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Byline: M. J. Valimaki (1), K. Kinnunen (1), R. Tahtela (2), E. Loyttyniemi (3), K. Laitinen (1), P. Makela (4), P. Keto (4), M. Nieminen (1) Keywords: Key words:Bone markers -- Calcitonin -- Calcium -- Cardiac transplantation -- Corticosteroids -- Osteoporosis Abstract: Cardiac transplantation exposes recipients to osteoporosis and increased risk of consequent fractures. The purpose of the present study was to examine the magnitude, timing and mechanism of bone loss following cardiac transplantation, and to establish whether bone loss can be prevented by calcium with or without calcitonin. Thirty patients (29 men, 1 woman), aged 26 -- 68 years (mean 48 years), were randomized into three groups of 10 to receive either no additional treatment, oral calcium 1 g twice daily for 12 months or the same dose of calcium plus intranasal calcitonin 400 IU/day for the first month and then 200 IU/day for 11 months. Bone mineral density (BMD) at the lumbar spine and three femoral sites (femoral neck, trochanter, Ward's triangle) was measured by dual-energy X-ray absorptiometry (DXA) at the time of transplantation and 6 and 12 months later. Markers of bone formation [serum bone-specific alkaline phosphatase (B-ALP), type I procollagen carboxyterminal propeptide (PICP) and aminoterminal propeptide (PINP)] and resorption [serum type I collagen carboxyterminal telopeptide (ICTP)], as well as serum testosterone in men, were assayed before transplantation and at 1 week and 1, 3, 6 and 12 months after transplantation. During the first 6 post-transplant months BMD calculated as a percent change from baseline decreased in the control group by 6.4% (p= 0.014) in the lumbar spine, by 6.0% (p= 0.003) in the femoral neck, by 5.0% (p= 0.003) in the trochanter and by 5.5% (p= 0.130) in Ward's triangle. Between 6 and 12 months a further decline in BMD occurred only at the three femoral sites, ranging from 2.2% to 9.8% (p= 0.004-0.079). In comparison with the control group, the group receiving calcium alone lost less bone in the trochanter between 0 and 6 months (p= 0.019), and the group receiving calcium together with calcitonin lost less bone in the femoral neck (p= 0.068) and WardA's triangle (p= 0.076) between 0 and 12 months. Seven (28%) of 25 assessable patients experienced vertebral compression fractures. Calcium with or without calcitonin had no effect on changes in biochemical parameters consequently, the three study groups were combined. The markers of bone formation increased, the elevations in mean values being 59% for B-ALP at 1 month (p= 0.009), 152% for PICP at 1 week (p &lt 0.0001) and 27% for PINP at 1 week (p= 0.021). After a temporary decline at 3 months B-ALP (p= 0.0002) and PINP (p &lt 0.0001) at 1 year were nearly doubled compared with baseline values. Throughout the study the marker of bone resorption, serum ICTP, was above normal, with a peak (mean values 67--69% above baseline) at 1 week (p= 0.0002) to 1 month (p &lt 0.0001). The mean concentration of total testosterone was decreased by 48% (p &lt 0.0001) 1 week and by 28% (p= 0.0005) 1 month after transplantation, but this was mainly explained by the concomitant drop in serum albumin. High bone turnover underlies bone loss after cardiac transplantation. Bone loss is most rapid during the first 6 post-transplant months. In the upper femur this bone loss may be reduced by treatment with calcium and calcitonin. Author Affiliation: (1) Department of Medicine, FI (4) Department of Radiology, University of Helsinki, Helsinki, FI (2) United Laboratories, Helsinki , FI (3) Department of Statistics, University of Turku, Turku, Finland, FI Article note: Received: 5 May 1998 / Accepted: 12 January 1999

Objective: To study if vitamin D fortification of milk products started in February 2003 has improved vitamin D status of young Finnish men, which has been poor before. Design: A longitudinal study of one cohort. Setting: Helsinki University Central Hospital. Subjects: Sixty-five healthy men, studied for the first time in January 2001, were re-examined in January 2004. They were aged 18-21 years in 2001. Methods: Blood was sampled for determination of serum 25-hydroxyvitamin D (25-OHD) and intact parathyroid hormone (iPTH). 25-OHD was measured by both radioimmunoassay (RIA) and high-pressure liquid chromatography (HPLC). Consumption of milk, sour milk and fish and use of vitamin D supplements were assessed using a questionnaire. Results: In January 2004, vitamin D fortification had raised serum 25-OHD level, with the mean of individual percent changes being 20.4% measured with RIA (P=0.0015). The correlation between the RIA and HPLC methods was high (r=0.85). Nineteen men (29.2%) had vitamin D deficiency (25-OHD[les]20 nmol/l) and 48 men (73.8%) had hypovitaminosis D (25-OHD[les]37.5 nmol/l). Serum 25-OHD and iPTH levels correlated inversely (r=-0.30; P=0.017). Serum 25-OHD levels were 52.0% higher for 13 vitamin D supplement users than for 51 non-users (P=0.0001). After exclusion of supplement users, an association between 25-OHD level and consumption of milk products was found (P=0.011), with the median vitamin D level being 6.5 nmol/l higher for those consuming four glasses of milk products or more daily than for those consuming one or less. Likewise, the higher the milk consumption, the higher the difference in 25-OHD between years 2004 and 2001 (P=0.0025). Conclusion: Vitamin D fortification of milk products slightly but insufficiently improved the poor vitamin D status of young Finnish men during winter. Further supplementation is warranted in order to normalize vitamin D levels and to support achievement of maximum peak bone mass. Sponsorship: Supported by Paulo Foundation, Juho Vainio Foundation, Emil Aaltonen Foundation and Research Funding from Helsinki University Central Hospital (Erityisvaltionosuus). European Journal of Clinical Nutrition (2007) 61, 493-497. doi: 10.1038/sj.ejcn.1602550; published online 29 November 2006 Keywords: 25-hydroxyvitamin D, milk products, vitamin D fortification, young men, peak bone mass, osteoporosis, Author(s): V-V Valimaki [1]; E Loyttyniemi [2]; M J Valimaki [1] Introduction Although the index diseases for vitamin D deficiency have long been considered to be rickets for children and [...]

Objective: To study the relationships of molecularly defined lactose malabsorption (LM) and self-reported lactose intolerance (LI) to bone mineral density (BMD) and fractures among Finnish postmenopausal women. Design: A cross-sectional study of two cohorts. Setting: Helsinki University Central Hospital. Subjects: One cohort was population-based and comprised 453 women, aged 62-78 (mean 69) y. Another comprised 52 women, aged 69-85 (mean 75) y, with osteoporotic fractures and 59 control women, aged 69-83 (mean 74) y, without osteoporosis. Methods: A single nucleotide polymorphism of the lactase (LCT) gene at chromosome 2q21-22 was studied. It shows complete association with intestinal disaccharidase activity, with the genotype CC[sub.-13 910] meaning adult-type hypolactasia (primary LM) and the genotypes CT[sub.-13 910] and TT[sub.-13 910] lactose absorption. BMD of the heel was measured by dual-energy X-ray absorptiometry (DXA). Results: In the population-based cohort, 16.0% of women had self-reported LI but only 15.3% of them had the CC[sub.-13 910] genotype. Calcium intake from dairy products (P=0.10) and BMD, adjusted for age, weight, height, exercise, smoking, and estrogen use (P=0.71) were similar for the genotypes. Women with self-reported LI had reduced calcium intake from dairy products (P [less than] 0.0001) but they were more frequent users of calcium supplements than lactose-tolerants (P [less than] 0.0001). Adjusted BMD was similar for lactose intolerant and tolerant women (P=0.60). Of 104 women with previous fracture in the population-based cohort, 13.5% had the CC[sub.-13 910] genotype, which did not differ from the prevalence of 19.3% among 347 women without fractures (P=0.29). The frequency of the CC[sub.-13 910] genotype (23.1%) for 52 women with established osteoporosis was similar as for 59 control women (15.3%) (P=0.19). Conclusion: Molecularly defined LM and self-reported LI are not risk factors for osteoporosis, if calcium intake from diet and/or supplements remains sufficient. Our study confirms the poor correlation between self-reported LI and LM established by different techniques. Sponsorhip: Supported by the Research Funding from Helsinki University Central Hospital (Erityisvaltionosuus) and by the Miina Sillanp#228;#228; Foundation, Helsinki, Finland. European Journal of Clinical Nutrition (2005) 59, 1105-1111. doi: 10.1038/sj.ejcn.1602219; published online 6 July 2005 Keywords: lactase, lactose intolerance, lactose malabsorption, genotype, bone mineral density, fractures, osteoporosis, Author(s): N Enattah [1]; T Pekkarinen [2]; M J Valimaki [3]; E Loyttyniemi [4]; I Jarvela [1, 5] Introduction Osteoporosis is a multi-factorial disease caused by both genetic and environmental [...]

Aim The aim of the study is to describe the connection between the burden of nurses' work experience and patient dissatisfaction using electronic indicators available in databases. Background The hospitals in this study have a lot of information stored in electronic databases, but the data is stored in different databases and there are no straight connections between them. Methods This study was retrospective. Inpatient rates, workload statistics, patient classification, patient satisfaction and financial statistics were collected on 39 hospital wards from electronic databases. The data were analysed statistically. Results The results showed that the higher care intensity index and number of gross treatment days are, the greater was the burden on nurses. The burden was smaller on those wards using a named nurse system. Conclusions Nurses' workload varies according to the condition of patients and patient flow. There is a connection between high workload and patient dissatisfaction. Nurse Managers should easily be able to use significant indicators. Implications for nursing management Nursing management must have tools that are easy to use in every day workload measurement, burden adjustment and personnel planning in the long run. This article presents patient classification and the number of beds used including daily change percentage of wards as instruments for nursing management. [ABSTRACT FROM AUTHOR]

Somatostatin analogue treatment is first-line medical therapy for acromegaly. This study compared the efficacy and tolerability of titrated doses of the long-acting somatostatin analogue preparation lanreotide Autogel® with fixed doses and with lanreotide prolonged release (PR) 30 mg microparticles. Patients entering the initial study had received a diagnosis of active acromegaly within the previous 5 years. This open, comparative, multicentre study was a 1-year extension of a previous trial during which patients with acromegaly had switched from lanreotide PR 30 mg microparticles injected intramuscularly every 7, 10 or 14 days, for at least 3 months, to one of three fixed doses of lanreotide Autogel® (120, 90, or 60 mg every 28 days, respectively). In this extension study, patients continued to receive 60, 90, or 120 mg of lanreotide Autogel® by deep subcutaneous injection every 28 days for 1 year. Doses could be titrated at entry or after four or eight injections, according to the GH/IGF-I response (dose increased if GH > 2·5 µg/l, or decreased if GH < 1 µg/l with normal IGF-I). Mean ± SEM GH and IGF-I concentrations were analysed and gallbladder echography performed at weeks 0, 16, 32, and 48. Acromegaly symptoms were recorded monthly and tolerance and side-effects were monitored throughout the study. In total, 130 patients entered this extension phase. After 1 year of treatment with titrated doses of lanreotide Autogel®, mean GH (2·4 ± 0·2 µg/l) and IGF-I (287 ± 12 µg/l) concentrations were significantly lower than with lanreotide microparticles (GH, 2·8 ± 0·2 µg/l, P < 0·001; IGF-I, 332 ± 15 µg/l, P < 0·01) or with fixed-dose lanreotide Autogel® (GH, 3·0 ± 0·2 µg/l, P < 0·001; IGF-I, 310 ± 14 µg/l, P = 0·02). GH hypersecretion was reduced to ≤ 2·5 µg/l in 68% of patients with titrated-dose lanreotide Autogel® compared with 49% with microparticles ( P < 0·001) and 56% with fixed-dose lanreotide Autogel® ( P ≤ 0·005). In the 65 patients who did not require any dose titration, there was no substantial change in serum lanreotide concentration, GH or IGF-I levels over the 12-month study duration . Acromegaly was effectively controlled (GH ≤ 2·5 µg/l and normalized IGF-I) in significantly more patients (43%) compared with microparticles (32%; P < 0·05). There was a trend for improved control of acromegalic symptoms with dose titration, whereas the incidence of gastrointestinal symptoms and local tolerance was similar with lanreotide Autogel® and lanreotide microparticles. Gallbladder echographies showed new lithiasis in 8% of lanreotide Autogel® patients. Dose titration of lanreotide Autogel® improved GH and IGF-I control in patients with acromegaly beyond that achieved using fixed doses of lanreotide Autogel® or lanreotide microparticles. Titrated long-term lanreotide Autogel® treatment is well tolerated. [ABSTRACT FROM AUTHOR]

Discusses autonomy, privacy and informed consent in the context of surgical care in Europe. Differences in patient and staff perceptions on these issues; Implications for nursing practice, education and research; Positive outlook of patients. INSET: KEY POINTS.

Part I. Explores the concepts of patient autonomy, privacy and informed consent in the context of the provision of nursing care. Psychological structure of autonomy; Protection of the patient's psychological, social and physical privacy; Right of the patient to participate in the decision-making process related to his or her treatment and care.