30.1.2006

Childhood growth and coronary events - Reply

Barker, D. J. P., Osmond, C. and Eriksson, J. G.

New England Journal of Medicine. 354 (3): 303-304 JAN 19 2006.  Letter

Reduction in fluoroquinolone susceptibility among non-typhoidal strains of Salmonella enterica isolated from Finnish patients

Hakanen, A. J., Kotilainen, P., Pitkanen, S., Huikko, S., Siitonen, A. and Huovinen, P.

J Antimicrob Chemother. 2006 Jan 25.

OBJECTIVES: The proportion of Salmonella isolates with reduced susceptibility to fluoroquinolones has increased during recent years in many countries, especially in South-east Asia. The present study was performed to evaluate the incidence of and changes in quinolone resistance in Salmonella isolates of either foreign or domestic origin in Finland.

METHODS: A total of 1004 Salmonella isolates collected from Finnish patients between 2000 and 2004 were analysed for ciprofloxacin susceptibility. Of these isolates, 504 were of domestic origin and 500 were of foreign origin, collected from travellers to 43 different countries. The Salmonella collection consisted of 89 different serotypes. All isolates belonged to non-typhoidal Salmonella enterica.

RESULTS: Of all isolates, 3 (0.3%) were ciprofloxacin-resistant (MIC >/= 4 mg/L) and 214 (21.3%) exhibited reduced susceptibility to ciprofloxacin (MIC >/= 0.125-2 mg/L). The annual proportion of reduced susceptibility varied between 3 and 15% among the domestic Salmonella isolates (P = 0.123). Between 2000 and 2004, the annual proportion of reduced susceptibility increased significantly (from 23 to 39%; P = 0.001) among all foreign isolates as well as among those from Spain alone (from 4 to 73%; P < 0.001). Among the isolates from Thailand, reduced ciprofloxacin susceptibility remained at a constantly high level (52-66%) throughout the study.

CONCLUSIONS: Our results show that reduced fluoroquinolone susceptibility in S. enterica is not restricted to South-east Asia alone but continues to grow rapidly in many parts of the world including countries of the European Union.

Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes

Hu, G., Jousilahti, P., Barengo, N. C., Qiao, Q., Lakka, T. A. and Tuomilehto, J.

Diabetes Care. 28 (4): 799-805 APR 2005.

OBJECTIVE - The aim of this study was to examine both single and joint associations of physical activity and conventional cardiovascular risk factors with total and cardiovascular mortality among patients With diabetes.

RESEARCH DESIGN AND METHODS - We prospectively followed 3,708 Finnish patients with type 2 diabetes aged 25-74 years. Physical activity, smoking Status, blood pressure height, weight, and serum cholesterol level were determined It baseline. Cox proportional hazard models were used to estimate single and joint effects of physical activity and Other cardiovascular risk factors on the risk of mortality.

RESULTS - During a mean follow-up of 18.7 years, 1,423 deaths were recorded, 906 of which were due to cardiovascular disease. Moderate or high levels of physical activity were associated with decreased total and cardiovascular mortality, whereas higher levels of BMI and blood pressure and current smoking were associated with increased total and cardiovascular mortality. High serum cholesterol levels also increased cardiovascular mortality. The protective effect of physical activity was consistent in diabetic patients with ally levels of BMI, blood pressure, total cholesterol, and smoking.

CONCLUSIONS - A moderate or high level of physical activity was associated with a reduced risk Of total and cardiovascular Mortality among patients With type 2 diabetes. The favorable association of physical activity with longevity was observed regardless of the levels of BMI, blood pressure, total cholesterol, and smoking.

Methods and results: Data were used from two large cross-sectional health examination surveys representing the entire Finnish adult population in 1980 and 2000. In the 1978-80 survey, the sample covered 5101 individuals aged >= 45, of whom 88% participated. The 2000-2001 survey comprised 5310 individuals in the same age range. Participation rate in the health examination was 87%. Prevalence of CHD decreased in men and women under the age of 65 and increased among those aged >= 75. Prevalence of large Q-waves indicating previous myocardial infarction decreased in all male age groups and in women aged 65-74. The total estimated number of persons with CHD increased by 18% (95% CI=6-30) during the past 20 years in Finland. In 1980, the most dominant CHD group was men aged 45-64, whereas in 2000, women aged >= 75 comprised the largest CHD group.

Conclusion: Although the prevalence of CHD has decreased among middle-aged persons, the number of CHD cases has increased during the past 20 years in Finland.

pH effects on 10 Streptomyces spp. growth and sporulation depend on nutrients

Kontro, M., Lignell, U., Hirvonen, M. R. and Nevalainen, A.

Lett Appl Microbiol. 2005; 41(1): 32-8.

AIMS: Streptomycetes are regarded to prefer neutral to alkaline environmental pH, although they commonly occur at remarkably variable pH and nutritional conditions. Therefore, the dependence of 10 Streptomyces spp. pH tolerance on nutrients was determined.

METHODS AND RESULTS: Ten environmental Streptomyces spp. were grown and sporulated between pH 4.0 and 11.5, at the interval of 1.5, on starch-casein-KNO(3), tryptone-yeast extract-glucose, glycerol-arginine and tryptone-soy agars, and three their modifications. On media with starch and casein; glucose, tryptone and yeast extract; tryptone and soy peptone; and glycerol-arginine and yeast extract strains grew over a broad pH range between 4.0-5.5 and 10.0-11.5. On glycerol-arginine and on medium with Na-propionate, NH(4)NO(3) and yeast extract, streptomycetes grew optimally at pH 7.0 and above. The high organic load enabled the growth over a wide pH range. The sporulation pH ranges followed those for growth.

CONCLUSIONS: The high organic load enabled the growth over a wide pH range. The strain-specific differences in sporulation were greater than those caused by pH. The best medium for sporulation contained glucose and tryptone with minerals of glycerol-arginine agar at pH 5.5.

SIGNIFICANCE AND IMPACT OF THE STUDY: The growth pH ranges, pH ranges for the optimal growth, and sporulation were strongly dependent on nutrients.

Alignment of capsid protein VP1 sequences of all human rhinovirus prototype strains: Conserved motifs and functional domains

Laine, P., Blomqvist, S., Savolainen, C., Andries, K. and Hovi, T.

Journal of General Virology. 87: 129-138 Part 1, JAN 2006.

 An alignment was made of the deduced amino acid sequences of the entire capsid protein VP1 of all human rhinovirus (HRV) prototype strains to examine conserved motifs in the primary structure. A set of previously proposed crucially important amino acids in the footprints of the two known receptor molecules was not conserved in a receptor group-specific way. In contrast, VP1 and VP3 amino acids in the minor receptor-group strains corresponding to most of the predicted ICAM-1 footprint definitely differed from those of the ICAM-1-using major receptor-group strains. Previous antiviral-sensitivity classification showed an almost-complete agreement with the species classification and a fair correlation with amino acids aligning in the antiviral pocket. It was concluded that systematic alignment of sequences of related virus strains can be used to test hypotheses derived from molecular studies of individual model viruses and to generate ideas for future studies on virus structure and replication.

Background: While recent studies have found problem-solving impairments in individuals who engage in deliberate self-harm (DSH), few studies have examined repeaters and non-repeaters separately. The aim of the present study was to investigate whether specific types of problem-solving are associated with repeated DSH.

Method: As part of the WHO/EURO Multicentre Study on Suicidal Behaviour, 836 medically treated DSH patients (59% repeaters) from 12 European regions were interviewed using the European Parasuicide Study Interview Schedule (EPSIS II) approximately I year after their index episode. The Utrecht Coping List (UCL) assessed habitual responses to problems.

Results: Factor analysis identified five dimensions - Active Handling, Passive-Avoidance, Problem Sharing, Palliative Reactions and Negative Expression. Passive-Avoidance - characterized by a pre-occupation with problems, feeling unable to do anything, worrying about the past and taking a gloomy view of the situation, a greater likelihood of giving in so as to avoid difficult situations, the tendency to resign oneself to the situation, and to try to avoid problems - was the problem-solving dimension most strongly associated with repetition, although this association was attenuated by self-esteem.

Conclusions: The outcomes of the study indicate that treatments for DSH patients with repeated episodes should include problem-solving interventions. The observed passivity and avoidance of problems (coupled with low self-esteem) associated with repetition suggests that intensive therapeutic input and follow-up are required for those with repeated DSH.

Incidence of dementia in very elderly individuals: A clinical, neuropathological and molecular genetic study

Polvikoski, T., Sulkava, R., Rastas, S., Sutela, A., Niinisto, L., Notkola, I. L., Verkkoniemi, A., Viramo, P., Juva, K. and Haltia, M.

Neuroepidemiology. 26 (2): 76-82 2006.

Aims: To evaluate the effect of medical record use on figures for the incidence of dementia and the effect of apolipoprotein E ( APOE) polymorphism on this incidence and neuropathologically defined Alzheimer's disease ( AD) in very elderly individuals.

Methods: Cognitive functions were examined in a cohort of 328 (92% of the very elderly people of a town participated in this study) nondemented Finnish elderly individuals 85 years of age or more in 1991. The examination was repeated in survivors in 1994, 1996, 1999 and 2001. Medical notes and social work records were evaluated. All these individuals were genotyped for APOE. Neuropathological analysis of AD-type pathology was performed on 159 of 303 subjects who died during the follow-up.

Results: Age group, gender or APOE did not significantly affect the incidence of dementia, which was over 20% higher ( 85 vs. 69 per 1,000 person-years) if the cognitive status at death was ascertained by medical and social work records than without this evaluation. The APOE epsilon 4 allele was highly significantly ( p = 0.002) and age almost significantly ( p = 0.06) associated with neuropathological AD in non-demented individuals.

Conclusions: Medical records should be analyzed in studies on the incidence of dementia in very elderly individuals. APOE polymorphism does not affect the incidence of dementia in this age group. However, clinical dementia diagnosis in very elderly individuals does not necessarily correlate well with the presence of neuropathological AD which, even in this age group, is significantly associated with the APOE epsilon 4 allele.

Copyright (C) 2006 S. Karger AG, Basel.

Prevalence and molecular genetics of macrolide resistance among Streptococcus pneumoniae isolates collected in Finland in 2002

Rantala, M., Huikko, S., Huovinen, P. and Jalava, J.

Antimicrob Agents Chemother. 2005; 49(10): 4180-4.

The prevalence and mechanisms of macrolide resistance among 1,007 clinical pneumococcal isolates collected in Finland were investigated. Of these, 217 (21.5%) were resistant to erythromycin and 11% to clindamycin. Among the erythromycin-resistant isolates, mef(E) was present in 95 isolates (44%), mef(A) was present in 12 isolates (6%), and erm(B) was present in 90 isolates (41%). A double mechanism, mef(E) and erm(B), was detected in five isolates (2%). Ribosomal mutation was detected in 14 (6%) macrolide-resistant isolates in which no other determinant was found. Based on the telithromycin MICs, two groups of isolates were formed: 83.3% of the isolates belonged to a major group for which the telithromycin MIC range was < or =0.008 to 0.063 microg/ml, and 16.7% belonged to a minor group for which the telithromycin MIC range was 0.125 to 8 microg/ml. All except three isolates in the minor population carried a macrolide resistance gene.

Economic evaluation of pneumococcal conjugate vaccination in Finland

Salo, H., Sintonen, H., Pekka Nuorti, J., Linna, M., Nohynek, H., Verho, J. and Kilpi, T.

Scand J Infect Dis. 2005; 37(11-12): 821-32.

The aim of this study was to evaluate cost-effectiveness of pneumococcal conjugate vaccine (PCV7) in children <5 y of age. A Markov simulation model was used to compare the cost-effectiveness of 4 doses (assumed 50.5 euros per dose) of PCV7 with no intervention. Only direct effects of the vaccine were taken into account. In Finland, vaccination of a birth cohort of 57,500 healthy infants would potentially prevent annually 60 cases of invasive PD, 1,400 cases of pneumococcal pneumonia, 15,000 episodes of acute otitis media, 3,000 otological surgery procedures and 0.9 deaths in children aged <5 y. Investing 12.0 million euros to vaccinate a birth cohort would save annually 6.3 million euros in medical, and 2.0 million euros in productivity and other, costs. Therefore, investing 1 euros in a vaccination programme would return 0.53 euros in medical costs and 0.70 euros in societal costs. In the base case, vaccination would cost society 139,986 euros per life y gained. To achieve cost savings from a health care provider (societal) perspective, without considering herd effects or replacement phenomenon, the price of PCV7 should be 50% (70%) of the price used in the base case.

Fine mapping of the multiple sclerosis susceptibility locus on 5p14-p12

Stensland, H., Saarela, J., Bronnikov, D. O., Parkkonen, M., Jokiaho, A. J., Palotie, A., Tienari, P. J., Sumelahti, M. L., Elovaara, I., Koivisto, K., Pirttila, T., Reunanen, M., Sobel, E. and Peltonen, L.

Journal of Neuroimmunology. 170 (1-2): 122-133 DEC 30 2005.

Linkage analyses have identified four major MS susceptibility loci in Finns, Here we have fine mapped the region on chromosome 5p in 28 Finnish MS families. Marker D5S416 provided the highest pairwise LOD score, and multipoint and haplotype analyses restrict the critical region to about 5.3 Mb on 5p15 between markers D5S1987 and D5S416. Ascertaining for HLA type and geographical origin indicated that families with and without the HLA DR15 risk haplotype, as well as families within and outside an internal high-risk region, Contributed to the linkage to 5p, implying the general significance for this locus in Finnish MS families. (C) 2005 Elsevier B.V. All rights reserved.

Stability over time of short-term heart rate variability

Tarkiainen, T. H., Timonen, K. L., Tiittanen, P., Hartikainen, J. E. K., Pekkanen, J., Hoek, G., Ibald-Mulli, A. and Vanninen, E. J.

Clinical Autonomic Research. 15 (6): 394-399 DEC 2005.

Heart rate variability (HRV) is a widely used method to assess cardiac autonomic control. However, the reproducibility of especially short-term HRV has not been properly evaluated. Therefore, we assessed the stability of short-term HRV over a three to four month period. We had seven consecutive electrocardiographic (ECG) recordings from 89 subjects with stable coronary artery disease obtained during a large multicenter study. The HRV assessments were performed from these 40-minute ECG-recordings simulating normal daily activities, i.e., recordings consisting of 5 to 10 minute periods of rest, paced breathing, standing, submaximal exercise and recovery. Both time and frequency domain HRV analyses were conducted from the whole 40-minute recordings and from the 5-minute periods of rest and paced breathing. The coefficient of variation (CV) varied between 5.1-16.7% for the 40-minute and 6.0-37.1% for the 5-minute time domain and 4.4-11.0% for the 40-minute and 7.2-16.5% for the 5-minute frequency domain measurements. The mean of the RR intervals and the total power showed the highest stability over time. The most unstable measure was the standard deviation of all NN intervals (SDNN). In conclusion, most short-term HRV measures were highly stable over time indicating low physiological variation. However, the SDNN showed large variability in consecutive recordings.