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Identification of alpha-haemolytic streptococci by
pyrosequencing the 16S rDNA and by Vitek 2
Haanperä, M., Jalava, J., Huovinen, P., Meurman, O. and Rantakokko-Jalava, K. J Clin Microbiol. 2007. IF 3.537 Alpha-haemolytic streptococci are very difficult to identify by phenotypic methods. In this study, a pyrosequencing method for the identification of streptococcal species based on two variable regions of the 16S rDNA is described. Almost all studied streptococcal species (n=51) represented by their type strains could be differentiated except for some closely related species of the S. bovis or S. salivarius group. The pyrosequencing results of alpha-haemolytic streptococci isolated from blood (n=99) or from the normal pharyngeal microbiota (n=25) were compared to the results obtained by the Vitek 2 with GP card (bioMerieux, Marcy l'Etoile, France). As expected, the results of the two methods did not completely agree, but 93 (75.0%) of the isolates were identified to the same streptococcal group by both methods and 57 (46.0%) reached consistent results at the species-level. However, ten strains remained unidentified by Vitek 2 and four isolates could not be designated to any streptococcal group by pyrosequencing. Identification of members of the S. mitis and S. sanguinis groups proved difficult for both methods. Furthermore, the pyrosequencing analysis revealed great sequence variation, as only 43 (32.3%) of the 133 isolates analysed by pyrosequencing had sequences identical to a type strain. The variation was greatest in the pharyngeal isolates, slightly lower in the blood culture isolates and nonexistent in invasive pneumococcal isolates (n=17) that all had the S. pneumoniae type strain sequence. The resolution of the results obtained by the two methods is impeded by the lack of a proper golden standard. Efficacy and safety of food fortification with calcium among adults in Finland Hirvonen, T., Tapanainen, H., Valsta, L., Hannila, M. L., Aro, A. and Pietinen, P. Public Health Nutr. 2006; 9(6): 792-7. IF 1.918 OBJECTIVE: To examine the efficacy and safety of foods fortified with calcium in the adult population in Finland. DESIGN: A simulation study based on the FINDIET 2002 Survey, which estimated habitual food consumption, dietary supplement use and nutrient intakes using 48-hour recall and two 3-day food records, and an Internet survey of the consumption of fortified foods and dietary supplements. SETTING/PARTICIPANTS: Participants of FINDIET 2002 were 25-64 years old from five areas (n = 2007). Participants of the Internet-based survey (n = 1537) were over 15 years of age from all over the country. RESULTS: If all potentially fortifiable foods were to be fortified with calcium, the proportion of participants with calcium intake below the recommended level (< 800 mg day(-1)) would decrease from 20.3% to 3.0% in men and from 27.8% to 5.6% in women compared with the situation where no foods were fortified. At the same time, the proportion of participants with calcium intake above the tolerable upper intake level (UL, > 2500 mg day(-1)) would increase from 0.6% to 12.7% in men and from 0.1% to 3.8% in women. However, in a probability-based model (11% of all fortifiable foods to be fortified with calcium) the proportion of participants with calcium intake below the recommended level would be 15.7% in men and 23.2% in women. The proportion with intake above the UL in this model would be 1.2% in men and 0.7% in women. CONCLUSIONS: Food fortification would be a relatively effective and safe way to increase the calcium intake of the Finnish adult population. Body mass index and the risk of Parkinson disease Hu, G., Jousilahti, P., Nissinen, A., Antikainen, R., Kivipelto, M. and Tuomilehto, J. Neurology. 2006; 67(11): 1955-1959. Article. IF 5.065 Objective: To examine the association between body mass index (BMI) and the risk of Parkinson disease (PD). Methods: Study cohorts included 22,367 Finnish men and 23,439 women 25 to 59 years of age without a history of PD at baseline. Hazards ratios (HRs) of incident PD were estimated for different levels of BMI. Results: During a mean follow-up period of 18.8 years, 272 men and 254 women developed incident PD. After adjustment for confounding factors ( age, study years, systolic blood pressure, total cholesterol, education, leisure-time physical activity, smoking, and alcohol, coffee, and tea consumption), the HRs of PD at different levels of BMI (< 23, 23 to 24.9, 25 to 26.9, 27 to 29.9, and >= 30 kg/m(2)) were 1.00, 1.97 (95% CI: 1.21 to 3.22), 1.83 (95% CI: 1.12 to 2.99), 2.34 (95% CI: 1.45 to 3.78), and 2.44 (95% CI: 1.44 to 4.15) in men, and 1.00, 1.50 (95% CI: 0.95 to 2.37), 1.65 (95% CI: 1.05 to 2.59), 1.79 (95% CI: 1.15 to 2.80), and 1.77 (95% CI: 1.12 to 2.78) in women, and 1.00, 1.70 (95% CI: 1.23 to 2.37), 1.70 (95% CI: 1.23 to 2.37), 2.02 (95% CI: 1.46 to 2.79), and 2.03 (95% CI: 1.44 to 2.85) in men and women combined (adjusted also for sex). In both sexes combined, the multivariate-adjusted direct association between BMI and the risk of PD was present both in subjects aged 25 to 49 years and 50 to 59 years, in never smokers and smokers and in participants diagnosed PD before and after 65 years of age. Conclusion: Body mass index is associated with a risk of Parkinson disease. The effect is graded and independent of other risk factors. Huovinen, E., Harkanen, T., Martelin, T., Koskinen, S. and Aromaa, A. Int J Epidemiol. 2006; 35(5): 1246-52. 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. From genes to systems: new global strategies for the characterization of NCL biology Jalanko, A., Tyynelä, J. and Peltonen, L. Biochim Biophys Acta. 2006; 1762(10): 934-44. IF 2.418 Neuronal ceroid lipofuscinoses (NCL) are rare neurological disorders with a uniform phenotype, caused by mutations in seven known genes. NCL provide a unique model to characterize molecular pathways critical for normal neuronal development and pathological neuronal degeneration. Systems biology based approach utilizes the rapidly developing tools of genomics, proteomics, lipidomics and metabolomics and aims at thorough understanding of the functions of cells, tissues and whole organisms by molecular analysis and biocomputing-assisted modeling. The systems level understanding of NCL is now possible by utilizing different model organisms. Initial work has revealed disturbed metabolic pathways in several NCL disorders and most analyses have utilized the infantile (INCL/CLN1) and juvenile (JNCL/CLN3) disease modeling and utilized mainly human and mouse samples. To date, the data obtained from transcript and lipidomic profiling has pinpointed the role of lipid metabolism and synaptic function in the infantile NCL. Changes in glutamate utilization and amino acid metabolism have been a common theme emerging from the transcript and metabolite profiling of the juvenile NCL. Further experimental models are being developed and systematic sample collection as well as data integration projects are needed. The combined analyses of the global information should provide means to expose all the NCL-associated molecular pathways. Kastarinen, M., Laatikainen, T., Salomaa, V., Jousilahti, P., Antikainen, R., Tuomilehto, J., Nissinen, A. and Vartiainen, E. J Hypertens. 2007; 25(2): 299-305. IF 5.218 OBJECTIVE: To assess the trends in blood pressure (BP) affecting lifestyle factors in hypertensive and normotensive Finns from 1982 to 2002. DESIGN AND SETTING: Five independent cross-sectional population surveys conducted in 1982, 1987, 1992, 1997 and 2002 in the provinces of North Karelia and Kuopio in eastern Finland and the region of Turku-Loimaa in southwestern Finland. PARTICIPANTS: Stratified random samples of men and women aged 25-64 years were drawn from the national population register. The participants (n = 28 235) were classified into four groups according to their BP level and treatment status: normotensive, unaware hypertensive, aware but untreated hypertensive, and treated hypertensive subjects. MAIN OUTCOME MEASURES: Alcohol intake, body mass index (BMI), 24-h urinary sodium and potassium excretion (a subsample of 5849 subjects) and the proportion of subjects with leisure-time physical activity (LTPA) at least three times a week. RESULTS: Mean BMI increased significantly in all groups except in untreated hypertensive women. Alcohol intake increased in all men but especially in hypertensive women (P < 0.001). The 24-h urinary sodium excretion decreased significantly in all BP groups. The proportion of subjects with a recommended level of LTPA increased significantly and similarly in all BP groups (P < 0.001). CONCLUSIONS: The unfavourable trends observed in mean BMI and alcohol intake in the entire population should be reversed in order to decrease the frequency of hypertension in Finland. The health behaviours of hypertensive subjects should be carefully monitored and modified in a more systematic and efficient way than at present. Nasopharyngeal colonization: a target for pneumococcal vaccination Käyhty, H., Auranen, K., Nohynek, H., Dagan, R. and Mäkelä, H. Expert Review of Vaccines. 2006; 5(5): 651-667. Review. The pneumococcal conjugate vaccine (PCV), licensed in 2000, is highly efficient in preventing serious disease caused by serotypes in the vaccine and also prevents symptomless colonization of the nasopharynx. Prevention of this first step in the infection cycle has important consequences: it reduces chances of spread of the infection and indirectly protects from disease. Through these indirect effects, the protection afforded by the vaccine extends to the whole population, including those not vaccinated (herd immunity). Already now, after 5 years of wide use of PCV for infant immunization in the USA, more cases are prevented through the indirect effects than by vaccine-induced immunity in those vaccinated. The extended protection increases the cost-effectiveness of PCV and should clearly encourage its use in poorly resourced countries. However, the accumulated experience also shows that the herd immunity, due to PCV, is partly offset by replacement of the vaccine serotypes by other, nonvaccine serotypes. Owing to the general reduced virulence of the latter, this has only had a modest effect on disease, but the possibility of more virulent nonvaccine serotypes arising cannot be ignored and should be the focus of continued surveillance. Kestilä, L., Koskinen, S., Martelin, T., Rahkonen, O., Pensola, T., Pirkola, S., Patja, K. and Aromaa, A. Eur J Public Health. 2006; 16(6): 617-26. IF 1.118 AIMS: To assess the association of parental education, childhood living conditions and adversities with daily smoking in early adulthood and to analyse the effect of the respondent's own education, main economic activity, and current family structure on these associations. METHODS: The study is based on a representative two-stage cluster sample (N = 1894, participation rate 79%) of young adults aged 18-29, in 2000, in Finland. The outcome measure is daily smoking. RESULTS: Parental smoking and the respondent's own education had the strongest effects on daily smoking. If both parents of the respondent were smokers, then the respondent was most likely to be a smoker too (for men OR (odds ratio) = 3.01, for women OR = 2.41 after all adjustments). Young adults in the lowest educational category had a much higher risk of daily smoking than those in the highest category (OR = 5.88 for women, 4.48 for men). For women parental divorce (OR = 2.31) and current family structure also determined daily smoking. Parental education had a strong gradient in daily smoking and the effect appeared to be mediated largely by the respondent's own educational level. CONCLUSIONS: Childhood living conditions are strong determinants of daily smoking. Much of their influence seems to be mediated through current living conditions, which are also determined by childhood conditions. Determinants of smoking behaviour are developed throughout the life course. The findings stress the importance of the respondent's education and parental smoking as determinants of smoking behaviour. Our results support the notion that intervention on smoking initiation and cessation should be considered throughout the life course. Parental involvement in fostering non-smoking would be important. Job Strain and Adverse Health Behaviors: The Finnish Public Sector Study Kouvonen, A., Kivimäki, M., Väänänen, A., Heponiemi, T., Elovainio, M., Ala-Mursula, L., Virtanen, M., Pentti, J., Linna, A. and Vahtera, J. J Occup Environ Med. 2007; 49(1): 68-74. IF 1.886 OBJECTIVE:: The objective of this study was to explore the association between job strain and the co-occurrence of adverse health behaviors; smoking, heavy drinking, obesity, and physical inactivity. METHODS:: The authors studied cross-sectional data of 34,058 female and 8154 male public sector employees. RESULTS:: Multinomial logistic regression models adjusted for sex, age, basic education, marital status, and type of job contract showed that high job strain and passive jobs were associated with 1.3 to 1.4 times higher odds of having >/=3 (vs 0) adverse health behaviors. Among men, low job control was associated with a 1.3-fold likelihood and among women active jobs were associated with a 1.2-fold likelihood of having >/=3 (vs 0) adverse behaviors. High demands were associated with a higher likelihood of co-occurrence of one to two (vs 0) adverse behaviors among women. CONCLUSIONS:: Job strain conditions may be associated with the co-occurrence of adverse health behaviors that contribute to preventable chronic diseases. CLINICAL SIGNIFICANCE:: Adverse job conditions may increase the likelihood of co-occurring health risk behaviors. Reducing work stress by increasing job control and decreasing psychologic demands might help efforts to promote healthy lifestyles. Functional biology of the neuronal ceroid lipofuscinoses (NCL) proteins Kyttälä, A., Lahtinen, U., Braulke, T. and Hofmann, S. L. Biochim Biophys Acta. 2006; 1762(10): 920-33. IF 2.418 Neuronal ceroid lipofucinoses (NCLs) are a group of severe neurodegenerative disorders characterized by accumulation of autofluorescent ceroid lipopigment in patients' cells. The different forms of NCL share many similar pathological features but result from mutations in different genes. The genes affected in NCLs encode both soluble and transmembrane proteins and are localized to ER or to the endosomes/lysosomes. Due to selective vulnerability of the central nervous system in the NCL disorders, the corresponding proteins are proposed to have important, tissue specific roles in the brain. The pathological similarities of the different NCLs have led not only to the grouping of these disorders but also to suggestion that the NCL proteins function in the same biological pathway. Despite extensive research, including the development of several model organisms for NCLs and establishment of high-throughput techniques, the precise biological function of many of the NCL proteins has remained elusive. The aim of this review is to summarize the current knowledge of the functions, or proposed functions, of the different NCL proteins. Insulin, glucose, insulin resistance, and incident colorectal cancer in male smokers Limburg, P. J., Stolzenberg-Solomon, R. Z., Vierkant, R. A., Roberts, K., Sellers, T. A., Taylor, P. R., Virtamo, J., Cerhan, J. R. and Albanes, D. Clinical Gastroenterology and Hepatology. 2006; 4(12): 1514-1521. Article. Background & Aims: Hyperinsulinemia is a putative colorectal cancer (CRC) risk factor. Insulin resistance (IR) commonly precedes hyperinsulinemia and can be quantitatively measured by using the homeostasis model assessment-insulin resistance (HOMA-IR) index. To date, few studies have directly examined serum insulin as an indicator of CRC risk, and none have reported associations on the basis of HOMA-IR. Methods: We performed a case-cohort study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study (n = 29,133). Baseline exposure and fasting serum biomarker data were available for 134 incident CRC case and 399 non-case subjects. HOMA-IR was derived as fasting insulin X fasting glucose/22.5. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by using age-adjusted and multivariable-adjusted Cox proportional hazards regression models. Results: Median (interquartile range) values for serum insulin, glucose, and HOMA-IR were 4.1 (2.9-7.2) mIU/L, 101 (94-108) mg/dL, and 0.99 (0.69-1.98) for case subjects and 4.1 (2.7-6.1) mIU/L, 99 (93-107) mg/dL, and 1.02 (0.69-1.53) for non-case subjects, respectively. On the basis of comparison of the highest versus lowest quartiles for each biomarker, insulin (HR, 1.84; 95% CI, 1.03-3.30) and HOMA-IR (HR, 1.85; 95% CI, 1.06-3.24) were significantly associated with incident CRC, whereas glucose was marginally associated with incident CRC (HR, 1.70; 95% CI, 0.92-3.13) in age-adjusted risk models. However, trends across biomarker quartiles were somewhat inconsistent (P trend = .12, .04, and .12, respectively), and multivariable adjustment generally attenuated the observed risk estimates. Conclusions: Data from this prospective study of male smokers provide limited support for hyperinsulinemia, hyperglycemia, and/or insulin resistance as CRC risk factors. Nohynek, H. Euro Surveill. 2006; 11(11): E061116 4. Reinivuo, H., Valsta, L. M., Laatikainen, T., Tuomilehto, J. and Pietinen, P. Eur J Clin Nutr. 2006; 60(10): 1160-7. IF 2.163 OBJECTIVE: To estimate cross-sectional and long-term dietary sodium intakes and sources in Finland, and to evaluate the validity of 48-h recall to assess sodium intake. DESIGN: Cross-sectional dietary surveys and food availability data (Food Balance Sheets). SETTING: Dietary surveys were carried out in Finland in 1992, 1997 and 2002. Food availability data were collected from 1980 to 1999. SUBJECTS: A stratified random sample was drawn from the population register. The total number of participants in the three dietary surveys was 6730. In the subsample for urine collection, the number of participants was 879. INTERVENTIONS: Nutrient intakes were estimated on the basis of a 3-day food diary in 1992, a 24-h recall in 1997 and a 48-h recall in 2002. The 24-h urinary excretion of sodium was used to validate sodium intake. In addition, salt intake was estimated based on Food Balance Sheets. RESULTS: Sodium intake has slowly decreased since the early 1980s. Reported daily sodium intake correlated significantly with sodium excretion. CONCLUSIONS: Sodium intake has decreased during the last two decades, but is still higher than the recommended daily intake. Sodium intake estimation based on dietary surveys and food availability data is a valid method provided that the food composition database is up to date and of good quality. SPONSORSHIP: All surveys were funded by the National Public Health Institute in Finland and the Ministry of Social Affairs and Health. Antidepressant use among children and adolescent in Finland: A register-linkage study, 1994-2003 Sihvo, S., Sevon, T., Haukka, J., Hemminki, E., Keskimaki, I., Lumme, S., McCallum, A. and Wahlbeck, K. Pharmacoepidemiology and Drug Safety. 2006; 15: S16-S17. Meeting Abstract. IF 1.773 Persistence of antidepressant use in Finland: A register-linkage study, 1994-2003 Sihvo, S., Sevon, T., Haukka, J., Hemminki, E., Keskimaki, I., Lumme, S., McCallum, A. and Wahlbeck, K. Pharmacoepidemiology and Drug Safety. 2006; 15: S226-S227. Meeting Abstract. IF 1.773 Simell, B., Jaakkola, T., Lahdenkari, M., Briles, D., Hollingshead, S., Kilpi, T. M. and Käyhty, H. Clin Vaccine Immunol. 2006; 13(10): 1177-9. Pneumococcal neuraminidase, NanA, is a pneumococcal vaccine candidate. Prior culture-confirmed pneumococcal contacts were shown to induce serum anti-NanA antibodies during the first 2 years of life. The antibody concentrations at neither 12 nor 18 months were significantly associated with the risk of subsequent pneumococcal carriage or acute otitis media. HIV epidemiology in the northwestern Federal District of Russia: Dominance of HIV type 1 subtype A Smolskaya, T., Liitsola, K., Zetterberg, V., Golovanova, E., Kevlova, N., Konovalova, N., Sevastianova, K., Brummer-Korvenkontio, H. and Salminen, M. AIDS Research and Human Retroviruses. 2006; 22(11): 1074-1080. Article. IF 2.531 A rapidly advancing epidemic of HIV-1 infection has been documented among injecting drug users (IDUs) in Russia. The Northwestern Federal District was the first of the seven Russian Federal Districts involved in a drug-related HIV epidemic through an outbreak in Kaliningrad in 1996. The Northwestern Federal District has a high HIV prevalence rate having reached 252 per 100,000 by the end of 2003, exceeding the Russian average (180) by 1.4 times. The epidemic peaked in 2001. Since then the annual number of new cases has decreased, probably reflecting saturation among at least some IDU populations. However, at the same time, the heterosexual spread of HIV has become more prominent. To study the genetic epidemiology of HIV-1, samples were collected from 150 individuals covering a wide geographical area and different transmission groups in the Northwestern Federal District. Phylogenetic analysis revealed that an Eastern European subtype A HIV-1 strain similar to those reported earlier among IDUs in other regions of Russia accounted for 80% of HIV-1 infections and was the predominant subtype in six out of seven administrative territories studied both among IDUs and heterosexually infected persons. As an exception to the dominant role of the Eastern European subtype A strain, the CRF03-AB strain was found to be dominant in the city of Cherepovets located in the north central European Russian territory of Vologda Oblast. This is the first report of the CRF03-AB strain causing an outbreak outside the Kaliningrad region. 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. Int J Epidemiol. 2006; 35(5): 1255-61. 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. Vaarala, O. Ann N Y Acad Sci. 2006; 1079: 350-9. IF 1.971 In humans the primary trigger of insulin-specific immunity is a modified self-antigen, that is, dietary bovine insulin, which breaks neonatal tolerance to self-insulin. The immune response induced by bovine insulin spreads to react with human insulin. This primary immune response induced in the gut immune system is regulated by the mechanisms of oral tolerance. Genetic factors and environmental factors, such as the gut microflora, breast milk-derived factors, and enteral infections, control the development of oral tolerance. The age of host modifies the immune response to oral antigens because the permeability of the gut decreases with age and mucosal immune response, such as IgA response, develops with age. The factors that control the function of the gut immune system may either be protective from autoimmunity by supporting tolerance, or they may induce autoimmunity by abating tolerance to dietary insulin. There is accumulating evidence that the intestinal immune system is aberrant in children with type 1 diabetes (T1D). Intestinal immune activation and increased gut permeability are associated with T1D. These aberrancies may be responsible for the impaired control of tolerance to dietary insulin. Later in life, factors that activate insulin-specific immune cells derived from the gut may switch the response toward cytotoxic immunity. Viruses, which infect beta cells, may release autoantigens and potentiate their presentation by an infection-associated "danger signal." This kind of secondary immunization may cause functional changes in the dietary insulin primed immune cells, and lead to the infiltration of insulin-reactive T cells to the pancreatic islets. The effects of a three-year smoking prevention programme in secondary schools in Helsinki Vartiainen, E., Pennanen, M., Haukkala, A., Dijk, F., Lehtovuori, R. and De Vries, H. Eur J Public Health. 2007. IF 1.118 BACKGROUND: This study evaluates the effects of a 3-year smoking prevention programme in secondary schools in Helsinki. The study is part of the European Smoking prevention Framework Approach (ESFA), in which Denmark, Finland, the Netherlands, Portugal, Spain and the UK participated. METHODS: A total of 27 secondary schools in Finland participated in the programme (n = 1821). Schools were randomised into experimental (13) and control groups (14). The programme included 14 information lessons about smoking and refusal skills training. The 3-year smoking prevention programme was also integrated into the standard curriculum. The community-element of the programme included parents, parish confirmation camps and dentists. The schools in the experimental group received the prevention programme and the schools in the control group received the standard health education curriculum. RESULTS: Among baseline never smokers (60.8%), the programme had a significant effect on the onset of weekly smoking in the experimental group [OR = 0.63 (0.45-0.90) P = 0.009] when compared with the control group. Being female, doing poorly at school, having parents and best friends who smoke and more pocket money to spend compared with others were associated with an increased likelihood of daily and weekly smoking onset. These predictors did not have an interaction effect with the experimental condition. CONCLUSION: This study shows that a school- and community-based smoking prevention programme can prevent smoking onset among adolescents. Villa, L. L., Costa, R. L. R., Petta, C. A., Andrade, R. P., Paavonen, J., Iversen, O. E., Olsson, S. E., Hoye, J., Steinwall, M., Riis-Johannessen, G., Andersson-Ellstrom, A., Elfgren, K., von Krogh, G., Lehtinen, M., Malm, C., Tamms, G. M., Giacoletti, K., Lupinacci, L., Railkar, R., Taddeo, F. J., Bryan, J., Esser, M. T., Sings, H. L., Saah, A. J. and Barr, E. British Journal of Cancer. 2006; 95(11): 1459-1466. Article. IF 4.115 Human papillomavirus (HPV) causes cervical, vulvar, and vaginal cancers, precancerous dysplasia, and genital warts. We report data for the longest efficacy evaluation to date of a prophylactic HPV vaccine. In total, 552 women (16-23 years) were enrolled in a randomised, placebo-controlled study of a quadrivalent HPV 6/11/16/18L1 virus-like-particle vaccine with vaccination at months 0, 2, and 6. At regular intervals through 3 years, subjects underwent gynaecologic examination, cervicovaginal sampling for HPV DNA, serum anti-HPV testing, and Pap testing, with follow-up biopsy as indicated. A subset of 241 subjects underwent two further years of follow-up. At 5 years post enrolment, the combined incidence of HPV 6/11/16/18-related persistent infection or disease was reduced in vaccine-recipients by 96% (two cases vaccine versus 46 placebo). There were no cases of HPV 6/11/16/18-related precancerous cervical dysplasia or genital warts in vaccine recipients, and six cases in placebo recipients (efficacy = 100%; 95% CI:12-100%). Through 5 years, vaccine-induced anti-HPV geometric mean titres remained at or above those following natural infection. In conclusion, a prophylactic quadrivalent HPV vaccine was effective through 5 years for prevention of persistent infection and disease caused by HPV 6/11/16/18. This duration supports vaccination of adolescents and young adults, which is expected to greatly reduce the burden of cervical and genital cancers, precancerous dysplasia, and genital warts. |