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The kinetic energy and direction of a fall contribute to the occurrence of fracture. However, the fracture risk associated with different types of fall, different amounts of energy and different landing directions is poorly understood. We recorded all falls and fall-related fractures over 7 years in an aged semi-rural home-dwelling population (n = 980), using intensive fall recording. The falls were classified according to type and place of occurrence into slip falls (SLFs), trip falls (TRFs), other extrinsic falls on the level (OEFs), intrinsic falls on the level (IFs), stair falls (STFs), falls from an upper level (ULFs) and nondefined falls (NDFs) occurring indoors or outdoors. Incidences of falls and fractures were calculated for the whole follow-up period. The population was clinically examined to assess general risk factors of fracture, after which the risk of fracture was determined in the first fall according to the different fall types. Comparison was made with intrinsic falling on the level. The overall incidences of indoor and outdoor falls were 328 (95% CI 314-345) and 198 (186 210) per 1000 person-years (PY), respectively, and those of fractures 23 (19-27) and 11 (8-4) per 1000 PY, respectively. Indoor SLFs, TRFs, OEFs, IFs, STFs, ULFs and NDFs occurred relatively evenly throughout the study period. The crude and adjusted relative fracture risks were greater in SLFs, OEFs and STFs compared with IFs. Indoor falls and fractures are more common than those occurring outdoors in aged home-dwelling persons. The kinetic energies produced in SLFs, OEFs and STFs may be higher than those generated in IFs, leading to increased risk of fracture.

Frequent use of health services has been associated with such concepts as alexithymia, hypochondriasis, and psychological distress. The aim of this case-control study was firstly to assess whether alexithymia, hypochondriasis, and psychological distress are associated with frequent attendance and secondly to assess the gender differences of these associations in a primary health care setting. A sample of 304 frequent attenders (eight or more visits during 1 year), including all of the frequent attenders during 1994, and 304 randomly selected age- and sex-matched controls were selected. Half of the sample (every second individual selected in date-of-birth order) was invited for an interview, 113 frequent attenders and 107 controls completed a questionnaire during the interview. Alexithymia was measured with the Toronto Alexithymia Scale-20 (TAS-20), hypochondriasis was screened with the Whiteley Index (WI), and Symptom Checklist-36 (SCL-36) was used to determine psychological distress. We found a distinct gender difference in the associations of these characteristics with frequent attending. Significant associations of alexithymia, hypochondriasis, and psychological distress with frequent attending were found among men, but not among women. Alexithymia, hypochondriasis, and psychological distress should be considered when treating frequent attenders, especially males.

Aim: To describe the prevalence and associates of major depression and minor depression among the Finnish non-demented population aged 85 years and older (n = 339)., Methods: DSM-III-R criteria were used in diagnosing major depression and dementia. Minor depression was diagnosed by the physician in those who did not fulfil the DSM-III-R criteria for major depression, but had still at least two depressive symptoms. In the first phase, cross-tabulation was used to determine relative risks (RR) and their 95% confidential intervals (95% CI). An additive logistic regression model was then used to find the independent associates of depressive disorders., Results: The prevalence of major depression was 8.1% in men and 4.9% in women, and that of minor depression 18.9% in men and 18.5% in women. In men major depression was associated independently with poor physical health and in women with rare contact with family or friends and poor physical health. Minor depression was associated independently with poor physical health and previous myocardial infarction in men and with poor physical health, a poor ability to walk, and smoking in women., Conclusions: The prevalence of depressive disorders is quite high among the oldest-old Finns. The factors associated with major and minor depression are largely similar. Although the results suggest that psychosocial stress factors affect the development of both major and minor depression in the oldest-old, no conclusions about causality can be made.

Background: The aim was to describe the relationships between poor marital and family relations and depression, and the predictive value of these factors for the subsequent occurrence of depression., Methods: The population for the cross-sectional study consisted of the married elderly (N = 498) living in Ahtäri, Finland, in 1989. The series of the longitudinal study was composed of married persons nondepressed in the epidemiological study in 1984-1985, and followed up until 1989-1990 (N = 347)., Results: In men, impaired functional abilities (OR 5.0) and poor family relations (OR 2.9), and in women, impaired functional abilities (OR 3.9), family violence (OR 4.2), age 70 years or over (OR 3.0) and a loss of father in childhood or youth (OR 2.5) were independently related to depression. Poor marital relations tended to be related to depression in both men (OR 2.1) and women (OR 2.2). In both sexes, poor self-appreciation (OR men 3.9; women 7.1) and age 70 years or over (OR men 2.9; women 4.2), and in women, a loss of father in childhood or youth (OR 4.5) were independent predictors of subsequent depression., Conclusions: The poor marital or family relations experienced by many depressed elderly persons are usually consequences rather than predictors of depression. Family violence may be a consequence of depression or even a risk factor for depression., Clinical Implications: Problems in spouse pairs and families should be inquired and solved when treating depressed elderly persons., Limitations of the Study: Due to the unknown validity of the measure concerning marital relations, the results are suggestive.

The effectiveness of simultaneously administered influenza and pneumococcal vaccines vs. influenza vaccine alone in preventing pneumonia, pneumococcal pneumonia and pneumococcal bacteraemia among the elderly was studied. The vaccines were offered to all persons aged 65 years or older (N=43,500) living in 35 administrative districts in Northern Finland. A total of 26,925 persons (62%) decided to participate. Allocation to the vaccination groups took place by year of birth (odd/even). The total follow-up of those vaccinated consisted of 38,037 person years. The incremental effectiveness of the pneumococcal vaccine was -20 (95% CI -50- + 10%) for pneumonia, -20 (95% CI -90- + 20%) for pneumococcal pneumonia and + 60% (95% CI -40- +90%) for pneumococcal bacteraemia. Thus the pneumococcal polysaccharide vaccine did not offer any additional protection from pneumonia among elderly people in Finland although it reduced the incidence of bacteraemia.

Objectives: To establish the role of orthostatic hypotension (OH) as a risk factor for cognitive decline among home-dwelling and institutionalized older people and to describe other predictors of cognitive decline., Design: Follow-up study with two clinical examinations., Setting: A community-based setting in northern Finland., Participants: All of the 1159 people aged 70 or more living in five rural municipalities around the town of Oulu in Northern Finland in 1991. At the time of the follow-up examination, 2.5 years later, 884 of the original participants were alive and 651 were re-examined., Measurements: In 1991, 907 people (78.3% of the total population) were tested for orthostatic hypotension, and their cognitive capacity was assessed with the Mini-Mental State Examination (MMSE). The calculation/spelling tasks were excluded from the final version used in the statistical analysis. The re-assessment of cognitive capacity was made on 651 subjects (73.6% of those alive) who had participated in the first examination. The data were analyzed using polychotomous and linear regression analysis models., Results: The prevalence of OH was 28.7%, with no age or sex differences. The mean sum score for the shortened MMSE in 1991 was 21.6 (+/-3.98) for persons with OH and 21.1 (+/-4.08) for non-OH persons. During the follow-up, the sum score declined in the OH group by .44 (+/-2.81) points and in the non-OH group by .83 (+/-3.61) points. No type of OH (systolic or diastolic 1- or 3-minute values or their combination) predicted cognitive decline; the only predictors were old age and low level of formal education., Conclusions: Orthostatic hypotension is a common clinical condition that affects every fourth person aged 70 years or older. By temporarily inducing cerebral hypoperfusion, it may cause or exacerbate cognitive dysfunction. In an unselected population, OH was not associated with cognitive deterioration, nor did it predict cognitive decline during a 2-year follow-up.

Background: Orthostatic hypotension (OH) predicts mortality in hypertensive persons with diabetes mellitus, but no increase in mortality has been found among random samples of home-dwelling persons with OH. We examined the risks of nonvascular and vascular deaths according to different definitions of OH among home-dwelling elderly persons., Subjects and Methods: The study population consisted of all persons aged 70 years or older living in 5 rural municipalities (N=969), of whom 833 (86%) participated. Orthostatic tests were successfully carried out in 792 persons by nurse examiners. Orthostatic hypotension was defined as a systolic blood pressure (BP) drop of 20 mm Hg or more or a diastolic BP drop of 10 mm Hg or more 1 minute or 3 minutes after standing up. Nonvascular and vascular deaths during the follow-up period were recorded. Data on diseases, symptoms, medications, the results of clinical examinations and tests, functional ability, and health behavior were collected at the beginning of the follow-up period., Results: Of the sample, 30% had OH: the prevalence of systolic OH 1 minute and 3 minutes after standing up was 22% and 19%, respectively; that of diastolic OH 1 minute and 3 minutes after standing up was 6% for each. No differences in the occurrence of nonvascular deaths were found according to any of these definitions. By Cox multivariate regression analysis, the hazard ratio of vascular death associated with a diastolic BP reduction of 1 mm Hg 1 minute after standing up was 1.02 (P=.03), adjusted for systolic BP postural changes at 1 and 3 minutes and a diastolic BP change at 3 minutes. Adjusted for other significant factors associated with vascular death, the hazard ratio for vascular death associated with diastolic OH 1 minute after standing up was 2.04 (95% confidence interval, 1.01-4.15). The corresponding hazard ratio for systolic OH 3 minutes after standing up was 1.69 (95% confidence interval, 1.02-2.80). Using a cutoff point of 7 mm Hg or greater for a diastolic BP change 1 minute after standing up, the hazard ratio for vascular death was highest: 2.20 (95% confidence interval, 1.23-3.93). By logistic regression analysis, the baseline associates of diastolic OH 1 minute after standing up were dizziness when turning the neck (odds ratio [OR], 2.44), the use of a calcium antagonist (OR, 2.31), the use of a diuretic medication (OR, 2.29), a high systolic BP (OR, 2.23), and a low body mass index (OR, 2.26). The baseline associates of systolic OH 3 minutes after standing up were male sex (OR, 1.52), diabetes mellitus (OR, 1.92), a high systolic BP (OR, 2.91), and a low body mass index (OR, 1.68)., Conclusions: The presence of diastolic OH 1 minute and systolic OH 3 minutes after standing up predict vascular death in older persons. They differ from each other in their prevalence and in several associates, suggesting different pathophysiologic backgrounds. Clinicians should prescribe vasodilating and volume-depleting medications with caution for elderly persons with diastolic OH 1 minute after standing up. Appropriate treatment of hypertension might be the best means to manage the different types of OH with poor vascular prognoses.

The characteristic feature of Chlamydia is its tendency to cause chronic infections. It has been hypothesized that prior exposure to C. pneumoniae may lead to chronic infection and the development of associated chronic cardiopulmonary disease. Few studies have so far addressed the occurrence of chlamydial antibodies in an elderly, unselected population. This information is important for the development of possible treatment strategies. Chlamydial antibodies were analysed from 1179 serum samples obtained from 481 men and 698 women, aged 64 y and over, who participated in an epidemiological survey carried out in a Finnish rural district. Specific IgG and IgA antibodies were measured by the microimmunofluorescence (micro-IF) test. The criterion for seropositivity was defined as a titre of > or =32 for both IgG and IgA, independently of each other. C. pneumoniae IgG antibodies occurred in 91% of the men and 75% of the women. The respective figures for C. pneumoniae IgA antibodies were 57% and 28%. The geometric mean titres (GMT) rose with increasing age and were higher in men than in women. The prevalences of C. trachomatis IgG antibodies were 13% in men and 18% in women, and for IgA antibodies, 2% and 1%, respectively. C. psittaci antibodies were rare. Only 3% of the men and women were IgG seropositive, whereas the respective figures for IgA seropositivity were 0.4% and 0.1%. C. pneumoniae antibodies indicative of recurrent or chronic infection were common in the elderly. The geometric mean titres correlated positively with age and were higher in men than in women. Other chlamydial antibodies occurred in low titres.

The purpose of this study was to examine possible seasonal variations in relations between hospital treatment periods and in deaths (asthma-related and other) among adult asthmatics. Out of a total of 364,871 asthma-induced hospitalization periods (diagnosis No. 493, International Classification of Diseases) recorded in the hospital discharge register maintained by the National Research and Development Centre for Welfare and Health during 1972-1992, all of those applying to persons aged >24 yrs during 1987-1992 were analysed here. The discharge file was linked to the register of deaths on the basis of the patients' social security numbers in order to analyse all deaths among the same patients during 1987-1993. A total of 81,243 asthma-related treatment periods were analysed. The monthly variation in the number of such periods showed a peak in January (18.2% above the mean number of monthly deaths in the study period) and a trough in July (26.1% below the mean). Of the 7,622 hospitalized asthmatics who died during the period examined here, 1,274 died of obstructive pulmonary diseases, with asthma as the primary cause in 489 cases. The majority of the deaths were caused by cardiovascular diseases. Mortality was highest in January (+14.7%) and lowest in August (-12.3%). The similarity in the seasonal variation observed between the treatment periods and deaths recorded for adult asthmatics may be taken to indicate a genuine need for treatment.

Objective: to study the prevalence of coronary heart disease (CHD) and its clinical manifestations among Finnish elderly people in a cross-sectional epidemiological survey in the rural district of Lieto, southwestern Finland, with special emphasis on the overlap of CHD manifestations with electrocardiogram (ECG) findings and factors associated with CHD., Design: observational population-based study., Setting: Health Centre in Lieto, Finland, 1990-91., Subjects: 488 men and 708 women aged 64-97 years., Main Outcome Measures: angina pectoris (AP) and dyspnoea were recorded using the London School of Hygiene cardiovascular questionnaires. Resting ECG findings were analysed and coded. Minnesota codes 1.1-1.3, 4.1-4.4, 5.1-5.3 or 7.1 were interpreted as ischaemic. The medical history of cardiovascular diseases was based on medical records., Results: the prevalence of AP was 9.1% [95% confidence interval (CI): 6.7-12.0] among men and 4.9% (3.5-6.8) among women. The respective figures for myocardial infarction (MI) were 13.9% (10.9-17.0) and 6.5% (4.8-8.6). Ischaemic ECG findings were common: 32.9% (28.7-37.1) of men and 39.3% (35.7-43.0) of women had such changes, whereas only a minority of them reported typical AP. The total prevalence of CHD, including AP, MI, past coronary artery by-pass operation or angioplasty or ischaemic ECG findings, was 37.7% (33.4-42.0) in men and 42.0% (38.3-45.6) in women. Among men, a higher prevalence of CHD was associated with increasing age [odds ratio (OR) 1.81; 95% .CI: 1.20-2.73] and a history of having smoked in the past (OR 1.66; 1.06-2.59), whereas among women it was associated with increasing age (OR 2.02; 1.48-2.77) and a lower educational level (OR 2.30; 1.37-3.86)., Conclusion: the prevalence of CHD among elderly people is high and the clinical picture of the disease is variable. The nature of CHD seems to be less severe among elderly women compared with men. Minor ECG changes, especially in the ST and T segments, are common with ageing and should not necessarily be interpreted as ischaemic. However, these findings combined with atypical chest pain or dyspnoea in an elderly person may indicate the possibility of CHD.

This paper discusses the clinical history of a Finnish person from the area north of the Arctic Circle with childhood-onset bronchiectasis. It covers a period of 30 years and is aimed at analysing the significance of the disease for the use of hospital services. Childhood bronchiectasis is a rare disease nowadays and difficult to diagnose, but it still leads to serious disability in some children, requiring regular hospitalisation. The prognosis for these cases with advancing age is not known.

The independent predictive roles of early losses, personality traits, acute losses and long-term stress situations for the occurrence of depression in elderly Finns were described using a longitudinal design. The persons non-depressed in an epidemiological study in 1984-85 were interviewed in 1989-90 (N = 679) and the occurrence of depression was determined according to DSM III-criteria. Logistic regression models were used to assess the independent roles of the hypothesized factors as predictors. An early loss of the mother among men and an early loss of the father among women independently predicted the occurrence of depression in logistic regression models. Older age in men, and a higher number of symptoms, the occurrence of previous depression and not living alone in women were also independent predictors. In men, impaired functional abilities and poor self-perceived health tended to predict depression. In conclusion, the psychological trauma which develops upon the experience of an early parental loss contributes to the development of depression even in old age. The role of stressors in life as independent predictors of depression in old age was also ascertained.

The incidence and age distribution of bronchiectasis is at present poorly known. The aim here was to describe the use made of hospital services by bronchiectasis patients in Finland over ten years and to estimate the incidence of this disease. Data on hospital admissions for bronchiectasis were obtained from the register maintained by the National Research and Development Centre for Welfare and Health. Admissions and new cases during the period 1983-1992 were calculated by age and sex in relation to the total population. There were 5,710 admissions for bronchiectasis and 1,928 new cases. The occurrence of cases treated in hospital was 4.9 per million person-years at age 0-14 years, 103.8 at 65 years or over and 38.9 in the total population. The estimated incidence of bronchiectasis is low in Finland, especially in childhood, and efforts aimed at its treatment should now be directed specifically at the elderly population, which continues to exert considerable pressure on even a relatively well developed health service in this respect.

The survival of aged Finns suffering from dysthymic disorder (DSM-III criteria) was assessed in two cohorts (60+ yrs and 65+ yrs) in a longitudinal epidemiological study conducted in Ahtäri in western Central Finland from 1984 onwards. The mortality of dysthymic persons (N = 214 and N = 115) was compared to that of the non-depressed population living in the same municipality (N = 982 and N = 853). Two follow-up periods (6 yrs and 11.5 yrs) were used for the first cohort, and one (6 yrs) for the second cohort. The Kaplan-Meier procedure and Mantel-Cox statistics followed by Cox proportional hazards models were used in the analyses. The occurrence of dysthymic disorder in men was related to higher mortality in both cohorts during all follow-up periods. In women, the occurrence of dysthymic disorder was related to higher mortality in the first cohort during the follow-up of 11.5 years, and in the second during the follow-up of 6 years. When age, sex, marital status, education, smoking, physical health and functional abilities were taken into account in the Cox proportional hazards models, high age, male sex, smoking, low educational level, the use of more than two medicines and lowered functional abilities emerged as predictors of mortality in the first cohort during both follow-up periods. In the second cohort, high age male sex, smoking, poor physical health and lowered functional abilities emerged as predictors. The results suggest that the higher mortality of the aged suffering from dysthymic disorder is explained by the high occurrence of somatic diseases and disabilities in dysthymic persons. They do not suggest that there might exist biochemical factors in the aetiology of dysthymic disorders that would increase mortality. Nor do they give any evidence to suggest that dysthymic disorders might be precursors of somatic diseases increasing mortality.

The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease. The aim of our study was, firstly, to describe functional abilities among elderly CHD patients and, secondly, to analyze the relationships between physical disability and the severity of chest pain or dyspnea. The third aim was to assess whether there is an independent association between physical disability and CHD. The study was carried out at the health center of the municipality of Lieto, southwestern Finland. From a population of 1196 community-dwelling persons aged > or = 64 years, 89 men and 73 women with CHD (angina pectoris and/or a past myocardial infarction) were selected along with 178 male and 146 female sex- and age-matched controls without CHD. Physical functioning was assessed by means of interviewer-based questionnaires, compared between patients and controls and described in relation to the severity of chest pain and dyspnea among patients. The associations between dependence or difficulties in mobility, ADL (activities of daily living) and IADL (instrumental activities of daily living) and CHD, age, smoking, comorbidities, drug therapy and clinical characteristics were assessed by logistic regression analyses. On items representing mobility and managing in IADL, patients reported more difficulties or dependence than controls. Among female patients, more severe chest pain was associated with poor managing in IADL and tended to be associated with poor mobility. More severe dyspnea was associated with poor mobility among both male and female patients, and with poor managing in IADL among male patients. Logistic regression analyses failed to show that CHD was associated independently with physical disability among the elderly. However, physical disability was associated with the use of cardiovascular drugs in the models among both genders, which probably indirectly indicated an association between physical disability and CHD. Several confounding factors, such as higher age, depression, cancer and the use of psychotropic drugs, contributed to the decline in functional abilities even among persons with CHD. In conclusion, elderly CHD patients have greater limitations in their functional ability than matched controls, which may depend on the severity of the disease. Especially male patients' limitations in physical abilities may be influenced by the fact that men with CHD are more likely to be depressed. Although an independent association between physical disability and CHD was not found, the associations found between physical disability and the use of cardiovascular drugs probably indicate a causal relationship between CHD and physical disability.

The aim of this study was to describe the association between glucose tolerance status and mortality in an elderly (> 70 years) Finnish community-living population (n = 379, of whom 141 were men). The baseline examination in 1991-1992 consisted of a postal questionnaire, a physical examination, and a 2-h oral glucose tolerance test. The follow-up was continued until death or 31 May 1996. The deaths were ascertained from official death certificates; 31% (n = 44) of the men and 18% (n = 40) of the women died within 4 years. The cumulative 4-year mortalities were 42% in previously diagnosed diabetic men, 25% in previously undiagnosed diabetic men, 27% in men with impaired glucose tolerance (IGT), and 31% in men with normal glucose tolerance (NGT). The corresponding figures for women were: 26%, 29%, 19%, and 8%, respectively. After adjusting for age, gender, smoking, body mass index and exercise by the Cox proportional hazards model in the total population, the estimated relative mortality rate was 2.2 (95% confidence interval (CI) 1.2 to 4.1) in previously diagnosed diabetic subjects, 1.7 (95% CI 0.8 to 3.7) in subjects with previously undiagnosed diabetes, and 1.2 (95% CI 0.7 to 2.1) in the IGT group, respectively, all in comparison to the NGT subjects. In separate modelling by gender these relative mortalities were higher in women than in men, but the gender difference could well be explained by chance variation. In conclusion, the results suggest that previously diagnosed diabetes is associated with increased mortality among the elderly and, particularly among elderly women, undiagnosed diabetes and even IGT may be associated with increased mortality.

The prognosis and risk factors for bronchiectasis are at present poorly known. The aim of this study was to examine the long-term prognosis and cause of death in this disease. The National Hospital Discharge Register was used to search for patients aged 35-74 yrs, with newly-diagnosed bronchiectasis in the period 1982-1986. Each of the 842 patients identified was matched with an asthmatic patient and a patient with chronic obstructive pulmonary disease (COPD), who were of the same age and sex and who had been treated in hospital at the same time. The use of hospital services by these subjects was examined up to the end of 1992, and mortality to the end of 1993. The prognosis for the bronchiectatic patients treated in hospital was better than that for the COPD patients but poorer than that for the asthmatics; the risk of death being 1.25 (95% confidence interval (95% CI) 1.15-1.36) for the COPD patients and 0.79 (95% CI 0.71-0.87) for the asthmatics, relative to the bronchiectatic patients. Bronchiectasis was the main cause of death in 13% of bronchiectatic patients, the risk of death being increased by a factor of 1.21 in the presence of asthma as the main secondary diagnosis, by 1.31 with COPD, by 1.35 with tuberculosis and its sequelae, and by 1.32 with some other secondary diagnosis, as compared with cases for which no secondary diagnosis was indicated. The fact that the prognosis for bronchiectatic patients is poorer than that for asthmatics points to a continued need for focused care and follow-up, particularly in the presence of additional illnesses.

Chronic obstructive pulmonary diseases, which have increased due to smoking and ageing of the population, constitute a national health problem, the treatment of which can be expected to arouse considerable discussion in health care organisations currently preoccupied with economic problems. Although extensive medication and easy access to treatment are often regarded as therapeutically desirable, it may be questioned whether they have any impact on objective measures such as mortality. International recommendations for the early treatment of asthma have met with satisfaction and the asthma situation can be said to be under control, even though occurrences tend to be on the increase. It should be noted, however, that the COPD treatment recommendations still remain to be tested and the general attitude towards treatment is still reserved, even pessimistic. By combining data from the Finnish national hospital discharge register and register of deaths with findings regarding the use of medications, differences in the survival of asthmatic and COPD patients can be discerned between areas with different treatment practices. Stressing the fact that effect-differences between different treatment strategies can not be proven on the basis register data and that random clinical trials are needed to gain further knowledge in the field, our results show that extensive medication and easy access to treatment are characteristic of areas where the survival of asthmatics and COPD patients is better.

Objective: To investigate the predictors of fractures during falling impacts among home-dwelling older adults., Design: A case-control study within a prospective, population-based survey., Setting: Five rural municipalities in northern Finland., Participants: The study population consisted of all home-dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow-up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period., Measurements: During a 4-year follow-up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4-year follow-up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross-tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed., Results: According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel-shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5-kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture-causing falls were frequent fear of falling (OR 2.50; CI 1.11-5.65), reduced knee extension strength (OR 3.38; CI 1.00-11.4), and poor distance visual acuity (OR 3.45; CI 1.13-10.6), whereas limited social participation (OR 0.29; CI 0.11-0.79) protected against the occurrence of fractures., Conclusion: Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors.

Objective: to describe how frequently antimicrobial agents are prescribed for elderly people and to examine the prescribing practice of treating physicians., Design: for each of the 1196 subjects examined, a review of the medical records was carried out for the year preceding the examination and data on antimicrobial prescriptions, including types of infections, were recorded. The sales statistics of antimicrobial agents in this population were compared with the nation-wide ones, collected by the National Agency for Medicines., Setting: a health centre in Lieto, a rural district in southwestern Finland; 1990-91., Subjects: 1196 subjects, aged 64-97 years, 488 men and 708 women., Main Outcome Measures: frequencies of prescriptions of specified antimicrobial agents, including types of infection in relation to gender and form of care over a 1-year period., Results: more women (36%) than men (28%) had received antimicrobial agents. The proportion who had received such agents increased with increasing age, the trend being more marked in men. The mean number of prescriptions per user per year was slightly lower in men than women (0.6 and 0.7 respectively). In both sexes, 54% of the users of antimicrobial agents had received only one prescription. Cephalosporins and penicillins were the most commonly prescribed agents. Among those who had received three or more antimicrobial prescriptions, cephalosporins had been used most frequently. Elderly people living in long-term institutional care were treated with antimicrobial agents more frequently than those living outside institutions. Of all antimicrobial prescriptions given to women, 60% were prescribed for urinary tract infections, 21% for respiratory infections and 8% for skin infections. The figures for men were 18, 45 and 10%., Conclusions: multiple use of antimicrobial agents is common in old age, especially in those in institutions. More attention should be to the provision of appropriate antimicrobial treatment.

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.

A hypothesis of a psychosocial origin of depression in diabetic persons (mainly patients with non-insulin-dependent diabetes mellitus, NIDDM) was tested. The population consisted of all the 1008 persons born in 1935 and living in a Finnish city (Oulu) on 1 October 1990. Data were collected in two phases. A screening for NIDDM and a collection of back ground data were carried out in the first phase. Oral glucose tolerance tests (OGTTs) were performed in the second phase in order to detect those with previously undiagnosed NIDDM, and depressive symptoms were measured with the Zung Self-Rating Depression Scale (ZSDS). Participants who scored 45 raw sum points or more were considered as suffering from depression. All those who were aware of their diabetes before the second phase were considered as previously diagnosed diabetics. Depression (raw sum score 45 points or more on the ZSDS) was associated with previously diagnosed diabetes mellitus, while it was not associated with undiagnosed diabetes. The sum scores on the ZSDS did not differ significantly from each other in the groups classified according to diabetic status. This finding was explained by the sum score of the ZSDS among the previously diagnosed diabetics, which had a skewed distribution towards higher sum scores. Among the previously diagnosed diabetic patients, all those who were depressed were on sick leave or retired, while the corresponding proportion for non-depressed patients was 52% (P = 0.009). The number of diagnosed diseases was higher among the former than the latter group (P = 0.025). Severe depressive symptoms were not associated with a more serious metabolic disease, but they tended to be associated with a great number of diagnosed diseases and with being on sick leave or retired. The results showed that the impact of diabetes mellitus itself on depression was not strong. Depression was not connected to elevated fasting blood glucose levels, but instead to a great number of diagnosed diseases and unfavourable social factors, such as being on sick leave or retired, which suggests a psychosocial origin of depression in NIDDM patients.

Aim: to describe the use of hospital services by Finnish adults aged 65 or over with pneumonia from 1972 to 1993., Material and Methods: the study was based on nation-wide hospital discharge records. Patients in hospital for over 150 days were excluded. The number of persons aged 65 or over was 458,156 in 1972 and 707,341 in 1993., Results: pneumonia caused 237,330 periods of hospital treatment and a total of 3,826,986 hospitalization days in elderly people during the 22-year period. Annual hospital treatment periods increased from 15.5 to 23.9 per 1000 of population aged 65 years or over within this interval. The average annual change in the age-adjusted rate of hospital admissions for pneumonia was 1.45% [95% confidence interval (CI) 1.03 to 1.87] for males and 0.83% (95% CI 0.39 to 1.28) for females. The increase was highest in the oldest male group, those aged 85 years or over. In 1972 the number of hospitalization days recorded was 126,690 (277 per 1000) and in 1993 it was 242,638 (343 per 1000), implying an absolute increase of 91.5%. However, the average annual change in the age-adjusted rate of hospitalization days for pneumonia showed a decrease of 0.62% (95% CI 1.04 to 0.19)., Conclusion: the recorded increase in the use of hospital services by elderly patients with pneumonia, combined with the current increase in size of the elderly population, suggests that the prevention and treatment of pneumonia in this sector of the population will pose a challenge for the health service in the future.

The purpose was to examine changes in the numbers of asthma-related hospitalizations among conscripts and possible seasonal fluctuations. Data on treatment periods for asthma among men aged 18-22 years at military hospitals in 1982-1992 were collected from the national hospital discharge register. Monthly numbers of hospitalizations were calculated for each year separately, together with the frequency of such periods per 1000 conscripts. Results. A total of 4894 asthma-related hospitalizations were recorded in 1982-1992, the frequency per 1000 conscripts increasing from 8.5 in 1982 to 27.7 in 1992. Evident seasonal fluctuations were observed in 1982-1989, the peaks being recorded for February (14% above the annual average), July (26%) and November (51%). A change in these seasonal fluctuations was observed in 1990-1992, however. The frequency of asthma-induced hospitalizations among conscripts tripled between 1982 and 1992, evidently indicating a real increase in the number of occurrences. The hospitalization peaks are located at the beginning of military service, a point at which factors tending to aggravate asthma exercise a major impact.

Unlabelled: All hospital treatment periods caused by asthma in children under 15 years in Finland during 1972-1992 were examined. The data were obtained from the Hospital Discharge Register, covering all hospitalisations in Finland. A total of 59,624 asthma related treatment periods were recorded. The monthly variation in hospitalisations peaked in May (35.6% above the trend) and in autumn and early winter (41.3% above the trend in October), whereas the monthly variations were low in late winter and in summer. The overall profile of seasonal variation was similar in both sexes, although admissions were lower for boys than for girls in winter and higher in autumn. The average monthly deviation was highest in the age group 0-4 years in May, 42.8% above the trend, and highest in the age group 5-9 years in October, 53.9% above the trend. Closer examination of the seasonal variation gives indirect information on possible trigger factors for acute asthma., Conclusion: A clear seasonal variation could be observed in childhood asthma hospital admissions, together with age and sex-related differences in this seasonality. Preventive treatment for asthma should be used effectively in order to avoid acute attacks leading to hospitalisation in children who are allergic to birch pollen and also at times of viral respiratory infections.

The aim of this investigation was to describe the use of hospital services among the Finnish working-age population aged 15 to 64 years on account of pneumonia. The study was based on nationwide hospital discharge records maintained by the National Research and Development Centre for Welfare and Health. Pneumonia caused 63,414 periods of hospital treatment and a total of 568,861 hospitalization days among working-age people in Finland from 1984 to 1993. The mean annual age-specific rate of pneumonia-related hospital treatment periods per 1000 persons among men was 2.67 (SD 0.17) and among women 1.10 (SD 0.08). The men had more treatment periods than the women in every 5-year age group, the greatest difference being in the youngest age groups and in the oldest ones. In men the mean annual rate of treatment periods increased rapidly after the age of 40 years (from 1.54 per 1000 persons in age group 40-45 years to 7.86 per 1000 in age group 60-64 years). In women the increase in corresponding age groups was more moderate (from 0.77 to 3.19). The increasing number of pneumonia-related hospital treatment periods after the age of 40 is facing the challenge for the occupational health care in the future.

Factors predicting impared glucose tolerance (IGT) and diabetes (DM) were studied in a community-living population aged 70 years or over, with initial normal glucose tolerance (NGT). The baseline examinations from 1991 to 1992 included an oral glucose tolerance test (OGTT), physical examinations and questionnaires. The follow-up examinations in 1994 and 1995 comprised of an OGTT. One hundred and thirteen of the eligible 134 subjects, with baseline NGT, participated in the re-examinations. Thirty six percent of these subjects progressed to IGT and 3% to DM. Obesity was the best predictor of IGT or DM, and central obesity was also associated with them. In addition, abnormal progression of glucose tolerance was also associated with those aged greater than 80 years, with systolic blood pressure greater than 160 mmHg, diastolic blood pressure greater than 80 mmHg, fasting blood glucose value of greater than 5.3 mmol/l, and 2 h of blood glucose value greater than 6.8 mmol/l.

We compared the coverage achieved with either an age-based, free-of-charge vaccination program offering influenza vaccine alone or with pneumococcal vaccine with a restricted risk disease-based influenza vaccination program supplemented by self-funded immunization. We also compared two means of informing the public, either using mailed personal reminders or through the mass media only. Forty-one administrative districts with a total of 41,500 persons aged 65 years or older participated in the study during three consecutive seasons from 1992 to 1994. The average vaccination coverage achieved by the risk disease-based program was 20%, by the age-based program with mass media information, 52%, and by the age-based program with mailed personal reminders 82%. The availability of free-of-charge vaccines is thus not sufficient to ensure a high vaccination rate. The effect of the personal reminders was restricted to the year they were sent. The addition of pneumococcal vaccine to the age-based influenza vaccination program had little influence on the acceptance rate.

Those patients with chronic obstructive pulmonary disease (COPD) who require hospital treatment are severely ill. We have studied the survival and cause of death among COPD patients in Finland after their first admission to hospital due to COPD. COPD-related treatment periods in all hospitals during 1972-1992 were collected from the national discharge register, and a subgroup was defined consisting of 2,237 patients aged 65-69 years who had their first admission during 1986-1990. Survival and causes of death were analysed for this group using the data contained in the national mortality statistics. The mortality data were recorded up to the end of 1993. By the end of 1993, 1,070 persons (48%) in the study group had died. The median survival time was 5.71 years (95% CI 5.27-6.15). Female COPD patients had a more favourable prognosis than males. COPD had been certified as the main cause of death for 33.3% of the women and 29.4% of the men. The proportion of COPD as main cause of death increased with an increasing number of treatment periods prior to death. In conclusion, the first hospital admission for COPD indicates a poor prognosis. A high incidence of pulmonary cancer contributes to the poor outcome in the case of men. COPD is obviously underrated on death certificates as the cause of death among COPD patients.

The purpose of this study was to investigate the association of serum antibody levels to Streptococcus pneumoniae, Haemophilus influenzae and Moraxella (Branhamella) catarrhalis with age, gender and smoking in an elderly population. The study population comprised all the inhabitants aged 65 years or over in a rural municipality in south-western Finland. Serum samples were obtained from 1,174 out of a total of 1,360 subjects. Bacterial antibodies were measured by enzyme immunoassay (EIA) using pneumolysin and whole bacterial cells of H. influenzae and M. catarrhalis (mixture of 10 different strains for both) as antigens. The main findings were as follows: (i) antibody levels generally decreased with increasing age both in men and in women; (ii) antibody titres against H. influenzae and M. catarrhalis were higher in men than in women; and (iii) antibody titres to H. influenzae and M. catarrhalis, but not to S. pneumoniae, were significantly higher in smokers than in non-smokers. These data suggest that antibody-mediated protection against respiratory pathogens may be impaired in the elderly, leading to a higher susceptibility to respiratory tract infections, that the exposure to H. influenzae and M. catarrhalis may be higher in men than in women, and that smokers have more respiratory infections or colonization due to these 2 bacteria than do non-smokers.

Objective: To describe functional ability of elderly persons with diabetes (DM) or impaired glucose tolerance (IGT) and to describe associations between functional ability and glucose tolerance., Design: A survey among an unselected non-institutionalized elderly population. Diabetes was assessed on the basis of self-reports and 2-h oral glucose tolerance tests. Functional ability was assessed in interviews by four items on mobility, five items on activities of daily living, and four items on instrumental activities of daily living., Setting: Three municipalities in northern Finland., Subjects: All non-institutionalized persons aged 70 years or over (n = 483; 180 men). The participation rate was 79%., Main Outcome Measures: Mobility, activities of daily living, and instrumental activities of daily living., Results: The functional ability of the diabetic persons was poorer than that of the non-diabetic persons. The subjects with IGT also graded their functional ability as somewhat poorer than the non-diabetic subjects. When adjusted for age, gender, history of cardiovascular disease or stroke, these associations became weaker., Conclusions: Impaired functional ability is associated not only with diabetes but also with IGT in the elderly, but, in addition to age, cardio- and/or cerebrovascular disease is the best predictor of decreased functional ability in the elderly.

Background: Hospital admissions in general are characterised by a marked seasonal variation. We studied the periodicity in hospital treatment for chronic obstructive pulmonary disease (COPD) in Finland where the unfavourable climate with great climatic differences between summer and winter may play an important role in causing the seasonality in COPD hospitalisation., Methods: Data by month were obtained for the years 1972-92 from the National Discharge Register, which contains information on patients treated in all hospitals in Finland. The search was concentrated on principal diagnoses conforming to International Classification of Diseases codes 491, 492 and 496. There were 182, 723 admissions of COPD patients aged 55 years or over during the period in question. Time series analysis was carried out on retrospective data over a 21 year period and analysed by two age groups (55-74 years or > 74 years) and gender. The autoregressive integrated moving average (ARIMA) model was used to analyse seasonality., Results: The seasonality pattern showed a peak in winter (13.4% excess mean monthly admissions in January) and a trough in summer (10.0% deficit in below mean monthly admissions in July). This pattern was more prominent in women and in those aged 75 years or over., Conclusion: The cold winter together with an increased incidence of respiratory infections may be the most probable cause of the periodicity noted here. Due to the unfavourable northern climate even a greater seasonal variation was expected.

Among 183 middle-aged Finnish subjects with impaired glucose tolerance (IGT) defined according to the 1985 World Health Organization (WHO) criteria) who were retested on average 2.1 years after the first examination, diabetes developed in 14 (7.7%), persistent IGT in 54 (29.5%), and IGT was transient in 115 (62.8%). The odds ratio for diabetes was 4.4 (95% Confidence Interval (CI): 1.3-15.3) among subjects with a body mass index (BMI) of 30 kg/m2 or more, compared with those with a BMI of less than 30 kg/m2. The increase in BMI during the follow-up period was also an independent risk predictor for diabetes. The odds ratios of having persistent rather than transient IGT were 3.0 (95% CI: 1.2-7.8) and 4.3 (95% CI: 1.5-12.6), among subjects with fasting insulin levels of 8.1-12.9 mU/1 and 13.0 mU/1 or more, respectively, compared with subjects with a fasting insulin level of no more than 8.0 mU/1. the degree of glucose intolerance and the diagnosis of hypertension at the initial examination were predictive of persistent IGT. It is evident from the present data that fasting hyperinsulinaemia forms an essential basis of persistence of IGT and diabetes, and that obesity plays a precipitating role for the deterioration from IGT to diabetes. Efforts to prevented diabetes should be focused on ways to reduce insulin resistance and obesity.

Background: Even though the efficacy of pneumococcal vaccine against invasive pneumococcal infections and other closely related infections has been established, its use in the United States is only one quarter of that of influenza vaccine. The simultaneous administration of the two vaccines could be expected to raise the coverage of pneumococcal vaccination to a considerable degree. There is a paucity of data regarding the reactions associated with the simultaneous administration of pneumococcal and influenza vaccines., Methods: All persons aged 65 years or older living in 29 administrative districts in Northern Finland were offered influenza vaccine alone or influenza and pneumococcal vaccines. A total of 9336 persons (49.6% of the target population) accepted vaccination: 4581 persons born in odd years received influenza vaccine, and 4755 persons born in even years received influenza and pneumococcal vaccines. Local reactions were recorded in a diary by vaccines on the day of vaccination and for 4 days afterward according to the following scale: no reaction, mild reaction, strong reaction, and disabling reaction. The participants who felt feverish were asked to measure and record their temperature. Ninety-three percent of those vaccinated returned the diary., Results: No serious reactions were observed. The incidence of local reactions was 284 per 1000 vaccinations in the influenza-vaccinated group and 441 per 1000 vaccinations in the influenza-pneumococcal-vaccinated group, a difference of 157 (95% confidence interval, 137 to 176), and that of fever (temperature, at least 37.5 degrees C) was 10 and 24 per 1000, respectively, for a difference of 14 (95% confidence interval, 9 to 19). The frequency of local reactions decreased with advancing age., Conclusion: Because the adverse reactions to the pneumococcal and influenza vaccines when given together were mild, we conclude that the simultaneous administration of the two vaccines to the elderly population, irrespective of age, is safe.

Haemoglobin A(1c) (HbA(1c)) measurement for diagnosis of diabetes and impaired glucose tolerance (IGT) was assessed during a prospective study of subjects with IGT; 183 of the 207 IGT persons underwent the second oral glucose tolerance tests (OGTT) 2.1 years, on the average, after the first tests. HbA(1c) was administered to every participant before the second OGTTs. The results of HbA(1c) were compared with those of the second OGTTs. The sensitivity of HbA(1c) test was 71% for diabetes and 41% for IGT, when the specificity was 93% at a cutoff point of 4.81%. The conclusion is that the HbA(1c) test is moderately sensitive for diabetes but insensitive for IGT, when it is specific. However, it may be useful for selecting and reducing the total number of subjects referred to 2-h OGTTs in a follow-up study of subjects with IGT, if the rate of progression to diabetes is not high.

Objective: Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly, although there are remarkable age and sex differences according to whether or not the falls recur. In this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year., Design: A community-based prospective study covering two years., Setting: All home-dwelling persons (N = 1016) aged 70 years or older living in five municipalities in northern Finland., Outcome Measures: The risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses., Results: Previous falls, peripheral neuropathy, use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling. The risk of recurrent falling increased with an increasing number of previous falls., Conclusions: Early preventive measures should be taken among the elderly persons who are prone to falling. In order to reduce the risk of recurrent falls among the elderly, the attending physician should take a critical view of the use of psychotropic medications, and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait.

Objective: To describe the prevalence of previously diagnosed and undiagnosed diabetes and impaired glucose tolerance (IGT) by sex, marital status, employment, exercise behaviour, and body mass index (BMI), and to compare previously diagnosed and undiagnosed diabetic patients., Design: A survey of the total 55-year-old population living in a Finnish city on 1 October 1990. All the participants who were not on antidiabetic medication were invited for an oral glucose tolerance test (OGTT)., Setting: Oulu, a city in northern Finland., Subjects: 1,008 eligible subjects (456 men and 552 women), of whom 345 men (76%) and 435 women (79%) participated., Main Results: The prevalence of previously diagnosed diabetes was 6.1% in the men and 3.0% in the women and that of previously undiagnosed diabetes 4.5% of the men and 3.7% of the women. The prevalence of IGT was 28.6% in the men and 26.7% in the women. Diabetes was related to BMI, and previously undiagnosed diabetes was related to the amount of physical exercise in both sexes. One third of the undiagnosed diabetic men and half of the undiagnosed diabetic women were identified among the persons with marked obesity (BMI 30 kg/m2 or more). The group of previously diagnosed diabetic patients included a significantly greater proportion of retired people and people on sick leave than the group of undiagnosed diabetic persons., Conclusions: Diabetes is common in middle-aged Finns. Undiagnosed diabetes was detected especially in persons with marked obesity who were not physically active.

Objective: To describe the incidence and associated factors of injury-causing falls by place of residence., Design: A prospective population-based study., Setting: Five municipalities in northern Finland., Participants: All persons in the five communities aged 70 years or older living at home (n = 1016) and in long-term institutionalized care (n = 143)., Measurements: We recorded all fall incidents during a 2-year period by occurrence and severity of injury, using diary reporting and regular calls and by examining the medical and nursing records of all participants. The times, places, circumstances, and medical treatment needed were recorded as well., Results: Men living at home experienced 71 minor injuries/1000 person years (PY), 42 major soft tissue injuries/1000PY, and 12 fractures/1000PY; women at home experienced 175 minor injuries/1000PY, 65 major soft tissue injuries/1000PY, and 33 fractures/1000PY. Institutionalized older men had 272 minor injuries/1000PY, 122 major soft tissue injuries/1000PY, and 41 fractures/1000PY; institutionalized women had 292 minor injuries/1000PY, 131 major soft tissue injuries/1000PY, and 58 fractures/1000PY. Falls causing injury to older adults in long-term institutionalized care were more evenly distributed by time of day than those that occurred at home. The majority of the injuries sustained in long-term institutionalized care were injuries to the head. The incidence rate of fall injuries requiring medical attention in women, 113/1000PY, was twice that in men, 57/1000PY., Conclusions: Injury-causing falls are more frequent in older people living in long-term institutionalized care, and the time-distribution and some circumstances differ from those of injury-causing falls in home-dwelling older people.

Objective: To describe and analyse the problems in self-maintaining activities among chronic obstructive pulmonary disease (COPD) patients aged 64 years and over., Design: A case-control study., Setting: Health Centre in Lieto, Finland, 1990-91., Subjects: 61 men and 21 women with COPD and 183 male and 63 female sex- and age-matched controls. The COPD group included 8 men and 11 women who also had asthma., Main Outcome Measures: Numbers of subjects with difficulties or dependence in self-maintaining activities., Results: The number of subjects with difficulty or dependence in the activities of daily living (ADL) was similar among the patients and the controls, but some differences between the two groups were seen on items of mobility and instrumental activities of daily living (IADL). The COPD patients had more difficulties or showed dependence in moving outdoors or walking at least 400 m. In addition, the male COPD patients reported more difficulty or dependence in doing heavy housework and the female patients in even doing light housework than the controls., Conclusion: The study indicated that the female COPD patients in particular have a great need for assistance in self-maintaining functions. This information is valuable for local primary health care planning.

This study was aimed at assessing the adequacy of a random capillary whole blood glucose (RCBG) test as a screening test for diabetes mellitus in a middle-aged (55-year-old) Finnish population. Both the screening test (RCBG) and a standard 2-h oral glucose tolerance test (OGTT) were performed on all the participants according to the WHO criteria. The prevalence based on the 2-h OGTTs was 8.5% (11.7% for men and 6.0% for women). The sensitivity, specificity and predictive values of the screening test for diabetes and the receiver operator characteristic (ROC) curves were studied. The likelihood ratios for diabetes within the test categories were also calculated. When a cut-off point of 6.2 mmol l-1 was used, which proved to be the most appropriate in the present study, the specificity was 92% and the sensitivity 63% (79% for men and 40% for women). The men had much higher sensitivities than the women at all cut-off points, but the specificities were comparable. The present study indicated that the RCBG test could be used as a screening test in a subpopulation with a high prevalence of diabetes and severe hyperglycaemia, but it would be quite insensitive in a subpopulation with a considerable overlap of RCBG values between the diabetic group and the non-diabetic one. It would be inappropriate to use the RCBG test as a routine screening test for diabetes in a general population, particularly among subjects with a known low prevalence of diabetes.

In a community study, 61 men and 21 women with mild to severe chronic obstructive pulmonary disease (COPD) were compared with age- and sex-matched controls (183 men and 63 women) to identify and analyze the associations between the occurrence of COPD and depressive symptoms, the occurrence of previous or current psychiatric disorders, the use of psychiatric drugs, and satisfaction with one's marital relationship. In men, no associations between COPD and the above factors were found. More women with COPD than controls reported feelings of dissatisfaction with life. The female patients also tended to be less satisfied with their marital relationship than the controls. Multivariate analysis showed that this disease in women was associated with disability (odds ratio 3.25, 95% confidence interval 1.17-9.06), feelings of dissatisfaction with life (odds ratio 3.56, 95% confidence interval 1.23-10.34), and low satisfaction with one's marital relationship (odds ratio 3.23, 95% confidence interval 1.10-9.47). These results seem to suggest that elderly female patients with COPD have more mental health problems than male patients and these will require more attention from the primary care providers.

The 5-year prognosis of 42 elderly patients with major depression (mean age 73.2 +/- 6.3 years for men and 73.0 +/- 7.3 years for women) is described. Furthermore, the clinical outcome of elderly patients with major depression is compared to that of 199 elderly patients with dysthymic disorder (mean age 69.9 +/- 7.2 years for men and 71.3 +/- 7.7 years for women) described in a previous article. Twelve percent of patients with major depression recovered, 26% still had depression after 5 years, 12% had possible dementia, 45% had died, and 5% could not be contacted. The outcome did not significantly differ between the sexes or the two age groups (65-74 and 75+). A poor clinical outcome of patients with major depression was related to a greater number of diagnosed diseases, strong feelings of restlessness, and higher sexual interest at the beginning of the follow-up. A poor prognosis was also found for the patients whose functional abilities and hobby activities declined during the follow-up. A poor prognosis tended to be related to absence of hypertension, frequent trembling of hands, low activity in listening to music, and high activity in watching TV at the onset, and to absence of malignant disease and occurrence of a high number of negative and positive life events during the follow-up period. Thirty-six percent of dysthymic patients recovered, 26% still had depression after 5 years, 9% had possible dementia, 25% had died and 4% could not be contacted. The outcome of dysthymic patients did not significantly differ between the sexes or the two age groups (65-74 and 75+). The clinical outcome of dysthymic patients tended to be more favorable than that of patients with major depression. The factors related to a poor outcome differed between patients with major depression and dysthymic patients.