18.12.2006

Aalto, M., Tuunanen, M., Sillanaukee, P. and Seppä, K.

Alcohol Clin Exp Res. 2006; 30(11): 1884-8. 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 > or =6, for the AUDIT-C with cutoff > or =5, for the Five Shot with cutoff > or =2.0, for the AUDIT-PC with cutoff > or =4, and for the AUDIT-QF with cutoff > or =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.

Macrolide and azithromycin use are linked to increased macrolide resistance in Streptococcus pneumoniae

Bergman, M., Huikko, S., Huovinen, P., Paakkari, P. and Seppälä, H.

Antimicrob Agents Chemother. 2006; 50(11): 3646-50. IF 4.379

The connection between regional rates of antimicrobial resistance in Streptococcus pneumoniae and regional antimicrobial use in Finland was investigated.

During the 6-year study period of 1997 to 2002, a total of 31,609 S. pneumoniae isolates were tested for penicillin resistance and a total of 23,769 isolates were tested for macrolide resistance in 18 central hospital districts in Finland. The regional macrolide resistance rates were compared with the local use of (i) all macrolides pooled and (ii) azithromycin. The penicillin resistance levels were compared with the consumption data for (i) penicillins, (ii) cephalosporins, (iii) all beta-lactams pooled, and (iv) all macrolides pooled. A statistically significant association between macrolide resistance and total use of macrolides and the use of azithromycin was found. Moreover, total use of beta-lactams and total use of cephalosporins were significantly connected to low-level penicillin resistance. A statistically significant association between penicillin-nonsusceptible isolates and penicillin or total macrolide consumption was not found. In conclusion, total macrolide use and azithromycin use are associated with increased macrolide resistance, and beta-lactam use and cephalosporin use are connected to increased low-level penicillin resistance in S. pneumoniae.

Unnecessary prescribing of macrolides and cephalosporins should be avoided.

Early growth, and coronary heart disease and type 2 diabetes: experiences from the Helsinki Birth Cohort Studies

Eriksson, J. G.

International Journal of Obesity. 2006; 30: S18-S22. Article. IF 4.482

Experiences during critical periods of development through the mechanisms of programming have consequences on later health outcomes. Observations worldwide linking a small body size at birth with adult health outcomes have greatly added to our understanding of the early origins of several non-communicable diseases like coronary heart disease (CHD) and type 2 diabetes. The pattern of growth predisposing to CHD is characterized by a small body size at birth and thinness through infancy up to 2 years of age, followed by accelerated gain in weight and body mass index (BMI) later in childhood. The early growth patterns of individuals who later develop type 2 diabetes very much resemble the growth patterns of CHD, that is, a small body size at birth and thinness at 1 year of age followed by higher body mass indices later in childhood. Numerous studies support the importance of events during critical periods of growth in the pathogenesis of many non-communicable diseases like CHD and type 2 diabetes. There are several possible mechanisms through which a non-optimal early growth associated with accelerated weight gain in childhood could lead to these diseases.

To get a better understanding of the patterns of growth affecting adult health outcomes, a life-course approach to the development of chronic diseases needs to be taken.

Rural-urban differences in health and health behaviour: A baseline description of a community health-promotion programme for the elderly

Fogelholm, M., Valve, R., Absetz, P., Heinonen, H., Uutela, A., Patja, K., Karisto, A., Konttinen, R., Makela, T., Nissinen, A., Jallinoja, P., Nummla, O. and Talja, M.

Scandinavian Journal of Public Health. 2006; 34(6): 632-640. Article. IF 0.727

Study objective: To ( 1) describe the setting and design of the Good Ageing in Lahti Region ( GOAL) programme; ( 2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals.

Design: The baseline data of a cohort study of ageing individuals living in three community types ( urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments.

Setting: Fourteen municipalities in the Lahti region (Paijat-Hame County) in Finland.

Participants: A regionally and locally stratified random sample of men and women born in 1946-50, 1936-40, and 1926-30. A total of 4,272 were invited and 2,815 (66%) participated.

Main results: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (< 2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semiurban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p < 0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43).

Conclusions: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Paijat-Hame County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Methodologic considerations in the measurement of glycemic index: glycemic response to rye bread, oatmeal porridge, and mashed potato

Hatonen, K. A., Simila, 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.

Trends in the magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland during 1994-2004

Helasoja, V., Lahelma, E., Prattala, R., Klumbiene, J., Pudule, I. and Tekkel, M.

Public Health. 2006; 120(9): 841-53. IF 0.986

BACKGROUND: Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland.

METHODS: The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11,634) and Finland (n=18,821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms.

RESULTS: The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women.

CONCLUSIONS: The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.

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): 1955-9. 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 > or =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.

Joint association of coffee consumption and other factors to the risk of type 2 diabetes: a prospective study in Finland

Hu, G., Jousilahti, P., Peltonen, M., Bidel, S. and Tuomilehto, J.

International Journal of Obesity. 2006; 30(12): 1742-1749. Article. IF 4.482

Objective: To examine joint associations of coffee consumption and other factors ( including physical activity, obesity and alcohol consumption) with the risk of type 2 diabetes. Design: Prospective follow-up study.

Subjects: In all, 10188 Finnish men and 11197 women aged 35-74 years without a history of stroke, coronary heart disease or diabetes at baseline.

Measurement: A self-administered questionnaire data on coffee, tea, alcohol and other food consumption, physical activity, smoking, socio-economic factors and medical history, together with measured height, weight and blood pressure using standardized protocol.

Results: During a mean follow-up of 13.4 years, there were 964 incident cases of type 2 diabetes. Multivariate-adjusted (age, study year, systolic blood pressure, education, smoking, physical activity, body mass index (BMI) and fruit, vegetable, sausage, bread, alcohol and tea consumption) hazard ratio of type 2 diabetes in participants who drank 0-2, 3-6 and >= 7 cups of coffee were 1.00, 0.77 and 0.66 (P = 0.022 for trend) in men, 1.00, 0.71 and 0.52 (P = 0.001 for trend) in women, and 1.00, 0.75 and 0.61 (P < 0.001 for trend) in men and women combined (adjusted also for sex), respectively. This inverse association was consistent in subjects with any joint levels of physical activity and BMI, and in alcohol drinkers and non-drinkers. Among obese and inactive people, coffee drinking of seven cups or more daily reduced the risk of type 2 diabetes to half.

Conclusions: Coffee drinking was associated with a reduced risk of type 2 diabetes in both men and women, and this association was observed regardless of the levels of physical activity, BMI and alcohol consumption.

Long-term psychosocial effects of parental divorce: a follow-up study from adolescence to adulthood

Huurre, T., Junkkari, H. and Aro, H.

Eur Arch Psychiatry Clin Neurosci. 2006; 256(4): 256-63. IF 2.264

OBJECTIVE: The purpose of this 16-year follow-up study was to investigate whether 32-year-old adults who had experienced parental divorce before 16 years of age (n = 317) differed in psychosocial well-being or life trajectories from those from non-divorced two-parent families (n = 1069).

METHOD: The data were obtained from a follow-up survey of a Finnish urban age cohort from the age of 16 till 32 years (n = 1471). The long-term impact of parental divorce on a variety of outcomes in adulthood, including psychological well-being, life situation, health behaviour, social networks and support, negative life events and interpersonal problems, was assessed.

RESULTS: Females from divorced compared to non-divorced families reported more psychological problems (higher scores in the Beck Depression Inventory, General Health Questionnaire and Psychosomatic Symptoms Score) and more problems in their interpersonal relationships. These differences were not found among males. Shorter education,unemployment, divorce, negative life events and more risky health behaviour were more common among subjects of both genders with a background of parental divorce.

CONCLUSIONS: The study revealed that parental divorce is an indicator of sufficient stress in childhood for its influences to persist well into adulthood, possibly with wider scope among females. It is important to recognise specific needs of children in the divorce process in order to prevent or minimize negative consequences and chain reactions during their subsequent life.

Is there any specific association between respiratory viruses and bacteria in acute otitis media of young children?

Kleemola, M., Nokso-Koivisto, J., Herva, E., Syrjänen, R., Lahdenkari, M., Kilpi, T. and Hovi, T.

J Infect. 2006; 52(3): 181-7. IF 1.882

BACKGROUND: Respiratory viral infections are usually preceding or coinciding with acute otitis media (AOM) in children. It is not known if a given viral infection would facilitate invasion of bacterial pathogens into the middle ear in a species-specific way. We reanalysed the microbiological results of the two prospective Finnish Otitis Media (FinOM) studies for this purpose.

METHODS: The children had been followed from 2 months to 2 years of age in specific study clinics and all referred AOM events were analysed. Combined results of virus detection tests from middle ear fluid and nasopharyngeal aspirate and those of bacterial culture from middle ear fluid were cross-tabulated for 529 AOM events in the FinOM Cohort Study and for 364 events in the FinOM Vaccine Trial.

RESULTS: In both studies the main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis while the main viruses detected were rhinoviruses and respiratory syncytial virus (plus enteroviruses in the Vaccine Trial). No distinct species-specific associations were observed between the viral and bacterial findings.

CONCLUSION: We did not find support to the theory that respiratory infection caused by a given viral species would favour growth of a certain bacterial pathogen in the MEF more than another.

Expression of MxA protein in blood lymphocytes of children receiving anticancer chemotherapy

Koskenvuo, M. M., Halminen, M., Blomqvist, M., Vainionpää, R., Ilonen, J., Julkunen, I., Salmi, T. T. and Mäkelä, M. J.

Pediatric Hematology and Oncology. 2006; 23(8): 649-660. Article. IF 0.532

The aim of the study was to evaluate whether IFN-alpha/beta-inducible MxA protein expression in children receiving anticancer treatment can be used as an indicator for virus infections during the febrile episodes. Twenty-six children with mainly hematological malignancies entered the study. Children with laboratory-confirmed virus infections had clearly elevated MxA protein levels compared to their counterparts with bacterial or unknown etiology. MxA protein expression increased moderately following the administration of cytostatic agents, even though these children had no clinical signs of infection.

Seroprevalence atlas of infections with oncogenic and non-oncogenic human papillomaviruses in Finland in the 1980s and 1990s

Lehtinen, M., Kaasila, M., Pasanen, K., Patama, T., Palmroth, J., Laukkanen, P., Pukkala, E. and Koskela, P.

Int J Cancer. 2006; 119(11): 2612-9. IF 4.700

Vaccines against high-risk (hr) human papillomaviruses (HPVs) causing cervical cancer may soon be licensed. Thus, nature of HPV epidemics needs to be studied now. Random sampling for studies on HPV epidemiology was done from all 230,998 women belonging to the population-based Finnish Maternity Cohort and having a minimum of 2 pregnancies between 1983 and 1994. First pregnancy serum specimens were retrieved for 7,805 subjects, and were analyzed for antibodies to HPV6/11, 16 and 18 with standard ELISAs. HPV16 seroprevalence almost doubled from the 1980s to the 1990s, and the epidemic spread to new areas in 23-31 year olds, i.e. the bulk of pregnant female population in the southwest part of the country. The HPV16 epidemic in the 14-22 year olds in 1983-1988 (1961-1974 birth cohorts) and in the 23-31 year olds in 1989-1994 (1958-1971 birth cohorts) overlapped with strong clustering of HPV16 and HPV18 infections in the latter (odds ratio 8.0, 95% confidence interval 6.6-9.7). Similar clustering of HPV16 and HPV6/11 infections was not found. The epidemic and the clustering may be due to high transmission probability of the hrHPV types and increase in sexual activity of the index birth cohorts.

Dietary Carotenoids and Risk of Colorectal Cancer in a Pooled Analysis of 11 Cohort Studies

Mannisto, S., Yaun, S. S., Hunter, D. J., Spiegelman, D., Adami, H. O., Albanes, D., van den Brandt, P. A., Buring, J. E., Cerhan, J. R., Colditz, G. A., Freudenheim, J. L., Fuchs, C. S., Giovannucci, E., Alexandra Goldbohm, R., Harnack, L., Leitzmann, M., McCullough, M. L., Miller, A. B., Rohan, T. E., Schatzkin, A., Virtamo, J., Willett, W. C., Wolk, A., Zhang, S. M. and Smith-Warner, S. A.

Am J Epidemiol. 2006. IF 5.068

Dietary carotenoids have been hypothesized to protect against epithelial cancers. The authors analyzed the associations between intakes of specific carotenoids (alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein + zeaxanthin, and lycopene) and risk of colorectal cancer using the primary data from 11 cohort studies carried out in North America and Europe. Carotenoid intakes were estimated from food frequency questionnaires administered at baseline in each study. During 6-20 years of follow-up between 1980 and 2003, 7,885 incident cases of colorectal cancer were diagnosed among 702,647 participants. The authors calculated study-specific multivariate relative risks and then combined them using a random-effects model. In general, intakes of specific carotenoids were not associated with colorectal cancer risk. The pooled multivariate relative risks of colorectal cancer comparing the highest quintile of intake with the lowest ranged from 0.92 for lutein + zeaxanthin to 1.04 for lycopene; only for lutein + zeaxanthin intake was the result borderline statistically significant (95% confidence interval: 0.84, 1.00). The associations observed were generally similar across studies, for both sexes, and for colon cancer and rectal cancer.

These pooled data did not suggest that carotenoids play an important role in the etiology of colorectal cancer.

When intracellular logistics fails - genetic defects in membrane trafficking

Olkkonen, V. M. and Ikonen, E.

J Cell Sci. 2006; 119(Pt 24): 5031-45. IF 6.543

The number of human genetic disorders shown to be due to defects in membrane trafficking has greatly increased during the past five years. Defects have been identified in components involved in sorting of cargo into transport carriers, vesicle budding and scission, movement of vesicles along cytoskeletal tracks, as well as in vesicle tethering, docking and fusion at the target membrane. The nervous system is extremely sensitive to such disturbances of the membrane trafficking machinery, and the majority of these disorders display neurological defects - particularly diseases affecting the motility of transport carriers along cytoskeletal tracks. In several disorders, defects in a component that represents a fundamental part of the trafficking machinery fail to cause global transport defects but result in symptoms limited to specific cell types and transport events; this apparently reflects the redundancy of the transport apparatus. In groups of closely related diseases such as Hermansky-Pudlak and Griscelli syndromes, identification of the underlying gene defects has revealed groups of genes in which mutations lead to similar phenotypic consequences. New functionally linked trafficking components and regulatory mechanisms have thus been discovered.

Studies of the gene defects in trafficking disorders therefore not only open avenues for new therapeutic approaches but also significantly contribute to our knowledge of the fundamental mechanisms of intracellular membrane transport.

Aire deficient mice do not develop the same profile of tissue-specific autoantibodies as APECED patients

Pöntynen, N., Miettinen, A., Petteri Arstila, T., Kampe, O., Alimohammadi, M., Vaarala, O., Peltonen, L. and Ulmanen, I.

J Autoimmun. 2006; 27(2): 96-104. IF 2.491

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED, or APS1), is a monogenic autoimmune disease caused by mutations in the autoimmune regulator (AIRE) gene. The three main components of APECED are chronic mucocuteaneous candidiasis, hypoparathyroidism and adrenocortical insufficiency. However, several additional endocrine or other autoimmune disease components, or ectodermal dystrophies form the individually variable clinical picture of APECED. An important feature of APECED is a spectrum of well-characterized circulating autoantibodies, reacting against tissue-specific autoantigens. Aire deficient mice develop some characteristics of APECED phenotype. In order to investigate whether the Aire deficient mice produce autoantibodies similar to human APECED, we studied the reactivity of Aire mouse sera against mouse homologues of 11 human APECED antigens. None of the APECED antigens indicated elevated reactivity in the Aire knock-out mouse sera, implying the absence of APECED associated autoantibodies in Aire deficient mice. These findings were supported by the failure of the autoantigens to activate mouse T-cells. Furthermore, Aire knock-out mice did not express increased levels of anti-nuclear antibodies compared to wt mice.

This study indicates that spontaneous induction of tissue-specific autoantibodies similar to APECED does not occur in the rodent model suggesting differences in the immunopathogenic mechanisms between mice and men.

Dietary intake of organotin compounds in Finland: a market-basket study

Rantakokko, P., Kuningas, T., Saastamoinen, K. and Vartiainen, T.

Food Addit Contam. 2006; 23(8): 749-56. IF 1.610

The objective of this study was to estimate the intake of organic tin compounds from foodstuffs in a Finnish market basket. The study was conducted by collecting 13 market baskets from supermarkets and market places in the city of Kuopio, eastern Finland. Altogether 115 different food items were bought. In each basket, foodstuffs were mixed in proportion to their consumption and analysed by GC/MS for seven organic tin compounds (mono-, di-, and tributyltin, mono-, di-, and triphenyltin, and dioctyltin). Organotin compounds were detected in only four baskets, with the fish basket containing the largest number of different organotins. The European Food Safety Authority has established a tolerable daily intake of 250 ng kg(-1) body weight for the sum of dibutyltin, tributyltin, triphenyltin and dioctyltin. According to this study, the daily intake of these compounds was 2.47 ng kg(-1) body weight, of which 81% originated from the fish basket. This exposure is only 1% of the tolerable daily intake and poses negligible risk to the average consumer. However, for consumers eating large quantities of fish from contaminated areas, the intake may be much higher.

Determinants of health promotion action: comparative analysis of local voluntary associations in four municipalities in Finland

Simonsen-Rehn, N., Ovretveit, J., Laamanen, R., Suominen, S., Sundell, J. and Brommels, M.

Health Promotion International. 2006; 21(4): 274-283. Article. IF 1.159

The World Health Organization makes a case for the importance of voluntary organizations in promoting health at local levels. The purpose of this paper is to contribute to understanding which factors explain local voluntary associations (LVAs) participation in health promotion in local contexts. It does so through (i) identifying indicators that represent determinants of health promotion action which were reported by LVAs and by (ii) comparing their actions with these determinants. The data reported are from a questionnaire survey of all registered LVAs in four municipalities in Finland. Principal component analysis revealed four determinants of health promotion action. Four factors in the final multivariate model explained over half of the variance of LVAs engagement in health promotion action: competence, values 'healthy' and also opportunities and municipality. There is some evidence to support a model of health promotion action which has not been tested empirically in relation to these types of organization. More detailed studies of determinants of health promotion action are needed to shape strategies in local communities.

Serum cholesterol during 27 years: Assessment of systematic error and affecting factors and their role in interpreting population trends

Sundvall, J., Leiviskä, J., Alfthan, G. and Vartiainen, E.

Clin Chim Acta. 2006. IF 2.149

BACKGROUND: The aim was to assess which factors cause a systematic error in serum total cholesterol measurements and how bias can influence the interpretation of serum cholesterol changes of the Finnish population.

METHODS: Data on precision and accuracy during 27 years for serum total cholesterol were documented from participation in 438 rounds of five different external quality assessment (EQA) programs.

RESULTS: The mean annual accuracy (bias) of the cholesterol assay using the results from all EQAs during 1978-2004 was -0.74% (95%CI -0.88 to -0.60). An exceptionally large deviation in bias coincided with the introduction of a new serum calibrator lot. New methods or instrumentation had only a minor impact on serum cholesterol bias. The mean serum cholesterol bias during the latest five population studies in 1982-2002 was -0.10% (95%CI -0.60 to 0.40) but comparison of the bias between the last study (CDC EQA in 2002) and the four previous ones (WHO EQA) showed a net difference of 3.32% (p<0.001). Correcting the mean serum cholesterol of men with respect to WHO and CDC EQA bias changed the interpretation for the last two survey years from an increase of 1.8% to no change.

CONCLUSIONS: It is necessary to participate in EQA programs, which include target values measured by the CDC cholesterol reference method and then to perform bias corrections on the mean cholesterol values of the populations.

Effects of ultrafine and fine particulate and gaseous air pollution on cardiac autonomic control in subjects with coronary artery disease: the ULTRA study

Timonen, K. L., Vanninen, E., de Hartog, J., Ibald-Mulli, A., Brunekreef, B., Gold, D. R., Heinrich, J., Hoek, G., Lanki, T., Peters, A., Tarkiainen, T., Tiittanen, P., Kreyling, W. and Pekkanen, J.

J Expo Sci Environ Epidemiol. 2006; 16(4): 332-41.

Previous studies have shown an association between elevated concentrations of particulate air pollution and cardiovascular morbidity and mortality.

Therefore, the association between daily variation of ultrafine and fine particulate air pollution and cardiac autonomic control measured as heart rate variability (HRV) was studied in a large multicenter study in Amsterdam, the Netherlands, Erfurt, Germany, and Helsinki, Finland. Elderly subjects (n=37 in Amsterdam, n=47 in both Erfurt and Helsinki) with stable coronary artery disease were followed for 6 months with biweekly clinical visits. During the visits, ambulatory electrocardiogram was recorded during a standardized protocol including a 5-min period of paced breathing. Time and frequency domain analyses of HRV were performed. A statistical model was built for each center separately. The mean 24-h particle number concentration (NC) (1,000/cm(3)) of ultrafine particles (diameter 0.01-0.1 microm) was 17.3 in Amsterdam, 21.1 in Erfurt, and 17.0 in Helsinki. The corresponding values for PM2.5 were 20.0, 23.1, and 12.7 microg/m(3). During paced breathing, ultrafine particles, NO(2), and CO were at lags of 0-2 days consistently and significantly associated with decreased low-to-high frequency ratio (LF/HF), a measure of sympathovagal balance. In a pooled analysis across the centers, LF/HF decreased by 13.5% (95% confidence interval: -20.1%, -7.0%) for each 10,000/cm(3) increase in the NC of ultrafine particles (2-day lag). PM2.5 was associated with reduced HF and increased LF/HF in Helsinki, whereas the opposite was true in Erfurt, and in Amsterdam, there were no clear associations between PM2.5 and HRV.

The results suggest that the cardiovascular effects of ambient ultrafine and PM2.5 can differ from each other and that their effect may be modified by the characteristics of the exposed subjects and the sources of PM2.5.

Murine model of food allergy after epicutaneous sensitization: Role of mucosal mast cell protease-1

Vaali, K., Puumalainen, T. J., Lehto, M., Wolff, H., Rita, H., Alenius, H. and Palosuo, T.

Scandinavian Journal of Gastroenterology. 2006; 41(12): 1405-1413. Article. IF 1.790

Objective. Studies of the pathological mechanisms of food allergy have been impeded by the lack of relevant animal models. The purpose of this study was to develop a physiological model of food allergy that was not dependent on immunostimulatory adjuvants.

Material and methods. Balb/c mice were epicutaneously sensitized four times at varying intervals over a 22-day period, and challenged orally from day 40, 6 times every 1-3 days with either saline or ovalbumin.

Results. After sensitization ( day 35) but before the oral challenges, the ovalbumin-sensitized groups showed increased specific IgE and IgG(1) production when compared with the sham-sensitized groups. Mucosal mast cell protease-1 (MMCP-1) was undetectable in serum before the intragastric challenge. MMCP-1 concentrations were increased after the first ovalbumin dose, solely in the ovalbumin-sensitized and -challenged group. After the challenge period, the mean serum MMCP-1 concentration increased from an undetectable level in controls to an over 44-fold level in the ovalbumin- sensitized and -challenged mice. In this group, MMCP-1-positive cells were present in the small intestine and expressions of IFN-gamma and CXCL-9 mRNA were decreased in the ileum, suggesting an impaired Th-1-type response. Within one hour of the last ovalbumin challenge, 5 out of 6 mice developed diarrhea in the ovalbumin- sensitized and -challenged group, but there was no diarrhea in the other groups.

Conclusions. A murine model of food allergy based on sensitization via epicutaneous exposure to allergen without immunostimulatory adjuvants was developed. Effective production of MMCP-1 together with specific IgE and IgG1 suggests a breakdown in oral tolerance to the allergen. Intragastric challenges were accompanied by mast cell-dependent immunopathological changes and diarrhea.

Macrophage Phospholipid Transfer Protein Contributes Significantly to Total Plasma Phospholipid Transfer Activity and Its Deficiency Leads to Diminished Atherosclerotic Lesion Development

Vikstedt, R., Ye, D., Metso, J., Hildebrand, R. B., Van Berkel, T. J., Ehnholm, C., Jauhiainen, M. and Van Eck, M.

Arterioscler Thromb Vasc Biol. 2006. IF 7.053

OBJECTIVE: Systemic phospholipid transfer protein (PLTP) deficiency in mice is associated with a decreased susceptibility to atherosclerosis, whereas overexpression of human PLTP in mice increases atherosclerotic lesion development. PLTP is also expressed by macrophage-derived foam cells in human atherosclerotic lesions, but the exact role of macrophage PLTP in atherosclerosis is unknown.

METHODS AND RESULTS: To clarify the role of macrophage PLTP in atherogenesis, PLTP was selectively disrupted in hematopoietic cells, including macrophages, by transplantation of bone marrow from PLTP knockout (PLTP(-/-)) mice into irradiated low-density lipoprotein receptor knockout mice. Selective deficiency of macrophage PLTP (PLTP(-M/-M)) resulted in a 29% (P<0.01 for difference in lesion area) reduction in aortic root lesion area as compared with mice possessing functional macrophage PLTP (384+/-36*10(3) microm(2) in the PLTP(-M/-M) group (n=10), as compared with 539+/-35*10(3) microm(2) in the PLTP(+M/+M) group (n=14)) after 9 weeks of Western-type diet feeding. The decreased lesion size in the PLTP(-M/-M) group coincided with significantly lower serum total cholesterol, free cholesterol, and triglyceride levels in these mice. Furthermore, plasma PLTP activity in the PLTP(-M/-M) group was 2-fold (P<0.001) lower than that in the PLTP(+M/+M) group.

CONCLUSIONS: Macrophage PLTP is a significant contributor to plasma PLTP activity and deficiency of PLTP in macrophages leads to lowered atherosclerotic lesion development in low-density lipoprotein receptor knockout mice on Western-type diet.