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To compare the effectiveness of pelvic floor training (PFT) with the aid of a home biofeedback device to PFT alone for urodynamic stress urinary incontinence (SUI) in women after a 1-year follow-up.A randomized study comparing two conservative interventions was conducted in an outpatient clinic of a university hospital. Thirty-five consecutive women were randomized to either the PFT with home biofeedback group or the PFT alone group. The intensive training period lasted 12 weeks. After 1 year, 33 women could be evaluated according to the protocol. At the 1-year visit pelvic floor muscle activity was measured and the need for surgical intervention was evaluated. Logistic multivariate analysis was used to predict response to the PFT.In the home biofeedback training group 11/16 (68.8%) avoided surgery vs. 10/19 (52.6%) in the PFT alone group. The difference was not statistically significant. In the nonoperated home biofeedback group the increase in pelvic floor muscle activity (p = 0.005 in supine,p = 0.005 in standing) and the decrease in leakage index (p = 0.05) was significant after 12 weeks and pelvic floor activity remained constant. By contrast, in the nonoperated PFT group the increase in pelvic floor muscle activity after 12 weeks predicted a good result for conservative treatment.This randomized controlled trial suggests that the home biofeedback method in PFT has a good success rate of 68.8%. The change achieved in leakage index after 12 weeks of training predicted an effective outcome for conservative treatment. [ABSTRACT FROM AUTHOR]

To evaluate physical activity among urinary incontinent women seeking treatment and to assess the change of physical activity after treatment.Part of a prospective observational intervention study to examine the factors influencing the severity of urinary incontinence.Tampere University Hospital—referral unit.Eighty-two urinary incontinent women were evaluated in the baseline and 69 (84%) one year (mean 13 months, range 6–21) after treatment.Physical activity was measured by self-report questionnaire and electronic motion sensor: Caltrac accelerometer worn by women for one week. The diagnosis and severity of urinary incontinence was estimated on the basis of urodynamics, pad test, diary and incontinence-specific quality of life measures. Treatment outcome was assessed according to objective parameters and patients satisfaction.Physical activity at work, leisure and sport expressed in MET (metabolic unit) and kilocalories, change in physical activity after treatment.Twenty-one (25.6%) of all women reported exercise of more than three times per week. Incontinent women with the highest leisure time activity≥6 MET (n= 23, above 75th centile) were younger; they had less body mass index and greater urine leakage than others. One year after treatment, there was no change in any parameters of physical activities. Also exercise habits among women who were completely dry (n= 37) after treatment were not changed.Urinary incontinent women who seek treatment are as physically active as the normal population. Even after successful incontinence treatment, exercise habits do not change. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the relationships between adolescent subjective well-being (SWB) and family dynamics perceived by adolescents and their parents. A sample of 239 pupils (51% female) from seventh and ninth grades completed the Berne questionnaire of SWB (youth form), two subscales from an original Finnish SWB scale and the Family Dynamics Measure II, and one of their parents (n = 239) filled in the Family Dynamics Measure II. Results indicated that parents assessed family dynamics better than did their adolescent child. Furthermore, there was no association between family dynamics perceived by adolescents and family dynamics assessed by one of their parents or between the adolescent SWB and parental perception of family dynamics. Multiple stepwise regression analysis indicated that certain aspects of family dynamics perceived by adolescents were related to adolescent global satisfaction and ill-being. Specifically, adolescents' perception of high level of mutuality and stability in the family as well as male gender and lack of serious problems in family were predictors of adolescent global satisfaction. Furthermore, disorganization in the family and poor parental relationship perceived by adolescents, being female, serious problems and illness in family predicted a high level of adolescent global ill-being. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether exposure to fungi (molds and yeasts) among children attending a water-damaged school was reflected by the children's immunoglobulin G (IgG) response to microorganisms typical of water damage and whether the presence of these IgG antibodies was associated with respiratory symptoms and morbidity. The relationships between positive IgG antibodies and atopy, described as elevated allergen-specific immunoglobulin E (IgE) antibodies, were also examined. The study population consisted of a randomly selected group of exposed children attending a water-damaged school and a group of unexposed children of the same age. Serum samples for analyses of IgG and IgE antibodies were drawn from the children. The respiratory morbidity, the number of positive IgG antibodies to nine microorganisms indicating water damage, and IgE sensitization to common environmental allergens (Phadiatop®) were studied. The mean number of positive IgG findings was significantly higher among the exposed children. The number of positive IgG antibodies did not correlate with respiratory illnesses or symptoms at the individual level even though the exposed children who had positive IgG antibodies to four or more microorganisms in the total group comparison tended to have higher respiratory morbidity. In the exposed group, a negative correlation was found between the number of positive IgG antibodies and the total value of allergen-specific IgE antibodies. As among adults exposed to microorganisms at work, IgG antibodies in children seem to be a relevant indicator of exposure to microorganisms in a water-damaged school on the group level. [ABSTRACT FROM AUTHOR]

Adolescent subjective well-being and realized values Aims of the study. The purpose of this study was to describe adolescent subjective well-being and realized values, and to examine the relationships between socio-demographic variables, realized values and subjective well-being from the adolescent perspective. Rationale. Adolescent subjective well-being was conceptualized by means of four different dimensions: satisfaction, ill-being, knowledge and activities related to well-being. The values were operationalized by eight core ideas from which a principal components analysis identified 10 factors representing the realized values. Design. Data were gained by self-report questionnaires from 245 adolescents from 7th and 9th grades, with a mean age of 14 years, in 13 secondary schools in southern Finland. The data were analysed statistically. Findings. According to the findings, most of the respondents were satisfied with life. However, one out of 10 did not experience the joy of life. There was no statistically significant difference in global satisfaction between girls and boys. Total ill-being among the adolescents was rare, but one out of four participants had fairly often worried about money and 17% were frequently unusually tired. Girls and pupils from the 9th class experienced more ill-being than boys and pupils from the 7th class. The findings suggest that certain values such as personal equilibrium, safe family relations, and family type are predictors of adolescent global subjective well-being. Conclusions. While assessing and promoting adolescent well-being it is important to pay special attention to the realization of values in life and not merely to appreciation of things. Implications for practice include the need to create opportunities for the realization of values when adolescents require health care services. [ABSTRACT FROM AUTHOR]

Development of a patient-orientated instrument to measure service quality in outpatient departments Aims of the study. To describe three stages in the development of an instrument to measure service quality from the patients’ perspective in hospital outpatient departments. Rationale. A reliable and valid service quality instrument is a valuable tool for collecting feedback from patients when improving outpatient services. Design. A multiphase process with several versions of the questionnaire testing its validity and reliability. The first version of the questionnaire was constructed from information collected in a previous interview study of patients’ service experiences. Using this version (47 questions) information was collected in 15 outpatient departments (314 patients) and the second version of the questionnaire was developed. At this stage, a survey of employees (n=111) was included in the development process. This second version of the questionnaire (43 questions) was used to collect more data in three outpatient departments of a university hospital and in two outpatient departments of two regional hospitals on three different occasions (1416, 369 and 124 patients) within a period of 2 years. The reliability of the instrument was tested in terms of stability by using three repeated measurements, and using the Cronbach’s α coefficient as an indicator of internal consistency. Content validity was assessed by means of percentage agreement between staff and patients. Logistic regression analysis was performed to assess construct validity. Results. The final version of the questionnaire contained 12 items. Agreement between patient and staff ratings was found to be acceptable for most questions (content validity). Two measurements on different occasions yielded a similar structure (construct validity). Internal consistency was acceptable (Cronbach’s α = 0·67–0·93 in the first and 0·71–0·94 in the second survey). The variance of the α coefficients was small in the retest (stability). Conclusions. The instrument developed is general to the extent that it is suitable for assessing service quality improvement needs in individual units and for making cross-departmental comparisons. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) and e-cessive alcohol use can both damage the myocardium. Their combined effect on the heart muscle has not been characterized. We set out to assess whether the presence of CAD modifies the effects of chronic alcohol consumption on the left ventricular (LV) structure in middle-aged men. Methods: A postmortem e-amination was performed on 700 Finnish men (age range, 33-70 years) who e-perienced a sudden, nonhospital death. A coronary arteriography and measurement of the LV wall thickness, cavity area, and ratio by planimetry of transversal ventricular slices were done at the autopsy. The men were grouped by the most severe coronary artery diameter stenosis (<30%, 30-60%, >60%) and by daily alcohol dose (<12 g, 12-72 g, 72-180 g, >180 g) estimated by a structured interview of their lifetime partner. Results: Analysis by ANCOVA, adjusted for age, body size, smoking, hypertension, and diabetes, showed a statistically significant interaction between the effects of coronary artery stenosis and daily alcohol dose on the LV cavity area ( p= 0.037) and on the LV wall thickness/cavity area ratio ( p= 0.018). In the group with <30% stenosis, the LV wall thickness/cavity area ratio (mean ± SEM) increased from 1.6 ± 0.2 mm/cm2 in men drinking <12 g/day to 6.2 ± 1.4 mm/cm2 in men drinking 72-180 g/day ( p= 0.021). A similar trend was seen in men with 30-60% coronary stenosis ( p= 0.32). By contrast, in men with >60% coronary stenosis, the LV wall thickness/cavity area ratio decreased with increasing daily alcohol use from 2.2 ± 0.3 to 1.4 ± 0.1 mm/cm2 ( p= 0.27). Conclusions: CAD modulates the effects of alcohol on the heart muscle. Heavy drinking results in concentric LV remodelling in men with no or only mild coronary artery stenoses whereas an opposite trend is seen in men with severe coronary artery obstructions. The mechanism of the interaction remains unknown. [ABSTRACT FROM AUTHOR]

Early childhood wheezing is associated with asthma later in life. However, the high spontaneous recovery rate and the lack of firm predictors for persistence of wheezing complicates the development of evidence-based guidelines for long-term management of wheezy infants and toddlers. Our aim was to define variables that could be used to identify wheezy individuals younger than 3 years of age who would continue to be symptomatic at school age. The method used was a questionnaire-based cross-sectional survey of 2027 randomly chosen, 6–13-year-old school children. Altogether 1829 (90%) questionnaires were returned. Emergency medical care had been sought for 186 (10.2%) children for wheezing during the first 3 years of life, and only 17.2% of these children had received similar emergency treatment during the 12 months preceding the survey. The total proportion of children with current asthma at school age was 11.4%. A logistic regression analysis indicated that for the early wheezers, a family history of asthma, an itchy rash or food allergy, and exposure to tobacco smoke at home before the age of 3 years, were all independently associated with symptom persistence until school age. Among all wheezy children younger than 3 years, those who have a history of food allergy, itchy rash, asthma occurrence in a sibling or parent, or are exposed to tobacco smoke during the first years of life are at highest risk for symptom persistence until school age. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine factors related to how the first-time mother experiences childbirth. The data were collected by questionnaire in a sample of 326 first-time mothers in Tampere University hospital in Finland. The multivariate method used was a stepwise regression analysis. The most important predictors for the nature of the childbirth experience were the characteristics of the midwife, such as empathy, friendliness, tenderness, calmness and lack of hurry; the attitude of the child's father toward the pregnancy; the duration of delivery; and the mother's age and marital status. The more positive the experience the mother had of the attending midwife caring for her, the more positively she experienced childbirth. The positive attitude of the child's father toward the pregnancy and a short duration of delivery were also predictors for a positive childbirth experience. Young and unmarried mothers also had more positive experiences of childbirth. On the basis of the research results, we can state that positive childbirth experiences of first-time mothers are enhanced by the positive characteristics and professional skills of the attending midwife, positive attitude of the spouse/child's father toward the pregnancy, and a short duration of delivery. [ABSTRACT FROM AUTHOR]

The specific symptoms of depression associated with increased mortality in the depressed elderly are poorly known. The aim of this paper is to analyse the individual depressive symptoms measured by the Zung Self Rated Depression Scale (ZSDS) and the Hamilton Rating Scale for Depression (HRSD) in association with mortality among depressed elderly subjects. The population consisted of 169 depressed (DSM-III criteria) aged (65+ years) persons from a Finnish epidemiological research project. The follow-up for deaths continued for about 6 years. When age, sex, smoking, physical health and functional abilities were taken into account, dissatisfaction, weight loss and gastrointestinal symptoms (anorexia and constipation) predicted mortality together with high age and poor physical health. Weight loss was related to an increased risk of death, specifically in the depressed. Dissatisfaction and gastrointestinal symptoms were more general markers of increased mortality. Copyright © 2000 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Nursing takes place in a working community and the working community influences the quality of nursing. The purpose of this study was to find out the effects of nurses’ individual characteristics, working conditions, and the ward sisters’ management skills on working climate and team spirit. Thirty-seven wards of two Finnish hospitals took part in the study, and 717 nurses answered the questionnaire. Statistical analyses indicate that the ward sister’s management skill is the best predictor of the climate and team spirit of the wards as perceived by nurses. The nurses’ age, education, and working experience have no direct effect on the working community. Nurses who work by the day, who have plenty of further education and permanent employment, are most likely to be dissatisfied with the climate. According to the results, it is important that the ward sister provides sufficient opportunities for professional development, especially for those who are highly motivated to advance their careers. The ward sister can influence the ward’s team spirit also by furthering operational preconditions of the ward. [ABSTRACT FROM AUTHOR]

The aim of the study was to ascertain those factors that are related to the way first-time mothers assess themselves to be coping with child care when leaving the maternity hospital. The study is part of a wider longitudinal project that follows-up first-time mothers’ growth into motherhood for a period of 8 months after the birth. Data collection was done using a questionnaire distributed between January and May 1995. The sample comprised 271 first-time mothers. The mothers completed the questionnaire on average on the fifth day after childbirth. A stepwise regression analysis was applied. The mothers who assessed themselves to be coping better with child care were those who went home feeling rested and in a good frame of mind and who had positive experience of child care in the maternity ward. The more functional support the mother perceived herself to receive from members of her social network the better she assessed herself to be coping with child care. Those mothers who had previous experience of taking care of infants also assessed themselves to be coping better with child care. On the basis of the research findings it may be stated that the first-time mother needs support from both nursing professionals and close relatives in order to trust their own abilities to cope better with child care during early motherhood. [ABSTRACT FROM AUTHOR]

This study was concerned with the objects of fear and the intensity of fears related to coronary arteriography (CA) in 378 patients scheduled for coronary arteriography at a university hospital. Intensity of fear was measured on a 10-point Likert-type scale which listed 26 objects of fear. The patients were asked to assess the intensity of their fears both before and after CA. The results showed that the intensity of fear varied depending upon the object of fear. The highest intensity was recorded for fear of coronary artery bypass surgery. A significant increase was found in fear of lying flat in bed after CA and fear of not receiving social support. Fears of uncertainty about the illness, the CA procedure, results of CA, pain, coronary artery bypass surgery and coronary angioplasty decreased significantly after CA. Significant associations were found between objects of fear and patient demographics. It is concluded that patients' fears should be assessed individually both before and after CA. Special attention should be paid to the fears of women, patients under 45 years, upper and lower level employees and the unemployed. [ABSTRACT FROM AUTHOR]

This study examined potential regional differences in the deposition of granulation tissue in cellulose sponges placed in the dorsum of rats. Four cellulose sponge implants, 10 × 10 × 5 mm in size, two in cranial and two in caudal positions, were used to induce granulation tissue formation in the back of the rat. A cranio-caudal difference in connective tissue formation was assessed from 1 to 24 weeks after implantation. Granulation tissue ingrowth, measured histomorphometrically, was enhanced at 2 weeks and the surrounding capsule was thinner from 1 to 3 weeks in implants located in the cranial part of the back. In the cranial position, the number of fibroblasts, assessed semiquantitatively, was higher and the ratio of inflammatory cells to fibroblasts lower at 2–3 weeks. Also, the ratio of hydroxyproline content to total nitrogen content was higher after the first week in cranial specimens. Thus, a distinct cranio-caudal difference in the proliferative phase was observed. These results show the obvious practical considerations underlying the need for randomization or comparison between implants from exactly corresponding cranio-caudal locations. [ABSTRACT FROM AUTHOR]

Nurses’ ability to perceive patients’ fears related to coronary arteriography ¶This study describes the congruence of the perceptions of 180 patient–nurse dyads concerning patients’ fears related to coronary arteriography (CA). The perceptions were measured with a purpose-designed instrument which listed 26 objects of fear. t-Tests and chi-square tests were used to compare the responses and the associations with demographic data. The results pointed to inconsistencies between patients’ and nurses’ perceptions. Nurses and patients had congruent perceptions of the 10 most intense fears related to CA. Otherwise nurses tended to overestimate patients’ fears. Nurses’ perceptions of the intensity of individual patients’ fears were incongruent so that before CA there was a tendency to overestimate the intensity of fears and after CA to underestimate it. The results suggest that nurses need to pay more attention to the assessment of individual patients’ fears and to avoid stereotypical views of patient fears. The use of an assessment instrument is recommended as one way of enhancing the quality of care. [ABSTRACT FROM AUTHOR]

The purpose of this study was to look at the factors related to the first-time mother's coping with child care when her child is 3 months old. This study is part of an extensive longitudinal project in which the development of mothering skills of first-time mothers was followed up for 8 months postpartum. The data were collected with a questionnaire between March and September 1995, in a sample of 271 first-time mothers. The mothers filled in the questionnaire when their babies were 3 months old. Coping with child care was assessed using Spearman correlation coefficient and stepwise regression analysis. Positive correlation was found between the mother's competence, attachment to the child, health, depression, relationship with the spouse, sense of isolation and role restriction, and the mother's coping with child care. The strongest correlation existed between the mother's competence and her coping. Positive correlation was also found between the child's mood, demandingness and acceptability, and the mother's coping with child care, with the child's demandingness having the strongest correlation. Positive correlation was again found between social support–the average functional support the mother received from her own social network, plus affect, affirmation, and aid from the public health nurses–and the mother's coping with child care. The predictors included in the multivariate method were the mother's competence, health, depression, and attachment to her child; the child's mood and ease or difficulty of care; and the affect and affirmation from the public health nurse. The results show that the first-time mother's coping with child care, when the child is 3 months old, is affected by the characteristics of both mother and child, as well as by the social support received from their social network and from the public health nurses at the child welfare clinic. [ABSTRACT FROM AUTHOR]

The present study evaluates the relationship of different alcohol consumption levels to blood pressure among women. Blood pressure values were compared between four groups of women consuming different amounts of alcohol. Three groups were formed from the middle-aged female population participating in a health survey ( n= 219): 15 consecutive alcohol abstainers, 136 consecutive moderate drinkers, and 68 consecutive heavy drinkers. Also, 78 consecutive female alcoholics reporting for treatment were included, forming the fourth group. The prevalence of systolic blood pressure ≥160 mm Hg did not increase in relation to alcohol consumption. In contrast, the percentage of women showing diastolic blood pressure ≥90 mm Hg clearly increased ( p= 0.004) from abstainers (7%) to moderate drinkers (18%), to heavy drinkers (32%), and to alcoholics (37%). The highest blood pressure values were found among heavy drinkers. Compared with abstainers, the mean difference in systolic blood pressure was -12 mm Hg, with a 95% confidence interval from -2 to -23 mm Hg. For diastolic blood pressure, the difference was -6 mm Hg with a 95% confidence interval from 1 to -13 mm Hg. Among alcoholics, the blood pressure values had returned essentially to normal after 4 days of abstinence. It is concluded that alcohol consumption increases both systolic and diastolic blood pressure values among women. However, only diastolic blood pressure values increase enough to be clinically significant. Moderately elevated diastolic blood pressure, combined with normal systolic blood pressure, might thus be a possible sign of alcohol abuse among women. Abstinence should be emphasized as an inexpensive and rapidly effective treatment for mild hypertension among female alcohol abusers. [ABSTRACT FROM AUTHOR]

Macrocytosis, a common finding in patients without anemia or other hematologic abnormalities, is often ignored. The purpose of this prospective study was to investigate 300 consecutive, adult health-center patients with a mean cell volume (MCV) value ≥ 100 fl. The incidence of macrocytosis was 2.4%. Of the 177 male and 123 female patients, only 14 (4.7%) were anemic; 80.2% of the men (89.3% of those under 60 years) and 34.1% of the women were alcohol abusers, representing the largest diagnostic group. The highest MCV value found in alcoholics without folate or vitamin B12 deficiency was 120 fl. The most useful laboratory test for identifying alcohol abuse among macrocytic patients was the measurement of serum gammaglutamyltransferase. Of the several morphologic abnormalities in the marrow the only specific finding were vacuoles in the granulocyte or erythrocyte precursors. No underlying cause was found for macrocytosis in 6.8% of the men and 35.8% of the women. Even when it is not associated with anemia, macrocytosis should not be ignored. It may be the only indicator of a disease which often, particularly in young and middle-aged men, is alcohol abuse. [ABSTRACT FROM AUTHOR]

Aging and chronic alcohol consumption can cause degenerative changes in the cerebellar cortex. In this study, the effects of aging and lifelong alcohol consumption on cerebellar cortical layer volumes (molecular and granular) and also white matter layer volumes were studied in alcohol-preferring (AA) and nonpreferring (ANA) rats of both sexes. The ethanol-consuming animals (EtOH) had 12% (w/v) ethanol as the only available fluid from 4 to 22 months of age, whereas the young (3 month) and old controls (24 months) had only water to drink. The volumes of molecular, granular, and white matter layers of the cerebellar vermis in folia II, IV, VII, and X were measured by using systematic sampling and a point-counting method. The volumes of the granular and white matter layers showed consistent increase between 3 and 24 months of age, whereas the volume of the molecular layer remained unchanged with increasing age. Individual ethanol intake was measured over a 1-week period at the beginning and at the end of chronic ethanol exposure. Significant (ANOVA, P= 0.000) sex difference was found in the drinking behavior in both lines, with females consuming more alcohol than males (daily ethanol consumption at 22 months of age 3.2 ± 0.3 vs. 7.1 ± 0.3 g/kg for AA males and females; 3.2 ± 0.3 vs. 5.4 ± 0.4 g/kg for ANA males and females, respectively). The only ethanol-induced effect on the cerebellum was observed in ANA-EtOH females with a 15% reduction in the volumes of the molecular and granular layer in folium II compared with age-matched controls and a significant ( P < 0.05, analysis of covariance with ethanol intake as a covariate) line difference in folium II (molecular and granular layers) was observed between ANA-EtOH females and AA-EtOH females. Furthermore, the volume of the molecular layer in folium II was significantly ( P < 0.05, analysis of covariance with ethanol intake and body weights as covariates) reduced for ANA-EtOH females, compared with ANA-EtOH males indicating a sex difference in the cerebellar degeneration due to chronic alcohol consumption. Of the three layers studied, the white matter layer was the most resistant layer to the effects caused by chronic alcohol consumption. In view of the fact that AA and ANA rats of both sexes differ regarding the drinking behavior and ethanol metabolism, they provide an important model for further research on ethanol-induced pathological changes in the central nervous system. [ABSTRACT FROM AUTHOR]

Environmental factors are suspected to be responsible in part for the deterioration in semen quality observed worldwide during the recent few decades. Alcohol might be one factor, considering the frequent changes in testicular function associated with heavy drinking. The dose-dependent effects of alcohol on human spermatogenesis are, however, not well known. We analyzed spermatogenesis and testicular tissue morphology of 195 men, aged 35-69 years, with computer-assisted microscopy in this autopsy study. The men were categorized into controls and four 'consumption groups' according to the average daily alcohol consumption, which was determined on the basis of blind interviews with relatives and acquaintances. When the average daily alcohol consumption was 40 g or less, 59 (66%) of the 90 men showed normal spermatogenesis, whereas 31 (34%) had partial spermatogenic arrest (SA). Of the 31 men with average daily intake between 40 and 80 g, 17 (54%) showed normal spermatogenesis, 13 (42%) had partial or complete SA, and 1 man exhibited more severe testicular damage-'Sertoli cell only' (SCO) syndrome. Among men with daily intake between 80 and 160 g, only 13 of 35 men showed normal spermatogenesis (37%), 19 (54%) had partial or complete SA (odds ratio = 2.92), and 3 (9%) had the SCO syndrome (odds ratio = 16.85). The frequencies of spermatogenic disorders were similar in men drinking in excess of 160 g. Both SA and the SCO syndrome showed a clear dependence on daily dose; p < 0.0001 and p < 0.0004, respectively. We conclude that long-term average daily consumption of <40 g of alcohol seems not to be associated with disorders of spermatogenesis. Consumption of moderate amounts of alcohol may affect semen quality more often than previously thought, whereas high alcohol consumption may even be associated with serious disorders of spermatogenesis. [ABSTRACT FROM AUTHOR]

Background . The 6-year survival of depressed elderly (N = 290) Finns was assessed and compared to that of a non-depressed population (N = 982), and the factors related to high mortality were analysed. Method . Depression was determined according to the DSM-III criteria, and a majority of the depressed population suffered from dysthymic disorder. Survival distributions were represented as Kaplan-Meier survival curves. The Cox proportional hazards model was used to analyse the simultaneous relationships between mortality and certain variables. Results . The survival curves showed an increased mortality of the depressed elderly in both men and women. However, when the simultaneous relationships of age, marital status, education, smoking, functional abilities, somatic illnesses and depression were taken into account, depression did not predict mortality. The predictors of mortality were high age, a high number of medicines, smoking, disability, male sex and occurrence of somatic illnesses. Conclusions . Evidence of once measured depression is not predictive of increased mortality in an unselected elderly population (60+) when the other factors known to influence survival probability are taken into account. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The predictive value of health, health behaviour and functional ability for the occurrence of depression in elderly Finns is described using a longitudinal design. The persons determined as not being depressed (DSM-III criteria) in an epidemiological study in 1984-85 were interviewed and examined in a follow-up study in 1989-90 (N = 679). The risk factors were analysed by contrasting the persons depressed in 1989-90 with those not depressed. Of the symptoms, recurrent falling and a loss of appetite in men, and palpitation, dyspnoea at rest, tremor in the hands, nausea, dizziness, recurrent falling, apathy and feebleness, fatigue and weakness, restlessness and sight disturbances in women predicted depression. Certain depressive symptoms, such as crying spells, psychomotor agitation, irritability, self-deprecation and suicidal thoughts in men, and sadness, tachycardia, a Loss of concentration, psychomotor retardation and indecisiveness in women, also predicted depression. Numerous somatic and psychosomatic symptoms and numerous depressive symptoms were risk factors for women. Old age, poor self- perceived health, dependence on outside help in negotiating stain and dependence on outside help in washing oneself were risk factors for men. A previous episode of depression was a predictor in both sexes. Sex was not related to the risk of depression. Both in men and women, an impairment of functional abilities during the follow-up was related to depression. A decline of self-perceived health, an occurrence of a serious disease and a decrease in the amount of physical exercise among women and moving into long-term institutional care and a decline of self-perceived health during the follow-up among men were associated with a greater risk. The occurrence of genitourinary diseases in men and the occurrence of vascular, cerebrovascular, thyroid or neurological disease in women during the follow-up were related to a high risk. The results support the hypotheses of a multifactorial aetiology and a relapsing and episodic course of depression in old age. [ABSTRACT FROM AUTHOR]

The 5-year prognosis for 199 elderly patients (60 yr+) suffering from dysthymic disorder is described. Twenty-nine per cent of the men and 39% of the women recovered, 26% of both were suffering from depression after 5 years, 9% of both had a possible dementia, 32% of the men and 22% of the women had died and 3% of the men and 5% of the women could not be contacted. The outcome did not differ between the sexes or age groups. A poor prognosis among men was related to a low educational level, a non-independent previous occupation, the occurrence of depression previously, a high number of hobbies and the following depressive symptoms: initial and delayed insomnia, retardation and psychomotor agitation. A poor prognosis was also found for those whose functional capacities, hobbies or emotional relations with their wives had declined or who had experienced a pulmonary disease or few or no social growth events during the follow-up. A poor prognosis among women was related to low self-perceived health, high sum score of the Hamilton Rating Scale for Depression, thyroid disorder and the following depressive symptoms: loss of libido and diurnal variation of symptoms. A poor prognosis was also found for those whose physical health, functional capacities, social participation rate or hobbies had declined or who had experienced a serious disease during the follow-up. A favourable prognosis was round for women who moved to live alone or became more active in taking physical exercise. [ABSTRACT FROM AUTHOR]

A prospective follow-up of 199 elderly (60 + yr) patients (65 men and 134 women) suffering from dysthymic disorder and 42 elderly (60+ yr) patients (13 men and 29 women) suffering from major depression is described. The mean duration of the follow-up was 15.3±4.3 months for dysthymic men, 15.2 ±4-4.4 months for dysthymic women, 15.3 ± 4.0 months for major depressive men and 14.0 ± 4.2 months for major depressive women. Forty-three per cent of the dysthymic men, 38% of the dysthymic women, 39% of the major depressive men and 48% of the major depressive women had a good outcome. In dysthymic men, few visiting contacts were associated with poor outcome. In dysthymic women, poor outcome was associated with many depressive symptoms, low social participation, not living alone, low sell-perceived health, intensive diurnal variation of symptoms, low interest in work and activities, low sexual interest, and hypochondrial and compulsive symptoms. In major depressive men, no variable was associated with outcome. In major depressive women, poor outcome was associated with diabetes mellitus, suicidal ideas or attempted suicide, and psychomotor agitation or psychomotor retardation. [ABSTRACT FROM AUTHOR]

Intracellular free calcium regulates contraction-relaxation processes in vascular smooth muscle. We compared intraplatelet free calcium ([Ca2+]i) and pH ([pH]i) in hypertensive pregnant women to those in normotensive pregnant and non-pregnant women. Plasma parathormone and vitamin D metabolite were simultaneously assessed. In hypertensive pregnancy, [Ca2+]i tended to be lower than in normotensive pregnant (P=0.08) and non-pregnant subjects (P=0.06). In hypertensive pregnancy, 1,25 (OH)2 vitamin D in plasma was in the same range as in non-pregnant women and significantly lower than in normotensive pregnancy (p<0.01). The other two vitamin D metabolites, parathormone and [pH]i were equal in the three groups. A five-day nifedipine treatment (10 mg t.i.d.) increased [Ca2+]i in hypertensive pregnant (P<0.05) and normotensive non-pregnant subjects (P=0.06), whereas [pH]i (P<0.05) and 25 (OH) vitamin D (P<0.05) decreased in the former and 24,25 (OH)2 vitamin D increased in the latter group (P<0.05). Initial [Ca2+]i did not correlate with blood pressure in any group. The antihypertensive effect of nifedipine did not correlate with any variable measured. In conclusion, [Ca2+]i and calcium-regulating hormones seem not to be related to the antihypertensive effect of nifedipine in hypertensive pregnancy. In this type of hypertension, intraplatelet calcium may not reflect calcium balance in smooth muscle cells regulating vascular tone and blood pressure. [ABSTRACT FROM AUTHOR]

Atrial natriuretic peptide exhibits natriuretic. diuretic and vasodilatory properties. We compared plasma concentrations of atrial natriuretic peptide, cyclic guanosine-3′,5′-monophosphate (cGMP), electrolytes and urinary excretion of cGMP and electrolytes in hypertensive pregnant women to those in normotensive pregnant and normotensive non-pregnant women. Plasma atrial natriuretic peptide concentrations in hypertensive pregnant and normotensive nonpregnant women were equal, whereas in normotensive pregnant women it was lower (P<0.05), than in non-pregnant. Urinary cGMP excretion was higher in both normotensive and hypertensive pregnant than in non-pregnant women (P<0.01). whereas plasma cGMP levels were similar. A five-day nifedipine treatment (10 mg t.i.d.) had no effects on any of the variables. In hypertensive pregnancy, a reduction of systolic blood pressure by nifedipine correlated with the initial plasma atrial natriuretic peptide (P<0.05) and a decrease in diastolic blood pressure with the initial plasma cGMP concentration (P<0.05). The results of this small material suggest that plasma atrial natriuretic peptide concentration predicts the response to nifedipine in hypertensive pregnancy. However, the atrial natriuretic peptide-cGMP system does not seem to mediate the antihypertensive effect of nifedipine, while plasma atrial natriuretic peptide remained unaltered. Increased urinary cGMP excretion in both pregnant groups but lowered plasma atrial natriuretic peptide in normotensive pregnancy suggest other factors than circulating atrial natriuretic peptide to promote renal cGMP excretion during pregnancy. [ABSTRACT FROM AUTHOR]

Oral cavity health was monitored in 2422 young people aged 13-15 years attending four health centres in Finland between 1992 and 1995 Assessments Were made in terms of DMF, D and CPITN indices at clinical examinations. Of those who had no carious teeth at the initial examination, 60% did not develop cavities during the whole period, whereas half of those who had at least two Carious teeth at the initial examination developed at least three new carious teeth. The treatment time needed by the latter accounted for half of the total time expended by the researchers until the end of the period. Costs can be saved or new patients brought into the dental care system by reorganizing the treatment of the patients who suffer from abundant caries and by reducing the resources devoted to the treatment of healthy patients. [ABSTRACT FROM AUTHOR]

Background: The study objective was to gain information about factors that contribute to the successful establishment of breastfeeding in first-time mothers while they are still in the maternity hospital. The study was part of a wider longitudinal project that examined the development of first-time mothers into motherhood during eight months after the birth. Methods: Data were collected by a questionnaire distributed between January and May 1995. The sample comprised 326 first-time mothers, who completed the questionnaires on about the fifth day after childbirth. A polychotomic logistic regression analysis was applied. Results: Mothers who had a positive experience of breastfeeding in the maternity ward and who began lactating 2 to 3 days postpartum coped better with breastfeeding than those whose experience was less positive and who lactated later. Moreover, the greater the emotional (affect) and concrete (aid) support received by the mother from members of her support network, the better she coped with breastfeeding. By contrast, those mothers who were upset while in the maternity ward coped less well with breastfeeding. Conclusions: Establishing successful breastfeeding in first-time mothers requires the professional guidance and support of the maternity staff and paying attention to the person closest to the new mother, who in this study was the spouse or father of the child. (BIRTH 25:3 September 1998). [ABSTRACT FROM AUTHOR]

Objective: To evaluate physical activity among urinary incontinent women seeking treatment and to assess the change of physical activity after treatment., Design: Part of a prospective observational intervention study to examine the factors influencing the severity of urinary incontinence., Setting: Tampere University Hospital-referral unit., Population: Eighty-two urinary incontinent women were evaluated in the baseline and 69 (84%) one year (mean 13 months, range 6-21) after treatment., Methods: Physical activity was measured by self-report questionnaire and electronic motion sensor: Caltrac accelerometer worn by women for one week. The diagnosis and severity of urinary incontinence was estimated on the basis of urodynamics, pad test, diary and incontinence-specific quality of life measures. Treatment outcome was assessed according to objective parameters and patients satisfaction., Main Outcome Measures: Physical activity at work, leisure and sport expressed in MET (metabolic unit) and kilocalories, change in physical activity after treatment., Results: Twenty-one (25.6%) of all women reported exercise of more than three times per week. Incontinent women with the highest leisure time activity > or =6 MET (n= 23, above 75th centile) were younger; they had less body mass index and greater urine leakage than others. One year after treatment, there was no change in any parameters of physical activities. Also exercise habits among women who were completely dry (n= 37) after treatment were not changed., Conclusion: Urinary incontinent women who seek treatment are as physically active as the normal population. Even after successful incontinence treatment, exercise habits do not change.

Background: Cobalt production workers are exposed to metallic cobalt and nickel and their compounds and to different irritant gases. The aim of our study was to determine whether long-term exposure is associated with an increased occurrence of respiratory symptoms and findings or diseases, other than asthma, which is a known hazard, among cobalt processing workers., Methods: The study population was comprised of 110 current and former cobalt workers who had worked more than 10 years in a cobalt plant. The reference group consisted of 140 unexposed workers. All the participants were men. The analysis was based on exposure history, pulmonary function, chest X-ray findings, and symptom questionnaires., Results: Symptoms of asthma based on questionnaire responses were statistically more prevalent among the exposed workers. The respiratory flow rates MEF25 and MEF50, which refer to smaller airways, were significantly lower among the smoking exposed workers than among the smoking unexposed workers. The causative factors of these symptoms and pulmonary function changes could not be determined by the study. One new case of cobalt asthma and one case of allergic asthma were diagnosed in the exposed population. No cases of hard metal disease or fibrosing alveolitis were found., Conclusions: No chronic respiratory diseases, except asthma, were found among cobalt production workers in this study., (Copyright 2003 Wiley-Liss, Inc.)