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PURPOSE: To study the efficacy of pneumococcal capsular polysaccharide vaccine among the elderly by use of a population-based intervention in one township, Varkaus, Eastern Finland. PATIENTS AND METHODS: A randomized, controlled trial in which elderly inhabitants (aged 60 years or older) of the catchment area were randomized to receive either pneumococcal and influenza vaccines (PI group = vaccinated) or influenza vaccine alone (I group = controls) and offered participation. The response rate was 67.4%. The PI group consisted of 1,364 persons and the I group of 1,473 persons. The vaccinations were performed in the municipal health center in the fall of 1982, and all elderly inhabitants were followed for 3 years for the development of radiologically confirmed pneumonia. Pneumococcal etiology was identified by serological methods. RESULTS: The incidence of pneumonia was 18.8 per 1,000 person-years in the Pi group (73 pneumonia episodes) and B6.6 per 1,000 person-years in the I group (69 episodes). Pneumococcal etiology was found in 27 episodes in the Pi group (incidence 7.0 per 1,000 person-years) and in 36 episodes in the I group (incidence 8.6 per 1,000 person-years). In controls (I group) the incidence of pneumococcal pneumonia was significantly higher among persons with increased risk for contracting pneumonia (19 per 1,000 person-years) than among controls with low risk status (4 per 1,000 person-years). No significant protection from pneumococcal pneumonia was found in the study group as a whole (vaccine efficacy 15%, 95% CI -43% to 50%). However, in persons with medical risk factors for contracting pneumonia, there was a statistically significant protective efficacy of 59% (95% CI, 6% to 82%). CONCLUSION: Pneumococcal vaccination significantly reduced the incidence of pneumococcal pneumonia in elderly persons at increased risk for contracting pneumonia. This increased/high-risk category comprised 34% of the population aged 60 years or older. Because targeted vaccination of this large group may be difficult to organize in an efficient manner, vaccinating all elderly persons may be the best strategy to prevent this rather common and often fatal disease. [C] 1997 by Excerpta Medica, Inc. Am J Med. 1997;103:281-290.

PURPOSE: To investigate the prevalence of certain chronic conditions among the elderly and to estimate the relative risk for pneumonia associated with each condition. PATIENTS AND METHODS: Medical records of all inhabitants aged 60 years or more (4,175 persons) in one township (population 24,716) in Finland were reviewed, seeking 15 chronic conditions. Which patients had pneumonia in the same population was prospectively ascertained over a period of 3 years (185 patients). RESULTS: Hypertension was the most frequent chronic condition (36.4%) in the study population. Other common conditions were heart disease (23.7%, with chronic compensated heart failure in 96.3% of these), other cardiovascular disease (13.1%), and diabetes (13.1%). The prevalence of any other condition was less than 5%. The following conditions were significantly more common among pneumonia patients than among control subjects: heart disease (38.4% versus 23.0%), lung disease (13.0% versus 3.8%), bronchial asthma (11.9% versus 3.1%), immunosuppressive therapy (2.7% versus 0.8%), alcoholism (2.2% versus 0.3%), and institutionalization (8.6% versus 3.9%). By multivariate logistic regression analysis, independent risk factors for pneumonia were alcoholism (relative risk [RR] = 9.0, confidence interval [Cl] = 5.1 to 16.2), bronchial asthma (RR = 4.2, Cl = 3.3 to 5.4), immunosuppressive therapy (RR = 3.1, Cl = 1.9 to 5.1), lung disease (RR = 3.0, Cl = 2.3 to 3.9), heart disease (RR =1.9, Cl = 1.7 to 2.3), institutionalization (RR = 1.8, Cl = 1.4 to 2.4), and age (70 years or more versus 60 to 69 years; RR = 1.5, Cl = 1.3 to 1.7). One third of the study population and 57% of the pneumonia patients had one or more of these risk factors. Diabetes, chronic pyelonephritis, and malignancies of sites other than the lungs were not associated with increased risk for pneumonia. CONCLUSION: We found which elderly persons have an increased risk for pneumonia. Although the highest relative risk was associated with alcoholism, that condition was rare in this elderly population. Chronic obstructive lung diseases were more common and were also associated with a high relative risk. Heart disease had the highest public health impact because it was very common among the elderly and increased the risk of contracting pneumonia almost twofold; it also increased the risk of pneumonia-related death. These population-based data confirm and extend previous findings derived from selected patient groups and are useful for designing cost-effective pneumonia prevention programs.

Several methods have been developed to assess differences in cultivar response to drought. This study consisted of 19 oat (Avena sativa L.) cultivars and breeding lines and three species of wild oats, and focused on comparison of several physiological screening methods -CO2 exchange rate (CER), stomatal conductance, stomatal resistance, disparity between air and leaf temperatures, accumulation of abscisic acid (ABA) and proline, and relative water content (RWC) - with yield losses. Early drought, occurring at four-five leaf stage or close to pollination date resulted in significantly reduced above-ground vegetative biomass and panicle weight. Reductions in panicle weight due to drought were greater than those in vegetative phytomass, which resulted in decreased harvest index (HI). Drought stress significantly increased stomatal resistance and accumulation of ABA and proline, whereas stomatal conductance, disparity between air and leaf temperatures and RWC, decreased owing to water deficit. Comparison of screening methods by calculating drought tolerance indices showed that none of the indices was associated with degree of yield losses. However, photosynthetic characters correlated with RWC both at early growth stages and close to pollination. Therefore, further studies that profoundly evaluate the relationship between these screening methods and degree of yield losses are needed.

It has been reported that foliar application of glycinebetaine reduces the effect of abiotic stresses on crops, including tobacco (Nicotiana tabacum L.), soybean [Glycine max (L.) Merr.], and maize (Zea mays L.), especially during the recovery period. The aims of this study were to determine the effect of foliar application of glycinebetaine on biomass accumulation and photosynthetic capacity of turnip rape (Brassica rapa L. ssp. oleifera) and pea (Pisum sativum L.). Experiments were carried out in a greenhouse and in the field, and records were taken on differentiation and emergence of floral organs. Biomass accumulation, relative growth rate (RGR), specific leaf area, leaf chlorophyll content, and nitrogen uptake were also measured for pea. In the experiment in the greenhouse, glycinebetaine application increased relative growth rate of both crops, especially when drought-stressed and when recovering from drought. Application of 0.20 M glycinebetaine increased RGR of pea, recovering from drought, by 13% compared with untreated plants, while the RGR of the drought-stressed pea increased by 45%, measured 14 days after glycinebetaine application. However, the difference in effect between treatments diminished one week later. The response of turnip rape was less marked than that of pea in the greenhouse experiment. The RGR of drought-stressed turnip rape treated with 0.05 M glycinebetaine application was 10% higher than that of untreated drought-stressed plants, being 6% in plants treated before recovery, and 17% under adequate watering. Glycinebetaine application also increased the RGR of both crops in field experiments. However, no clear effects of foliar application of glycinebetaine on duration of different development phases and emergence of floral organs were recorded in the field.