13.7.2009

Antila, M., Partonen, T., Kieseppä, T., Suvisaari, J., Eerola, M., Lönnqvist, J. and Tuulio-Henriksson, A.

Journal of Affective Disorders. 2009; 116(1-2): 70-79. Article. IF 3.271

Background: Bipolar I disorder patients show cognitive impairments, and genetic vulnerability to other psychotic disorders may modify these impairments. We set out to assess cognitive functions and estimate their heritability in bipolar I disorder patients (bipolar families) and unaffected relatives in a group of families with bipolar I disorder only and in another group of families with both bipolar I disorder and schizophrenia or schizoaffective disorder (mixed families).

Methods: A neuropsychological test battery was administered to 20 bipolar patients and 36 relatives from bipolar families, 19 bipolar patients and 28 relatives from mixed families and 55 controls, all representing population-based samples.

Results: Irrespective of the family group, patients and relatives were impaired in psychomotor processing speed. Both patient groups were impaired in executive functioning, but the deficit was more severe in patients from mixed families. Patients from bipolar families scored lower than controls in nearly all measures of verbal memory. All relatives were slightly impaired in executive functioning. The heritability of cognitive functions was generally similar irrespective of psychopathology in the family. However, there were greater genetic effects in several cognitive tasks in mixed families. Limitations: The small sample size and familial type of bipolar disorder could limit the generalizability of the results.

Conclusion: Impaired psychomotor processing speed and executive functions may represent markers of susceptibility to bipolar I disorder irrespective of psychopathology within the family. Generalized impairment in verbal memory, in turn, may associate more with bipolar disorder than to vulnerability to other psychotic disorders. (C) 2008 Elsevier B.V. All rights reserved.

Impact of radiotherapy and chemotherapy on biomarkers of oxidative DNA damage in lung cancer patients

Crohns, M., Saarelainen, S., Erhola, M., Alho, H. and Kellokumpu-Lehtinen, P.

Clinical Biochemistry. 2009; 42(10-11): 1082-1090. Article. IF 1.926

Objectives: To assess oxidative damage to DNA during lung cancer (LC) treatments.

Design and methods: Urinary levels of 8-oxoguanine (8-oxoGua) and levels of 8-oxo-2'-deoxyguanosine (8-oxodG) from urine and whole blood were determined in 36 non-cancer controls and 65 LC patients before any treatments. Samples were also obtained of LC patients during and after radiotherapy (RT, n = 33) and chemotherapy (CT, n = 16).

Results: Stage IV LC patients had higher urinary 8-oxoGua and 8-oxodG levels than patients with stage I-III disease (P=0.044 and p=0.034, respectively). Urinary 8-oxodG levels increased during the first week of RT (p < 0.001). Nuclear 8-oxodG increased during RT and 3 months after start of RT. Nuclear 8-oxodG levels also rose between the first two CT cycles (p=0.043), and urinary 8-oxodG levels during the sixth CT cycle (p=0.009).

Conclusions: Urinary DNA damage biomarker levels may be associated with LC stage. Both RT and CT increase the parameters of DNA oxidation. (c) 2009 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Sucrose in the diet of 3-year-old Finnish children: sources, determinants and impact on food and nutrient intake

Erkkola, M., Kronberg-Kippilä, C., Kyttälä, P., Lehtisalo, J., Reinivuo, H., Tapanainen, H., Veijola, R., Knip, M., Ovaskainen, M. L. and Virtanen, S. M.

Br J Nutr. 2009; 101(8): 1209-17. IF 2.764

The aim was to identify the important sources of added sucrose and determinants of high intake, and to evaluate what impact a high proportion of energy from added sucrose has on the intake of foods and nutrients. The subjects consisted of children invited to the nutrition study within the Type 1 Diabetes Prediction and Prevention birth cohort and born in 2001 (n 846). Of these, 471 returned 3 d food records at 3 years of age. The average daily intake of added sucrose was 35 (sd 17) g (11.3 % of energy intake) and that of total sucrose was 41 (sd 18) g (13.3 % of energy intake). Sucrose added by manufacturers accounted for 82 %, naturally occurring sucrose for 15 % and sucrose added by consumers for 3 % of the total sucrose. Juice drinks, yoghurt/cultured milks, and chocolate and confectionery were the main contributors to added sucrose intake. Consumption of rye bread, porridge, fresh vegetables, cooked potatoes, skimmed milk, hard cheeses, margarine and fat spread as well as intake of most nutrients decreased across the quartiles of added sucrose (P < 0.05). Being cared for at home, having a father with a vocational school degree, having at least two siblings and a milk-restricted diet increased the risk for a high-sucrose diet. The study implied that a high proportion of added sucrose in the diet had mainly an unfavourable impact on the intake of recommended foods and key nutrients in Finnish children. The rationale for the recommendation to reduce the intake of refined sugars to ensure adequate intakes of nutrients seems reasonable.

Large-Scale Analysis of Association Between GDF5 and FRZB Variants and Osteoarthritis of the Hip, Knee, and Hand

Evangelou, E., Chapman, K., Meulenbelt, I., Karassa, F. B., Loughlin, J., Carr, A., Doherty, M., Doherty, S., Gomez-Reino, J. J., Gonzalez, A., Halldorsson, B. V., Hauksson, V. B., Hofman, A., Hart, D. J., Ikegawa, S., Ingvarsson, T., Jiang, Q., Jonsdottir, I., Jonsson, H., Kerkhof, H. J. M., Kloppenburg, M., Lane, N. E., Li, J., Lories, R. J., van Meurs, J. B. J., Nakki, A., Nevitt, M. C., Rodriguez-Lopez, J., Shi, D. Q., Slagboom, E., Stefansson, K., Tsezou, A., Wallis, G. A., Watson, C. M., Spector, T. D., Uitterlinden, A. G., Valdes, A. M. and Ioannidis, J. P. A.

Arthritis and Rheumatism. 2009; 60(6): 1710-1721. Article. IF 6.787

Objective. GDF5 and FRZB have been proposed as genetic loci conferring susceptibility to osteoarthritis (OA); however, the results of several studies investigating the association of OA with the rs143383 polymorphism of the GDF5 gene or the rs7775 and rs288326 polymorphisms of the FRZB gene have been conflicting or inconclusive. To examine these associations, we performed a large-scale meta-analysis of individual-level data.

Methods. Fourteen teams contributed data onpolymorphisms and knee, hip, and hand OA. For rs143383, the total number of cases and controls, respectively, was 5,789 and 7,850 for hip OA, 5,085 and 8,135 for knee OA, and 4,040 and 4,792 for hand OA. For rs7775, the respective sample sizes were 4,352 and 10,843 for hip OA, 3,545 and 6,085 for knee OA, and 4,010 and 5,151 for hand OA, and for rs288326, they were 4,346 and 8,034 for hip OA, 3,595 and 6,106 for knee OA, and 3,982 and 5,152 for hand OA. For each individual study, sex-specific odds ratios (ORs) were calculated for each OA phenotype that had been. investigated. The ORs for each phenotype were synthesized using both fixed-effects and random-effects models for allele-based effects, and also for haplotype effects for FRZB.

Results. A significant random-effects summary OR for knee OA was demonstrated for rs143383 (1.15 [95% confidence interval 1.09-1.22]) (P = 9.4 x 10(-7)), with no significant between-study heterogeneity. Estimates of effect sizes for hip and hand OA were similar, but a large between-study heterogeneity was observed, and statistical significance was borderline (for OA of the hip [P = 0.016]) or absent (for OA of the hand [P = 0.19]). Analyses for FRZB polymorphisms and haplotypes did not reveal any statistically significant signals, except for a borderline association of rs288326 with hip OA (P = 0.019).

Conclusion. Evidence of an association between the GDF5 rs143383 polymorphism and OA is substantially strong, but the genetic effects are consistent across different populations only for knee OA. Findings of this collaborative analysis do not support the notion that FRZB rs7775 or rs288326 has any sizable genetic effect on OA phenotypes.

Variation in Use and Costs of Primary Health and Social Services in Mental Health or Drinking Problems

Forma, L., Jarvala, T., Ahonen, J., Vitikainen, K. and Rissanen, P.

Journal of Mental Health Policy and Economics. 2009; 12(2): 79-86. Proceedings Paper. IF 1.806

Background: Psychiatric inpatient hospital care was cut dramatically in Finland in recent last decades, and patients were assigned to care in the community. Consequently, the burden of care shifted from hospital districts to municipalities, which have considerable autonomy in organizing health and social services. These changes probably created locally differing service patterns in mental health care.

Aims of the Study: We assessed the use of primary social and health care due to mental health and drinking problems and the resulting costs. We also examined differences between municipalities, and analysed factors which may be associated with the variation in use and costs of these services.

Methods: Data were collected in five municipalities in Pirkanmaa Hospital District, Finland, using a short questionnaire containing questions on e.g. the reason for the visit, time spent during the visit, and of the client's psychosocial functioning (Global Assessment of Function Scale, GAF). The questionnaire was completed at all individual clients' visits to these services during a two-week period in December 2003, by professionals (MD's, nurses, social workers etc.) who worked in either local health or social services. Descriptive statistics and several regression techniques were used to describe and analyse factors associated with the use and costs of services.

Results: During the study period, altogether 25,738 visits took place, the total number of visitors being 10,265. Of these visitors, 1,360 had mental health or drinking problems totalling to 4,471 visits. Most of these visits took place to mental health clinics or were visits made as home care. The average cost of mental health work in primary care per client was 29.8 (sic) in two weeks, ranging between municipalities from 29 (sic) to 52 (sic). Client's poor GAF and being a recipient of home care were associated with higher costs of services. Even after controlling for visitor-related factors, use and costs of services were associated with the local service patterns. Discussion: The response rate could not be calculated for each service producer; however, we estimated that this varied between 50% and 100%. Therefore our results represent this visitor population. However, our limited data did not allow any analysis of municipality-related factors which might explain the role of service patterns in costs and use of services.

Implications for Health Care Provision and Use: A considerable proportion of total use and costs of local welfare services are due to mental health problems. The differences between municipal service patterns cause variation in total costs of care of mental disorders.

Implications for Health Policies: Some capacity in local primary services is allocated to mental health problems, thus enabling a shift from institutional care toward community care. However, varying local patterns may cause a risk to unequal access to mental health services.

Implications for Further Research: In future studies it is important to analyse the properties of local service patterns which influence appropriate use and optimal costs of care.

Population dynamics of serologically identified coinfections with human papillomavirus types 11, 16, 18 and 31 in fertile-aged Finnish women

Kaasila, M., Koskela, P., Kirnbauer, R., Pukkala, E., Surcel, H. M. and Lehtinen, M.

Int J Cancer. 2009. IF 4.734

Licensed human papillomavirus (HPV) vaccines are expected to prevent high-risk (hr) HPV-infections (most notably types 16 and 18). Whether HPV vaccination will change the distribution of hrHPVs at the population level is open, since competition between HPV types is not well understood. Two stratified random subcohorts (1983-1997 and 1995-2003) of 7,815 and 3,252 women with a minimum of 2 pregnancies (<32 years) were selected from the Finnish Maternity Cohort. Using ELISA based on virus-like particles (VLP), we determined antibodies to HPV11, 16, 18 and 31 in paired sera of the women and used Poisson regression models to estimate the risk of further infection with other HPV types in those positive for HPV16 or HPV18 at baseline. Baseline HPV16 seropositivity was associated with increased risk of later infections with HPV18 (3.1, 95% CI: 1.7, 5.6). HPV18 seropositivity was associated with increased risk of HPV16 (3.9, 95% CI: 2.5, 6.1).

Our observations favor a coinfection rather than superinfection model for the different HPV types and are not suggestive for type-replacement following HPV vaccination. (c) 2009 UICC.

The unique substrate specificity of human AOC2, a semicarbazide-sensitive amine oxidase

Kaitaniemi, S., Elovaara, H., Gron, K., Kidron, H., Liukkonen, J., Salminen, T., Salmi, M., Jalkanen, S. and Elima, K.

Cell Mol Life Sci. 2009. IF 5.511

Semicarbazide-sensitive amine oxidases (SSAOs) catalyze oxidative deamination of primary amines, but the true physiological function of these enzymes is still poorly understood. Here, we have studied the functional and structural characteristics of a human cell-surface SSAO, AOC2, which is homologous to the better characterized family member, AOC3. The preferred in vitro substrates of AOC2 were found to be 2-phenylethylamine, tryptamine and p-tyramine instead of methylamine and benzylamine, the favored substrates of AOC3. Molecular modeling suggested structural differences between AOC2 and AOC3, which provide AOC2 with the capability to use the larger monoamines as substrates. Even though AOC2 mRNA was expressed in many tissues, the only tissues with detectable AOC2-like enzyme activity were found in the eye. Characterization of AOC2 will help in evaluating the contribution of this enzyme to the pathological processes attributed to the SSAO activity and in designing specific inhibitors for the individual members of the SSAO family.

The impact of newly identified loci on coronary heart disease, stroke and total mortality in the MORGAM prospective cohorts

Karvanen, J., Silander, K., Kee, F., Tiret, L., Salomaa, V., Kuulasmaa, K., Wiklund, P. G., Virtamo, J., Saarela, O., Perret, C., Perola, M., Peltonen, L., Cambien, F., Erdmann, J., Samani, N. J., Schunkert, H. and Evans, A.

Genet Epidemiol. 2009; 33(3): 237-46. IF 2.203

Recently, genome wide association studies (GWAS) have identified a number of single nucleotide polymorphisms (SNPs) as being associated with coronary heart disease (CHD). We estimated the effect of these SNPs on incident CHD, stroke and total mortality in the prospective cohorts of the MORGAM Project. We studied cohorts from Finland, Sweden, France and Northern Ireland (total N=33,282, including 1,436 incident CHD events and 571 incident stroke events). The lead SNPs at seven loci identified thus far and additional SNPs (in total 42) were genotyped using a case-cohort design. We estimated the effect of the SNPs on disease history at baseline, disease events during follow-up and classic risk factors. Multiple testing was taken into account using false discovery rate (FDR) analysis. SNP rs1333049 on chromosome 9p21.3 was associated with both CHD and stroke (HR=1.20, 95% CI 1.08-1.34 for incident CHD events and 1.15, 0.99-1.34 for incident stroke). SNP rs11670734 (19q12) was associated with total mortality and stroke. SNP rs2146807 (10q11.21) showed some association with the fatality of acute coronary event. SNP rs2943634 (2q36.3) was associated with high density lipoprotein (HDL) cholesterol and SNPs rs599839, rs4970834 (1p13.3) and rs17228212 (15q22.23) were associated with non-HDL cholesterol. SNPs rs2943634 (2q36.3) and rs12525353 (6q25.1) were associated with blood pressure.

These findings underline the need for replication studies in prospective settings and confirm the candidacy of several SNPs that may play a role in the etiology of cardiovascular disease.

Integrated primary health care: Finnish solutions and experiences

Kokko, S.

Int J Integr Care. 2009; 9: e86.

BACKGROUND: Finland has since 1972 had a primary health care system based on health centres run and funded by the local public authorities called 'municipalities'. On the world map of primary health care systems, the Finnish solution claims to be the most health centre oriented and also the widest, both in terms of the numbers of staff and also of different professions employed. Offering integrated care through multi-professional health centres has been overshadowed by exceptional difficulties in guaranteeing a reasonable access to the population at times when they need primary medical or dental services. Solutions to the problems of access have been found, but they do not seem durable.

DESCRIPTION OF POLICY PRACTICE: During the past 10 years, the health centres have become a ground of active development structural change, for which no end is in sight. Broader issues of municipal and public administration structures are being solved through rearranging primary health services. In these rearrangements, integration with specialist services and with social services together with mergers of health centres and municipalities are occurring at an accelerated pace. This leads into fundamental questions of the benefits of integration, especially if extensive integration leads into the threat of the loss of identity for primary health care.

DISCUSSION: This article ends with some lessons to be learned from the situation in Finland for other countries.

Dioxins interfere with differentiation of osteoblasts and osteoclasts

Korkalainen, M., Kallio, E., Olkku, A., Nelo, K., Ilvesaro, J., Tuukkanen, J., Mahonen, A. and Viluksela, M.

Bone. 2009; 44(6): 1134-42. IF 4.145

We have previously shown that the environmental contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) affects bone growth, modelling and mechanical strength in vivo.

In this study, we utilized differentiation of bone marrow stem cells to osteoblasts and osteoclasts as a model system to study the effects of TCDD on bones. Stem cells were isolated from bone marrow of femurs and tibias of rats and mice. Progress of osteoblastic differentiation was monitored by measuring mRNA expression levels of differentiation markers from control and TCDD-treated cells using quantitative RT-PCR. TCDD significantly and dose-dependently decreased the mRNA levels of RUNX2, alkaline phosphatase and osteocalcin. Also the activity of alkaline phosphatase was significantly inhibited in both rat and mice cells. In the case of osteoclasts, TCDD decreased the number of TRACP+ multinucleated cells, with corresponding decreases in the number of F-actin rings and the area of resorption. Studies in AHR-knockout mice indicated that TCDD has no effect on the expression of osteoblastic differentiation markers suggesting that TCDD mediates its effects by AHR. Both osteoblastic and osteoclastic effects took place at very low doses of TCDD, as in most cases 100 fM TCDD was enough to significantly affect the differentiation markers. Therefore, differentiation of osteoblasts and osteoclasts from bone marrow stem cells seems to be a very sensitive target for TCDD. Disrupting effects in osteoblastic cells, in addition to disturbed osteoclastogenesis, may thus play a role in adverse effects on bone quality in TCDD exposed animals.

Reduced fluoroquinolone susceptibility in Salmonella enterica isolates from travelers, Finland

Lindgren, M. M., Kotilainen, P., Huovinen, P., Hurme, S., Lukinmaa, S., Webber, M. A., Piddock, L. J., Siitonen, A. and Hakanen, A. J.

Emerg Infect Dis. 2009; 15(5): 809-12. IF 6.449

We tested the fluoroquinolone susceptibility of 499 Salmonella enterica isolates collected from travelers returning to Finland during 2003-2007. Among isolates from travelers to Thailand and Malaysia, reduced fluoroquinolone susceptibility decreased from 65% to 22% (p = 0.002). All isolates showing nonclassical quinolone resistance were from travelers to these 2 countries.

Hospitalizations and deaths associated with Clostridium difficile infection, Finland, 1996-2004

Lyytikäinen, O., Turunen, H., Sund, R., Rasinperä, M., Könönen, E., Ruutu, P. and Keskimäki, I.

Emerg Infect Dis. 2009; 15(5): 761-5. IF 6.449

To determine whether the rate of Clostridium difficile-associated disease (CDAD) and CDAD-related deaths were increasing in Finland, we analyzed registry data from 1996 through 2004. We determined the number of hospital discharges that had a diagnosis code specific for CDAD from the International Classification of Diseases, 10th revision: "enterocolitis due to Clostridium difficile" (A04.7) and "pseudomembranous enterocolitis associated with antimicrobial therapy" (K52.8), listed as any diagnosis in the National Hospital Discharge Registry. CDAD-related deaths were identified from death certificates. Those discharged with a CDAD diagnosis doubled from 810 (16/100,000 population) in 1996 to 1,787 (34/100,000) in 2004. The increase was most prominent for patients 7gt;64 years of age but concerned only those discharged with diagnosis code A04.7. The number of those discharged with diagnosis code K52.8 remained stable. The age-standardized mortality rate associated with CDAD increased from 9/million in 1998 to 17/million in 2004; the increase was limited to persons 7gt;64 years of age.

Maternal care and birth outcomes among ethnic minority women in Finland

Malin, M. and Gissler, M.

BMC Public Health. 2009; 9: 84. IF 2.029

BACKGROUND: Care during pregnancy and labour is of great importance in every culture. Studies show that people of migrant origin have barriers to obtaining accessible and good quality care compared to people in the host society. The aim of this study is to compare the access to and use of maternity services, and their outcomes among ethnic minority women having a singleton birth in Finland.

METHODS: The study is based on data from the Finnish Medical Birth Register in 1999-2001 linked with the information of Statistics Finland on woman's country of birth, citizenship and mother tongue. Our study data included 6,532 women of foreign origin (3.9% of all singletons) giving singleton birth in Finland during 1999-2001 (compared to 158,469 Finnish origin singletons).

RESULTS: Most women have migrated during the last fifteen years, mainly from Russia, Baltic countries, Somalia and East Europe. Migrant origin women participated substantially in prenatal care. Interventions performed or needed during pregnancy and childbirth varied between ethnic groups. Women of African and Somali origin had most health problems resulted in the highest perinatal mortality rates. Women from East Europe, the Middle East, North Africa and Somalia had a significant risk of low birth weight and small for gestational age newborns. Most premature newborns were found among women from the Middle East, North Africa and South Asia. Primiparous women from Africa, Somalia and Latin America and Caribbean had most caesarean sections while newborns of Latin American origin had more interventions after birth.

CONCLUSION: Despite good general coverage of maternal care among migrant origin women, there were clear variations in the type of treatment given to them or needed by them. African origin women had the most health problems during pregnancy and childbirth and the worst perinatal outcomes indicating the urgent need of targeted preventive and special care. These study results do not confirm either healthy migrant effect or epidemiological paradox according to which migrant origin women have considerable good birth outcomes.

A comparison of hepatitis B seroepidemiology in ten European countries

Nardone, A., Anastassopoulou, C. G., Theeten, H., Kriz, B., Davidkin, I., Thierfelder, W., O'Flanagan, D., Bruzzone, B., Mossong, J., Boot, H. J., Butur, D., Slacikova, M., Panait, M. L. C., Hellenbrand, W., De Melker, H., Sobotova, Z., Icardi, G., Andrews, N., Pebody, R. G., Van Damme, P., Kafatos, G., Miller, E. and Hatzakis, A.

Epidemiology and Infection. 2009; 137(7): 961-969. Article. IF 2.360

To inform current and future vaccination strategies, we describe the seroepidemiology of hepatitis B virus (HBV) infection in ten representative European countries using standardized serology that allowed international comparisons. Between 1996 and 2003, national serum banks were compiled by collecting residual sera or by community sampling; sera were then tested by each country using its preferred enzyme immunoassays and testing algorithm, and assay results were standardized. Information on current and past HBV vaccination programmes in each country was also collected. Of the ten countries, six reported low levels (<3%) of antibodies against HBV core antigen (anti-HBc). Of the eight countries testing for HBV surface antigen (HBsAg), the highest prevalence was reported in Romania (5.6%) and in the remaining seven countries prevalence was <1%. Universal HBV vaccination programmes had been established in seven countries as recommended by the World Health Organization, but the seroprevalence of antibodies against HBsAg (anti-HBs) was lower than the reported vaccine coverage in three countries. Regular serological surveys to ascertain HBV status within a population, such as reported here, provide important data to assess the need for and to evaluate universal HBV vaccination programmes.

Are Patient Rights to Information and Self-Determination in Diagnostic Genetic Testing Upheld? A Comparison Of Patients' and Providers' Perceptions

Nyrhinen, T., Hietala, M., Puukka, P. and Leino-Kilpi, H.

Journal of Genetic Counseling. 2009; 18(1): 72-81. Article.

This study assessed how the patient's right to receive information and the right to self-determination were followed during diagnostic testing, according to the perceptions of patients and parents of tested children (group 1, n=106) and healthcare personnel (group 2, n=162). Data were collected in three Finnish university hospitals using a questionnaire. Results revealed one between group difference: patients/parents agreed more strongly than did personnel that self-determination was followed before testing. Within groups included: patients/parents had stronger agreement that self-determination was followed before testing than after testing; personnel had stronger agreement about information received after testing than before testing, and they had weaker agreement about how well self-determination was followed before testing than after testing. Received information was experienced as similar both before and after testing and by patients/parents and by personnel. Providing adequate time to consider whether or not to be tested and giving more support to patients after testing would promote the rights of patients. Furthermore, assessment of personnel characteristics is needed to determine, for example, the kinds of value conflicts that exist between personnel's own values and patients' values.

Personal invitations for population-based breast cancer screening

Saalasti-Koskinen, U., Mäkelä, M., Saarenmaa, I. and Autti-Rämö, I.

Acad Radiol. 2009; 16(5): 546-50. IF 2.021

RATIONALE AND OBJECTIVES: Women who are invited for breast cancer screening should get enough information about the benefits and harms of screening to make an informed decision on participation. Personal invitations are an important source of information, because all invited women receive them. The objective of this study was to evaluate the information breast cancer screening units send to women invited for screening in Finland.

MATERIALS AND METHODS: A questionnaire was sent to all breast cancer screening units in Finland in 2005 and 2008, and the information (eg, invitations, results letters, leaflets) the units sent to women was collected. Results from 2005 were sent as feedback to the units. Data were analyzed descriptively, and results from the 2 years were compared.

RESULTS: Screening units sent personal invitation letters usually providing fixed appointment times. Most units informed about participation free of charge and the benefits of detecting breast cancer early. Harm associated with screening was seldom mentioned; no unit mentioned the possibility of false-negative results or overtreatment.

CONCLUSION: The screening units provided very variable information, which often was biased toward optimizing participation. The high participation rate (approximately 88%) in Finland may be due partly to the prescriptive nature of the invitation letters. National templates for information letters would be useful.

Joint analysis of prevalence and incidence data using conditional likelihood

Saarela, O., Kulathinal, S. and Karvanen, J.

Biostatistics. 2009; 10(3): 575-587. Article. IF 3.394

Disease prevalence is the combined result of duration, disease incidence, case fatality, and other mortality. If information is available on all these factors, and on fixed covariates such as genotypes, prevalence information can be utilized in the estimation of the effects of the covariates on disease incidence. Study cohorts that are recruited as cross-sectional samples and subsequently followed up for disease events of interest produce both prevalence and incidence information. In this paper, we make use of both types of information using a likelihood, which is conditioned on survival until the cross section. In a simulation study making use of real cohort data, we compare the proposed conditional likelihood method to a standard analysis where prevalent cases are omitted and the likelihood expression is conditioned on healthy status at the cross section.

Maternal smoking during pregnancy and testicular cancer in the sons: a nested case-control study and a meta-analysis

Tuomisto, J., Holl, K., Rantakokko, P., Koskela, P., Hallmans, G., Wadell, G., Stattin, P., Dillner, J., Ogmundsdottir, H. M., Vartiainen, T., Lehtinen, M. and Pukkala, E.

Eur J Cancer. 2009; 45(9): 1640-8. Review. IF 4.475

Some large ecological studies have noted a significant association of testicular cancer (TC) with maternal smoking during pregnancy, while several more controlled studies have been negative. It has been difficult to obtain reliable data on exposure because of the long lag time to cancer diagnosis. We performed a case-control study nested within Finnish, Swedish and Icelandic maternity cohorts exploiting early pregnancy serum samples to evaluate the role of maternal smoking in the risk of TC in the offspring. After reviewing the literature, we also performed a meta-analysis of published studies. For each index mother of the TC patient, three to nine matched control mothers with a cancer-free son born at the same time as the TC case were identified within each cohort. First trimester sera were retrieved from the 70 index mothers and 519 control mothers and were tested for cotinine level by a novel HPLC-MS-MS method developed. No statistically significant association between maternal cotinine level and risk of TC in the offspring was found (OR 0.68; 95% CI 0.35, 1.34). This is the first study based on individual exposure measurements. Its results agree with our meta-analysis of seven previous epidemiological studies (total number of 2149 cases, 2762 controls) using indirect exposure assessment (OR 1.0; 95% CI 0.88, 1.12).

An outbreak of pneumonia associated with S-pneumoniae at a military training facility in Finland in 2006

Vainio, A., Lyytikäinen, O., Sihvonen, R., Kaijalainen, T., Teirilä, L., Rantala, M., Lehtinen, P., Ruuska, P. and Virolainen, A.

APMIS. 2009; 117(7): 488-491. Article. IF 1.316

Streptococcus pneumoniae is a well-known cause of community-acquired bacterial pneumonia. The purpose of this study was to assess the cause and extent of the outbreak of pneumonia which occurred among military recruits following a 1-week hard encampment in Finland. We also assessed the carriage rate and molecular characteristics of the S. pneumoniae isolates. All pneumococcal isolates were studied for antibiotic susceptibility, serotyped, genotyped by multilocus sequence typing (MLST), and the presence of pneumococcal rlrA pilus islet was detected. The genotype results defined by MLST corresponded with the serotype results. S. pneumoniae serotype 7F, ST2331, seemed to be associated with an outbreak of pneumonia and nasopharyngeal carriage among 43 military recruits. Of the 43 military recruits, five (12%) were hospitalized with pneumonia and two (40%) of them were positive for S. pneumoniae serotype 7F, ST2331 by blood culture. Eighteen (42%) of the 43 men were found to be positive for S. pneumoniae by nasopharyngeal culture, and nine (50%) of them carried pneumococcal serotype 7F, ST2331. The outbreak strain covered 55% of all the pneumococcal findings. Outbreaks of invasive pneumococcal disease seem to occur in a crowded environment such as a military training facility even among previously healthy young men.

SARS knowledge, perceptions, and behaviors: a comparison between Finns and the Dutch during the SARS outbreak in 2003

Vartti, A. M., Oenema, A., Schreck, M., Uutela, A., de Zwart, O., Brug, J. and Aro, A. R.

Int J Behav Med. 2009; 16(1): 41-8. IF 1.437

BACKGROUND: The SARS outbreak served to test both local and international outbreak management and risk communication practices.

PURPOSE: The study compares SARS knowledge, perceptions, behaviors, and information between Finns and the Dutch during the SARS outbreak in 2003.

METHOD: The participants of the study, who used a modified SARS Psychosocial Research Consortium survey, were drawn from Internet panels in Finland (n = 308) and the Netherlands (n = 373) in June 2003. Multiple logistic regression analyses were used to calculate odds ratios (with 95% confidence intervals) to compare Finns with the Dutch for various levels of perceptions and behaviors.

RESULTS: Adjusted for age, education, and income, Finns were more likely to be knowledgeable and worried about SARS as well as to have low perceived comparative SARS risk and poor personal efficacy beliefs about preventing SARS. Finns were also more likely than the Dutch to have high confidence in physicians on SARS issues but less likely to have received information from the Internet and have confidence in Internet information.

CONCLUSIONS: The study shed light on how two European populations differed substantially regarding lay responses to SARS. Understanding these differences is needed in formulating and executing communication and outbreak management.

Survival of amoebae on building materials

Yli-Pirilä, T., Kusnetsov, J., Hirvonen, M. R., Seuri, M. and Nevalainen, A.

Indoor Air. 2009; 19(2): 113-21. IF 3.151

Moisture damage and concurrent microbial growth in buildings are associated with adverse health effects among the occupants. However, the causal agents for the symptoms are unclear although microbes are assumed to play a major role. Fungi and bacteria are not the only microbes inhabiting moist building materials; it was recently revealed that amoebae are also present. As amoebae have the potential to harbor many pathogens and to modulate the characteristics of growing microbes, a better appreciation of the growth and survival of amoebae in moisture damage conditions will add to the understanding of their effects on health outcomes. In this study, we investigated the ability of amoebae to survive on six building materials. Furthermore, both aged and unused materials were tested. Amoebae survived on gypsum board and mineral wool for the whole 2 months experiment even without additional sustenance. When sustenance (heat-killed bacteria) was available, aged pine wood and birch wood also allowed their survival. In contrast, amoebae were quickly killed on fresh pine wood and they did not survive on concrete or linoleum. In conclusion, our data show that amoebae can persist on several common building materials once these materials become wet. PRACTICAL IMPLICATIONS: Amoebae are able to survive on many building materials should the materials become wet. Amoebae have the potential to increase growth, cytotoxicity, and pathogenicity of other microbes present in moisture damages, and they may carry potentially pathogenic bacteria as endosymbionts and thus introduce them into the indoor air. Therefore, amoebae may have a prominent role in the microbial exposures occurring in moisture-damaged buildings. The presence of amoebae could be usefully included in reporting the microbial damage of material samples.