disorder (MDD). Factors predicting reversal of the suicidal process are unknown. Our aim was to test the hypothesis that a decline in suicidal ideation is preceded by a decline in hopelessness among patients with MDD. Method: Of the 269 Vantaa Depression Study patients with DSM-IV MDD, 103 patients scored ! 6 points at baseline on the Scale for Suicidal Ideation (SSI). Seventy of these patients were followed-up weekly either until they scored zero points on the SSI, or up to 26 weeks. Results: The median duration for a decline of suicidal ideation to zero was 2.2 months after baseline. The level of baseline suicidal ideation, depressive symptoms, and the presence of any personality disorder predicted duration of suicidal ideation. A decline in both depression (BDI) and hopelessness (HS) independently predicted a decline in suicidal ideation. Limitations: Due to study design, we do not know if suicidal ideation relapsed after the first time the patient reached zero score in the SSI. Conclusions: Among patients with major depressive disorder having suicidal ideation, the decline in suicidal ideation is independently predicted by preceding declines in the levels of both depressive symptoms as well as hopelessness. The findings are consistent with possible causal roles of declines in depression and hopelessness in reversing the suicidal process. (c) 2006 Elsevier B.V. All rights reserved. Trends and educational disparities in functional capacity among people aged 65-84 years Sulander, T., Martelin, T., Sainio, P., Rahkonen, O., Nissinen, A. and Uutela, A. International Journal of Epidemiology. 2006; 35(5): 1255-1261. Article. IF 4.045 Background This study examined 10 year trends in functional capacity by gender, age, and education among elderly Finns aged 65-84 years, focusing on difficulties in basic activities of daily living (BADL). Educational disparities and their trends in the prevalence of these difficulties were also assessed. Methods Data were derived from nationally representative monitoring surveys conducted biennially from 1993 to 2003 by the National Public Health Institute (KTL). A total of 5740 men and 5746 women were included in the study (response rate 80%). Activities of daily living (ADL) measures were used to assess levels of functional capacity. Education was divided into two groups: low (0-8 years) and high (9+ years). Age-adjusted trends and logistic regression analyses were computed. Results A clear downward trend in BADL difficulties was observed in all age groups in both genders. 80-84 year olds had clearly poorer functional ability than 65-69 year olds, even when adjusted for chronic diseases. Despite the overall improvement in functional capacity in both educational groups, low educational status persistently predicted poorer functional capacity. When chronic diseases and survey period were controlled for, the educational disparities attenuated slightly but remained significant. Conclusions The number of Finnish elderly with BADL difficulties has declined markedly over the past 10 years. However, persistent educational disparities continue to present a challenge to public health initiatives for reducing inequalities in health. Tolppanen, A. M., Pulkkinen, L., Kolehmainen, M., Salopuro, T., Schwab, U., Tuomilehto, J. and Uusitupa, M. Diabetologia. 2006; 49: 36-36. Meeting Abstract. IF 5.337 Tuisku, V., Pelkonen, M., Karlsson, L., Kiviruusu, O., Holi, M., Ruuttu, T., Punamäki, R. L. and Marttunen, M. Eur Child Adolesc Psychiatry. 2006; 15(4): 199-206. IF 1.367 OBJECTIVE: We aimed to analyse and compare prevalence and associated clinical features of suicidal ideation, self-harm behaviour with no suicidal intent and suicide attempts among adolescent outpatients with depressive mood disorders with or without comorbidity. METHOD: A sample of 218 consecutive adolescent outpatients aged 13-19 years with depressive mood disorders was interviewed using K-SADS-PL for DSM-IV Axis I diagnoses. They filled out self-report questionnaires assessing depressive and anxiety symptoms. Suicidal behaviour was assessed by K-SADS-PL suicidality items. RESULTS: Half of the subjects reported suicidal ideation or behaviour. There was no difference in prevalence of suicidal behaviour between non-comorbid and comorbid mood disorder groups. Multivariate logistic regression analyses produced the following associations: (1) suicidal ideation with self-reported depressive symptoms and poor psychosocial functioning, (2) deliberate self-harm behaviour with younger age and poor psychosocial functioning, and (3) suicide attempts with self-reported depressive symptoms and poor psychosocial functioning. CONCLUSIONS: Depressed mood disorders, whether comorbid or not, are associated with suicidal ideation and suicide attempts. Diagnostic assessment should be supplemented by self-report methods when assessing suicidal behaviour in depressed adolescents. Simple risk factors for developing type 2 diabetes mellitus as identified in the STOP-NIDDM trial Tuomilehto, J., Peltonen, M., Qiao, Q., Chiasson, J. L., Hellmich, M., Lehmacher, W. and Evers, T. Diabetologia. 2006; 49: 439-440. Meeting Abstract. IF 5.337 Wright, M. E., Lawson, K. A., Weinstein, S. J., Pietinen, P., Taylor, P. R., Virtamo, J. and Albanes, D. Am J Clin Nutr. 2006; 84(5): 1200-1207. IF 5.853 BACKGROUND: A meta-analysis of 19 trials suggested a small increase in the risk of all-cause mortality with high-dose vitamin E supplementation. Little is known, however, about the relation between mortality and circulating concentrations of vitamin E resulting from dietary intake, low-dose supplementation, or both. OBJECTIVE: We examined whether baseline serum alpha-tocopherol concentrations are associated with total and cause-specific mortality. DESIGN: A prospective cohort study of 29 092 Finnish male smokers aged 50-69 y who participated in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study was carried out. Fasting serum alpha-tocopherol was measured at baseline by using HPLC. Only 10% of participants reported vitamin E supplement use at baseline, and thus serum concentrations of vitamin E mainly reflected dietary intake and other host factors. Risks of total and cause-specific mortality were estimated by using proportional hazards models. RESULTS: During up to 19 y of follow-up, 13 380 deaths (including 4518 and 5776 due to cancer and cardiovascular disease, respectively) were identified. Men in the higher quintiles of serum alpha-tocopherol had significantly lower risks of total and cause-specific mortality than did those in the lowest quintile [relative risk (RR) = 0.82 (95% CI: 0.78, 0.86) for total mortality and 0.79 (0.72, 0.86), 0.81 (0.75, 0.88), and 0.70 (0.63, 0.79) for deaths due to cancer, cardiovascular disease, and other causes, respectively; P for trend for all < 0.0001]. Cubic regression spline analysis of continuous serum alpha-tocopherol values indicated greater risk reductions with increasing concentrations up to approximately 13-14 mg/L, after which no further benefit was noted. CONCLUSION: Higher circulating concentrations of alpha-tocopherol within the normal range are associated with significantly lower total and cause-specific mortality in older male smokers. |