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Objective To examine how different dimensions of social capital and health behaviour are associated. Design Cross-sectional data of the Health 2000 Health Examination Survey including a personal interview and self-administered questionnaires. Setting Representative sample (N=8028) of the Finnish adult population. Participants 6986 (87%) adults aged 30 years or over. Main Outcome Measures Non-smoking, non-excessive drinking, leisure-time physical activity, daily use of vegetables, adequate duration of sleep. Results Social capital was found to be associated with health behaviour. The dimension of social participation and networks was positively associated with every type of health behaviour. High levels of trust and reciprocity were related to non-smoking and adequate duration of sleep, and high levels of social support to adequate duration of sleep and daily use of vegetables. These associations persisted after controlling for age, gender, education and living arrangements. According to our findings, structural social capital seems to be associated with health behaviour more strongly than cognitive social capital. Conclusion Irrespective of their social status, people with higher levels of social capital—especially in social participation and networks—engage in healthier behaviour. When trying to reduce health inequalities, one strategy could be to promote social participation especially among people in danger of social exclusion. [ABSTRACT FROM AUTHOR]

We performed ecological and individual register studies to compare disability-free life expectancies and disability pensions among Swedish-speaking and Finnish-speaking Finns residing on the western coast of Finland. The study was conducted to establish our assumption that the Swedish-speaking ethnic minority has a longer active life than the Finnish-speaking majority and to show that this disparity can be seen in a limited geographical area with similar socio-economic and health service structures. We suggest that the observed disparities in active life and in mortality depend on differences in the extent of social capital. A detailed characterization of the social capital and its impact on the health of the Swedish-speaking individuals is in progress.

Background: Previous register studies have shown that mortality rates and disability pension statistics favor Swedish-speakers when compared to their Finnish-speaking neighbors in the same bilingual region in Finland. The purpose of the present questionnaire survey was to determine whether the Swedish-speaking community has more social capital and if the social capital is associated with health at the individual level., Methods: The study population consisted of randomly selected samples of Finnish-speakers (N 1,000, response rate 66%) and Swedish-speakers (N 1,000, response rate 63%) representing all adults living in bilingual Ostrobothnian municipalities (75,000 Finnish-speakers and 78,000 Swedish-speakers). To inquire into social capital and health indicators, a bilingual questionnaire was composed to cover variables and indicators of sociodemography, health status, health behavior, and social capital (interpersonal trust and civic engagement). Data were analyzed with multiple logistic regression for two binary outcome variables: language group (Finnish vs Swedish) and self-rated health (good vs almost good/fair/poor/bad)., Results: When health-related variables (urban residence, migration, age, BMI, household income, smoking, singing in a choir, membership in any voluntary association, participation in community events, and long-term diseases) were controlled for, the Finnish-speakers were more often migrated (P = 0.0001) and mistrusting (P = 0.0001) and less active in community events (P = 0.0016) and in singing in a choir (P = 0.02) than the Swedish-speakers. After controlling for language and the above-mentioned health-related variables, the number of auxiliary (willing to help) friends (P = 0.001), mistrust (P = 0.037), and membership in any religious association (P = 0.0096) were significantly and independently associated with good self-rated health in the whole sample., Conclusions: The Swedish-speaking community seems to hold a fair quantity of social capital, which is associated with good health. Since the ecological and socioeconomic circumstances are equal for both language communities, a great deal of health inequality can be explained by differences in social capital., (Copyright 2001 American Health Foundation and Academic Press.)

To assess the association between the economic recession of the 1990s in Finland and sleep behaviour, a longitudinal study was conducted in an adult Finnish population cohort. Baseline data were obtained by means of reports on sleep behaviour, health-related behaviour, health status, and objective laboratory tests in 1983-1987. The second screening conducted in 1992-1995, i.e. during economic recession, repeated data collection by postal questionnaires. The prevalences of various sleep symptoms including insomnia, daytime tiredness, fatigue, parasomnias and the use of hypnotics remained similar in the same age cohorts during economic recession. Alcohol consumption and snoring increased among the middle-aged (30-49 years), though snoring shows the greatest individual stability among various sleep symptoms. Despite some baseline differences in the sleep/health behaviour frequencies, the changes were independent of gender and socioeconomic class. The prevalences over eight years of insomnia and snoring show fair chronicity, whereas daytime tiredness and fatigue seem to be less chronic. Middle-aged participants who were stably employed at the initial screening but became unemployed during economic recession were studied separately. Prospectively unemployed persons suffered more from insomnia and used more hypnotics than the continuously employed. We conclude that the sleep quality of the general Finnish population has not drastically deteriorated during severe economic recession except among unemployed blue-collar workers.

Thirty-nine (39) middle-aged subjects with mild to moderate hypertension (WHO stages I-II) and 35 healthy normotensive controls from a community sample participated in this psychophysiological study, the aim of which was to study whether the electrodermal lability as an indicator of increased sympathetic activity is related to hypertension. Resting blood pressure was measured by using a mercury sphygmomanometer. Electrodermal activity was recorded with a constant voltage circuit. Bipolar skin electrodes were placed on the palmar side of the middle phalanges of the index and middle fingers of both hands. Six years after the electrodermal measurements, the possible use of reimbursed antihypertensive medication was checked in both groups, and blood pressure re-measured in the control group. Multivariate analysis controlling for age, gender and body mass showed that the electrodermal lability was increased in the hypertensive as compared to the normotensive group. This supports the hypothesis that the sympathetic nervous system tonus is increased at least, in some middle-aged subjects with mild to moderate hypertension.

Multiple sleep latency test (MSLT)-defined daytime sleepiness and its relationships with nocturnal and daytime psychophysiological activation were investigated in a random community sample of 77 subjects aged 35-55 years. The correlation structure between all study variables was explained by a simple model of daytime sleepiness. The model suggested that indicators of psychophysiological arousal (psychological distress, nocturnal motor activity and serum thyrotropin level) and daytime reported tiredness, body mass index (BMI) and age were related significantly and independently to MSLT-defined daytime sleepiness. The arousal theory of insomnia and poor sleep in relation to MSLT behavior is discussed and the need of a multivariate approach is emphasized in MSLT studies.

Objective: The incidence of sleep apnoea is increased in acromegaly. The aim of the study was to determine the occurrence of nocturnal breathing abnormalities and upper airway morphology in acromegalic patients some years after adenomectomy., Design: A case-control study., Patients: Eleven patients with treated acromegaly and two control groups: (1) sleep studies: 197 subjects randomly selected from the population, (2) cephalometry: 27 healthy subjects and 17 patients with obstructive sleep apnoea., Measurements: Nocturnal breathing was monitored with a static charge-sensitive bed. The upper airway soft tissues and bone morphology were assessed by cephalometric X-ray photography. The upper airway collapsibility was investigated with dynamic nasopharyngoscopy. Endocrinological investigations were also performed., Results: Nocturnal breathing abnormalities were present in all but one acromegalic patient (91%), which was far more frequent than in the general population (29.4%, P < 0.0001). Treated acromegaly was the most powerful predictor of breathing abnormalities, independent of the other significant predictors, age and body mass index. The predominant breathing abnormality was periodic breathing with symmetrically waxing and waning respiratory effort without a major body movement component. Episodes of complete obstruction with repetitive arousals were rare. Except for the longer soft palate, the cephalometric findings were similar to normal. In comparison to obstructive sleep apnoea, the treated acromegalic patients had rather prognathic than retrognathic mandibles. Fibreoptic endoscopy in the acromegalic patients revealed collapsible upper airways at the level of the soft palate, whereas at the base of the tongue little, if any, dynamic narrowing was observed., Conclusion: Our study confirms that nocturnal breathing abnormalities are common in treated acromegaly, and may persist years after the removal of the GH secreting tumour. The breathing abnormalities and the upper airway morphology in acromegalic patients after adenomectomy are different from those observed in primary obstructive sleep apnoea, suggesting a different pathophysiology of the airway obstruction.

Nocturnal motor activity was examined in long-term rehabilitation patients complaining of poor sleep and having fibromyalgia syndrome (N = 24) or other musculoskeletal disorders (N = 60) and compared with that in 91 healthy controls drawn from a random community sample. Self-reports on sleep complaints and habits were collected. The frequency of nocturnal body movements, the "apnoea" index and ratio of "quiet sleep" to total time in bed were measured using the Static Charge Sensitive Bed (SCSB) (BioMatt). As a group, patients with fibromyalgia syndrome did not differ from patients with other musculoskeletal disorders or from healthy controls in their nocturnal motor activity. The "apnoea" index was a little higher in the fibromyalgia group than in the healthy control group but did not differ from that of the group of other musculoskeletal patients. Further multivariate analyses adjusted for age, BMI, medication and "apnoea" index did not support the assumption that an increased nocturnal motor activity characterizes patients with fibromyalgia syndrome.

The possible relation of cortisol secretion to self-perceived fatigue was examined in an adult community sample. Serum cortisol levels measured after the dexamethasone suppression test (DST) did not predict fatigue whereas depression assessed by the Beck Depression Inventory (BDI) and current medical treatment were significant and independent predictors. Confounding variables such as age, gender, body mass and social status were not predictive of fatigue. Of putative hypothalamic-pituitary-adrenal abnormalities hypersecretion of cortisol does not typify subjects with self-perceived fatigue.

The relationships between nocturnal motor activity and daytime psychophysiological activation were investigated in a random community sample of 199 subjects aged 35-55 years. Nocturnal motor activity was recorded with the static charge sensitive bed (SCSB, Bio-Matt). The association of nocturnal motor activity with demographic features, health status, laboratory blood values, afternoon electrodermal activity (EDA) and psychological distress was studied. A model for nocturnal motor activity was constructed and statistically analyzed. The analysis revealed that psychological distress, breathing disturbance, plasma glucose level and sympathetic activity were related significantly and independently to nocturnal motor activity. Their relations and the associations of sex, age, body mass index (BMI), sleep latency and health status with nocturnal motor activity were discussed in the context of the arousal theory of poor sleep.

Fifty-six chronic low back pain (CLBP) patients participated in a controlled, prospective 5-yr follow-up study evaluating the long-term effects of five-session couple therapy. Twenty-eight patients were included both in the treatment group and in the control group. Outcome measures were self-reported psychological distress, marital satisfaction, health locus of control, pain and disability as well as clinical examinations. The reliability of the outcome measures was statistically analysed and found acceptable. At the 5-yr follow-up assessments, psychological distress was found to be decreased in the treatment group and increased in controls. The difference between the groups was significant. No difference was found in the other self-reported or clinical outcome measures. We conclude that couple therapy has a prolonged beneficial effect on the mental well-being of CLBP patients.

It is generally assumed that a good night's sleep has a beneficial effect on mood. The present survey aimed to evaluate what a good night's sleep means for mental well-being and psychic functional capacity. A random community sample of 670 adult subjects was divided into three groups: good, intermediate and poor sleepers according to a sleep habit questionnaire based on self-reports. Their cognitive, emotional and personality features were assessed with various psychometric and personality tests, and differences between the groups were evaluated statistically. In the age- and gender-adjusted population the average good sleeper turned out to be a person who falls asleep in 10 minutes, after which his/her 7.5 hours' sleep is serene and without parasomnias. Immediately on awakening in the morning and later during the day he/she is mentally alert without distress or emotional problems. Definite mood and personality differences between good and other sleepers in the adult population surveyed revealed that good sleepers are psychologically capable of maintaining a self-esteem which is in functional balance with their life-goals and mental well-being.

Hypothesizing that a positive DST result could reflect an aberrant stress reaction in subjects with alexithymic features, the authors investigated the relationship between alexithymic features and DST results in 266 subjects from a Finnish adult population sample. Alexithymic features were assessed with the Beth Israel Questionnaire. The authors found a statistically significant association between observed alexithymic features and a positive DST result. This association could be seen after adjustment separately for age, social rank, marital status, and the occurrence of depression.

Marital adjustment, psychological distress, health attitudes and prevalence of musculoskeletal pain symptoms were studied and compared between 63 chronic low back pain (CLBP) patients and their spouses. The CLBP patients experienced somatization significantly more than their spouses, while other psychological distress scores did not reveal statistically significant differences between the couples. The CLBP patients experienced significantly more feelings of guilt at having pain than their spouses. The patients experienced significantly more internal control, while their spouses experienced more external locus control of health. The female spouses had had significantly more musculoskeletal pain symptoms in neck and shoulders during the past week than the male spouses. The prevalence of musculoskeletal pain symptoms in the CLBP patients did not differ significantly between sexes. The results of this study are compared to population studies where the same methods have been used.

To evaluate the possible first-night effect on the nocturnal motor activity 25 poor sleepers and 12 good sleepers slept on the Static Charge Sensitive Bed (SCSB) during two consecutive nights. The frequency of body movements in poor sleepers was almost two times higher than in good sleepers. The method itself was reproducible across two nights. There were no statistically significant and systemic level differences between the nights in the movements in bed (MIB). The difference t-test did not either reveal group differences in the magnitude or direction of changes from night to night. Results are consistent with the view that the level of motor activity is one of the determinants of sleep quality. No first-night effect exists in terms of psychomotor activity.

Nocturnal motor activity of 67 poor sleepers referred to the Rehabilitation Research Centre (RRC) and of 16 healthy subjects were recorded to distinguish poor sleepers without affective disorders from those with affective disorders. All subjects slept on the static charge sensitive bed (SCSB) in a single room of the patient dormitory. All subjects filled out a sleep questionnaire about their subjective sleep quality. After comprehensive rehabilitation consultations the poor sleepers were divided into two subgroups: those with and those without affective disorders. Complaints about insomnia and sleep disorders distinguished poor sleepers from healthy controls but the subgroups of poor sleepers did not differ in the estimation of the quality of sleep. However, when the distribution of body movements through the night was considered, the dynamic of nocturnal motor activity typified poor sleepers with affective symptoms.

The aim of this study was to assess the cognitive skills and visuo-motor performances of patients with type-2 diabetes. An ADL questionnaire, neurophysiological EEG recordings and a comprehensive battery of neuropsychological tests were administered to 33 type-2 diabetics and to 33 matched controls. Neither neuropsychological nor neurophysiological EEG findings differentiated type-2 diabetics as a group from their controls.

In order to elucidate the interplay of prolactin and dopamine in schizophrenia, base-line levels of prolactin were assayed in the cerebrospinal fluid (CSF) of chronic schizophrenic patients with or without lobotomy. Cental and cortical atrophy and significantly lowered CSF prolactin levels were found in lobotomized patients in comparison to equally neuroleptic-treated non-lobotomized patients. The mean CSF prolactin level in the female patients was significantly higher than in the male patients. This study did not support the 'dopamine hypothesis' of schizophrenia, since CSF prolactin levels did not correlate with schizophrenic symptoms. The brain atrophy blocked completely the expected elevation of CSF prolactin levels induced by neuroleptics.

Neuroendocrinologists are now realising that the brain-pituitary relationships in man are more complex than they had previously thought. It seems that the brain is also a gland, whereas the pituitary produces neuropeptide hormones which work in the brain. Since most substances which carry information between those two neuroendocrine partners are present in cerebrospinal fluid, it is natural to assume that cerebrospinal fluid has an important role as a carrier of molecular signals between the brain and pituitary. Whether or not the analysis of cerebrospinal fluid neuropeptide hormones will give more information about the brain activity in neurological and psychiatric patients is not yet known exactly despite some promising new findings.

Clinical and psychological characteristics of 33 patients with low back pain were correlated with prolactin and cortisol concentrations in cerebrospinal fluid (CSF). A significant sex difference was found in CSF prolactin levels: women secreted more prolactin into the CSF than did men. High CSF cortisol levels were associated with a rhizographically-demonstrable abnormality, suggesting a relationship between cortisol and an 'organic' origin of pain symptoms. Impairment-disability indices also were associated with CSF hormone levels. Moreover, the two hormones had dissociated psychological correlates. Prolactin was related to depression and anxiety, whereas cortisol was related to somatization. Sex differences were observed in the cortisol response to the symptoms of chronic low back pain, especially in the presence of anxiety and somatization. The sex differences in psychoneuroendocrine and emotional responses suggest that male and female pain patients have different coping mechanisms.

The psychoendocrine aspects of coping with distress were studied under mental and physical laboratory strain as well as in response to naturalistic stress. In spite of the common underlying endocrine responses to distress, gender differences in psychological response appeared to modify endocrine responses to the experience of pain. If the aspiration level task in the laboratory was well controlled by the subject hypothalamo-pituitary stress hormones were no longer secreted. Furthermore, heavy, physical work elevated blood levels of stress hormones (dopamine, noradrenaline, adrenaline, prolactin, cortisol, somatotropin) but especially hypothalamo-pituitary hormones responded to psychological state factors. Hence the role of psychoendocrine coping mechanisms seems to vary and depends on various psychosocial and biological determinants. Controllability is one of the key factors in an individual's ability to cope.