Differences in cardiometabolic risk profiles between Chinese and Finnish older adults with glucose impairment and central obesity.

BACKGROUND: Obesity and ethnicity play important roles in cardiovascular complications in patients with type 2 diabetes mellitus (T2DM). This study aimed to compare cardiometabolic risk profiles between Chinese and Finnish older adults of central obesity with prediabetes or T2DM. METHODS: Study subjects were 60-74 years old and originated from two population samples. The Finnish subjects came from the Kuopio Ischemic Heart Disease (KIHD) study (n = 1089), and the Chinese subjects came from the Shanghai High-risk Diabetic Screen (SHiDS) study (n = 818). The KIHD and SHiDS studies used similar questionnaires to determine participants' baseline characteristics regarding the history of medication use and diseases and lifestyle factors. All study subjects participated in glucose tolerance tests and anthropometry assessments, including waist circumference measurements. RESULTS: Among study subjects of central obesity with prediabetes (n = 298), fasting and 2-h glucose, and fasting insulin and insulin resistance were significantly higher in Chinese than in Finnish (p < 0.0001-0.016). In addition, triglyceride (TG) level was higher and the low-density lipoprotein cholesterol (LDL) and LDL to high-density lipoprotein cholesterol (HDL) ratio were lower in Chinese than in Finnish (p < 0.0001-0.003). Among subjects of central obesity with T2DM (n = 251), Chinese subjects had significantly less proportions of antihypertensive, glycaemic control medication, and statin users as well as lower level of physical activity (p < 0.0001 for all), while higher blood pressure (p = 0.002 for systolic blood pressure and p < 0.0001 for diastolic blood pressure), TG levels (p < 0.05) and HDL (p = 0.002) than the Finnish counterparts. There were no differences in ß-cell function (HOMA-ß) between Chinese and Finnish both in prediabetes and T2DM. CONCLUSIONS: Our results indicated that Chinese and Finnish older adults of central obesity with prediabetes and T2DM had similar ß-cell function. However, Chinese individuals with prediabetes are prone to insulin resistance. Meanwhile, lipid metabolism dysfunction is also different between Chinese and Finnish. Chinese older adults of central obesity with prediabetes showed higher TG, but Finnish showed higher LDL and LDL/HDL. Strategic for T2DM prevention and treatment should be ethnically specific.

Comparison across 12 countries on knowledge, attitude, and behavior scores about medication errors in Intensive Care Units: an international study.

OBJECTIVE: The aim of the study was to explore the degree of agreement of intensive care unit nurses working on a set of medication error preventive strategies and to examine possible predictors of nurses' knowledge, attitude and behavior. MATERIALS AND METHODS: Observational, international, and cross-sectional study. Iran, Malta, Spain, Pakistan, Nepal, Qatar, Ecuador, Australia, Finland, Italy, Egypt, and Jordan were the countries included in this survey. To collect data, the Knowledge, Attitude and Behavior in Medication Errors questionnaire was used. A descriptive statistical analysis was performed for the socio-demographic characteristics of the sample and three multiple logistic regressions were performed. RESULTS: The international sample consists of 1383 nurses, of whom 478 (34.6%) were men and 900 (65.1%) were women and their mean age was 35.61 years with a range of 19-61. Descriptive statistics conducted on the international sample show a medium to high degree of agreement among participants concerning some preventive strategies of medication error. In addition, the results of the present study show a strong relationship between positive nurses' attitudes and correct behaviors and/or adequate knowledge, as well as between adequate knowledge and correct behaviors (p< 0.01). CONCLUSIONS: Further studies are needed to explore the issue of medication error concerning nurses' cultural backgrounds, as well as to assess similarities and disparities among international nurses.

Interprofessional medication assessment among home care patients: any impact on functioning? Results from a randomised controlled trial.

BACKGROUND: Multimorbidity and polypharmacy are related to the use of potentially inappropriate medicines and negative clinical outcomes including drug-related adverse events and functional declines. Home care clients are a vulnerable patient group often exposed to these risks. The aim of this study was to examine whether an interprofessional medication assessment can influence the functioning of home care patients. METHODS: The FIMA study was a randomised controlled intervention study comparing a general practitioner-led interprofessional medication assessment conducted at the baseline of the study with usual care with a six-month follow-up. We used linear mixed models (LMM) with a random subject effect to detect differences between the usual care and intervention groups in the following outcome measures; Katz index of Activities of Daily Living (ADL), Lawton and Brody scale of Instrumental Activities of Daily Living, Timed up and go-test (TUG), Mini-Mental State Examination, Geriatric Depression Scale and the 3-level version of EQ-5D. RESULTS: Home care patients (n = 512) had major disease burdens and functional limitations. Regarding TUG times, the LMM detected a one second improvement in the FIMA group and 2.4 s worsening in the usual care group. However, the result was not statistically significant. The ADL revealed an interaction across time, treatment and sex (p = 0.026). The ADL score decreased in both groups; the decline being the steepest among women in the intervention group. CONCLUSIONS: In general, medication assessments may have limited impact on functioning of older people. Nonetheless, the FIMA intervention may prevent worsening of mobility among older home care patients. TRIAL REGISTRATION: The Interprofessional Medication Assessment for Older Patients, Clinical Trials.gov. NCT02398812 . First registration, 26 March 2015. Retrospectively registered.

Behavioral and electrophysiological indicators of auditory distractibility in children with ADHD and comorbid ODD.

Involuntary switching of attention to distracting sounds was studied by measuring effects of these events on auditory discrimination performance and event-related brain potentials (ERPs) in 6-11-year-old boys with Attention Deficit-Hyperactivity Disorder (ADHD) and comorbid Oppositional Defiant Disorder (ODD) and in age-matched controls. The children were instructed to differentiate between two animal calls by pressing one response button, for example, to a dog bark and another button to a cat mew. These task-relevant sounds were presented from one of two loudspeakers in front of the child, and there were occasional task-irrelevant changes in the sound location, that is, the loudspeaker. In addition, novel sounds (e.g., a sound of hammer, rain, or car horn) unrelated to the task were presented from a loudspeaker behind the child. The percentage of correct responses was lower for target sounds preceded by a novel sound than for targets not preceded by such sound in the ADHD group, but not in the control group. In both groups, a biphasic positive P3a response was observed in ERPs to the novel sounds. The later part of the P3a appeared to continue longer over the frontal scalp areas in the ADHD group than in the controls presumably because a reorienting negativity (RON) ERP response following the P3a was smaller in the ADHD group than in the control group. This suggests that the children with ADHD had problems in reorienting their attention to the current task after a distracting novel sound leading to deterioration of performance in this task. The present study also indicates that children with ADHD and comorbid ODD show same kind of distractibility as found in previous studies for children with ADHD without systematic comorbid ODD.

Penetration and migration success of Diplostomum spp. cercariae in Arctic charr.

We exposed 2 groups of young-of-the-year Arctic charr (Salvelinus alpinus) singly to 54 +/- 2 (mean +/- SE) Diplostomum spp. cercariae that had emerged from 4 randomly sampled snail hosts (Lymnaea stagnalis). The rearing tanks of the fish received Diplostomum spp. cercariae via the incoming water; therefore, 18 of the 36 fish had parasites in their eyes before the experimental exposure. Of the Diplostomum spp. cercariae presented to the fish, 19% penetrated and 46% of those that had penetrated the fish migrated successfully to the lens of the fish eye. The migration success of Diplostomum spp. from the site of penetration to the fish eye lens was lower in the previously parasitized (37.0 +/- 8.7% [mean +/- SE] adjusted with the number of penetrated cercariae) than in the unparasitized fish (55.3 +/- 8.8%) and differed between the individual snail host from which the cercariae had emerged. In addition, the migration success of Diplostomum spp. decreased with an increase in the number of the cercariae that penetrated the fish. At the individual snail host level, there seemed to be a trade-off between penetration and migration ability of the cercariae. The results indicate that success of Diplostomum spp. in penetration and especially in migration to the fish eye is affected by both the molluscan first intermediate host and the piscine second intermediate host.

Metabolic depression and spleen and liver enlargement in juvenile Arctic charr Salvelinus alpinus exposed to chronic parasite infection.

The present study on the connection between standard metabolic rate (R(S)) and chronic Diplostomum spp. infection resulted in a decrease in R(S), and an enlargement in spleen and liver sizes in the infected juvenile Arctic charr Salvelinus alpinus compared to control fish. As splenic enlargement observed in infected fish was not due to condition-related changes in the spleen, it could most probably be explained by increased leucocyte synthesis. The higher liver masses in infected S. alpinus may have been related to disorders in energetic function, which could have had major effects on biochemical regulation by the liver. The proposed metabolic syndrome with a possible reduction in insulin sensitivity in tissues results in ineffective glucose and lipid metabolism and thus it is suggested that chronic Diplostomum infection in S. alpinus might not impose direct energetic costs, but it may weaken the efficiency of energy metabolism and thus lead to lowered R(S).

A genome scan for developmental dyslexia confirms linkage to chromosome 2p11 and suggests a new locus on 7q32.

Developmental dyslexia is a distinct learning disability with unexpected difficulty in learning to read despite adequate intelligence, education, and environment, and normal senses. The genetic aetiology of dyslexia is heterogeneous and loci on chromosomes 2, 3, 6, 15, and 18 have been repeatedly linked to it. We have conducted a genome scan with 376 markers in 11 families with 38 dyslexic subjects ascertained in Finland. Linkage of dyslexia to the vicinity of DYX3 on 2p was confirmed with a non-parametric linkage (NPL) score of 2.55 and a lod score of 3.01 for a dominant model, and a novel locus on 7q32 close to the SPCH1 locus was suggested with an NPL score of 2.77. The SPCH1 locus has previously been linked with a severe speech and language disorder and autism, and a mutation in exon 14 of the FOXP2 gene on 7q32 has been identified in one large pedigree. Because the language disorder associated with the SPCH1 locus has some overlap with the language deficits observed in dyslexia, we sequenced the coding region of FOXP2 as a candidate gene for our observed linkage in six dyslexic subjects. No mutations were identified. We conclude that DYX3 appears to be important for dyslexia susceptibility in many Finnish families, and a suggested linkage of dyslexia to chromosome 7q32 will need verification in other data sets.

A dominant gene for developmental dyslexia on chromosome 3.

Developmental dyslexia is a neurofunctional disorder characterised by an unexpected difficulty in learning to read and write despite adequate intelligence, motivation, and education. Previous studies have suggested mostly quantitative susceptibility loci for dyslexia on chromosomes 1, 2, 6, and 15, but no genes have been identified yet. We studied a large pedigree, ascertained from 140 families considered, segregating pronounced dyslexia in an autosomal dominant fashion. Affected status and the subtype of dyslexia were determined by neuropsychological tests. A genome scan with 320 markers showed a novel dominant locus linked to dyslexia in the pericentromeric region of chromosome 3 with a multipoint lod score of 3.84. Nineteen out of 21 affected pedigree members shared this region identical by descent (corrected p<0.001). Previously implicated genomic regions showed no evidence for linkage. Sequencing of two positional candidate genes, 5HT1F and DRD3, did not support their role in dyslexia. The new locus on chromosome 3 is associated with deficits in all three essential components involved in the reading process, namely phonological awareness, rapid naming, and verbal short term memory.

Correlations between radon concentration and indoor gamma dose rate, soil permeability and dwelling substructure and ventilation.

Correlations between radon concentration and indoor gamma dose rate, soil permeability and dwelling substructure and ventilation were studied using data from 84 low rise residential houses collected in an area of enhanced indoor radon concentration. The radon concentrations varied from 30 to > 5000 Bq m(-3). Cross-tabulation, comparisons of means and multiplicative models were used to test the significance of the effects. In this study a quite high percentage of explained variation R2 (68%) was found. It was found that the most important factors were the substructure and the permeability of the soil. Due to the rather small sample size and moderate variation in the uranium content of the bedrock of the area, the effect of the indoor gamma dose rate was not so prominent. The effects of ventilation habits and sleeping with open windows were not detected in this study.

Two translocations of chromosome 15q associated with dyslexia.

Developmental dyslexia is characterised by difficulties in learning to read. As reading is a complex cognitive process, multiple genes are expected to contribute to the pathogenesis of dyslexia. The genetics of dyslexia has been a target of molecular studies during recent years, but so far no genes have been identified. However, a locus for dyslexia on chromosome 15q21 (DYX1) has been established in previous linkage studies. We have identified two families with balanced translocations involving the 15q21-q22 region. In one family, the translocation segregates with specific dyslexia in three family members. In the other family, the translocation is associated with dyslexia in one family member. We have performed fluorescence in situ hybridisation (FISH) studies to refine the position of the putative dyslexia locus further. Our results indicate that both translocation breakpoints on 15q map within an interval of approximately 6-8 Mb between markers D15S143 and D15S1029, further supporting the presence of a locus for specific dyslexia on 15q21.

High indoor radon variations and the thermal behavior of eskers.

Measurements of indoor radon concentrations in houses built on the Pispala esker in the city of Tampere were taken. The objective was to find connections between indoor radon concentrations, esker topography, and meteorological factors. The results show that not only the permeable soil but also subterranean air-flows in the esker strongly affect the indoor radon concentrations. The difference in temperature between the soil air inside the esker and the outdoor air compels the subterranean air to stream between the upper and lower esker areas. In winter, the radon concentrations are amplified in the upper esker areas where air flows out from the esker. In summer, concentrations are amplified in certain slope zones. In addition, wind direction affects the soil air and indoor radon concentrations when hitting the slopes at right angles. Winter-summer concentration ratios are typically in the range of 3-20 in areas with amplified winter concentration, and 0.1-0.5 in areas with amplified summer concentrations. A combination of winter and summer measurements provides the best basis for making mitigation decisions. On eskers special attention must be paid to building technology because of radon.

Studies of high indoor radon areas in Finland.

Solid state nuclear track detectors were used in a regional survey of radon in indoor air. The study area comprises seven rural municipalities and two towns in an area of 80 X 50 km2 with a population of about 65,000. Measurements were made in 754 houses in 31 subareas. The highest and lowest subarea means were 1,200 Bq/m3 and 95 Bq/m3, respectively. The estimated mean for the whole area was 370 Bq/m3. The concentrations 2,000 Bq/m3 and 800 Bq/m3 were exceeded in 32 and 90 houses, respectively. The present lung cancer incidence does not differ significantly from the national mean.

Duchenne-like muscular dystrophy in two sisters with normal karyotypes: evidence for autosomal recessive inheritance.

Two sisters, products of a consanguineous marriage (with a total of 12 children) showed muscle weakness at ages 7 and 6 yrs, respectively. The symptoms progressed rapidly and the patients were confined to wheelchairs at ages of 12 and 11 yrs, respectively. They had mild facial weakness and pseudohypertrophy of the calves, but neither cardiomyopathy nor mental retardation. Serum CK activities exceeded upper normal limit by 70 to 85-fold. Muscle biopsies were compatible with muscular dystrophy. Both girls had a normal karyotype. The healthy mother had mild CK elevations in two out of three occasions, but the muscle biopsy was normal. Three out of the six unaffected sibs had mild CK elevations. The findings support the concept of severe progressive muscular dystrophy with autosomal recessive inheritance. The condition is clinically indistinguishable from Duchenne muscular dystrophy.

Experience with preoperative irradiation in head and neck cancer.

Experience with 47 patients with head and neck carcinoma operated after preoperative megavoltage irradiation of about 3 000 rads over 3 weeks is reported. The 3-year survival for the series was 25/47 (53%), for the cases of Stages I--II 13/19 (68%) and Stages III--IV 12/28 (43%). Neoplastic cells could not be detected in 18% of the cases at operative biopsy. The remaining neoplastic cells were considered to be degenerated and non-vital in 14%, but in 68% of the cases the histological examination revealed a viable neoplasm. Changes in the macroscopic appearance did not correlate very well with the histological findings. Disadvantages of the irradiation were so minimal that the authors consider the general application of preoperative radiation in the therapy of head and neck malignancies to be the treatment of choice.

Chest wall recurrences after operation and postoperative irradiation of mammary carcinoma.

The frequency of recurrences in a material of 463 patients with mammary carcinoma following treatment by surgery with or without postoperative roentgen or cobalt irradiation to the operation area and regional lymph nodes is analysed. Postoperative irradiation to the operation area seems to prevent the chest wall recurrences even in stage I mammary carcinoma.

Effects of megavoltage therapy of cancer on the eye.

Twenty-two cases with carcinomas of the nasal cavity, sinuses, buccal and orbital regions treated in the Radiotherapy Clinic of University Central Hospital in Turku, are presented. The dose delivered to the eye was 1400 to 6300 rd. The most usual radiation complication was keratitis which appeared in 15 cases, cataract was diagnosed in seven cases, corneal ulcer in three, iritis in two, retinopathia in two, and glaucoma in three cases. Most of the complications could be relieved or cured with appropriate therapy. In only one case the eye was to be enucleated because of severe glaucoma and corneal ulceration. As the prognosis of malignant tumours in this area usually is bad, irradiation to the eye on the affected side is to be taken as a calculated risk to achieve a more effective cancer control.

Complications following radiotherapy in gynaecological carcinoma: comparison between X-ray and megavoltage therapy.

The use of megavoltage therapy has in some investigations been shown to be associated with improvement in the prognosis of gynaecological carcinoma. Our purpose was to clarify whether the character or number of complications has changed with the increased effectiveness of treatment. During the years 1967-1970 a total of 449 cases of gynaecological carcinoma (cervical, endometrial, ovarian) were treated at the Department of Obstetrics and Gynaecology and the Department of Radiation Therapy, Turku University; tele-Cobalt was used for external radiation. The comparison period was the years 1963-1965 when 289 patients were treated, the external radiation then in use being X-ray therapy. Intracavitary radiation was given in both groups using the modified Stockholm method for cervical carcinoma and the Heyman method for endometrial carcinoma. Operative activity was about the same in both periods. Patients with cervical carcinoma treated with tele-Cobalt appeared to have a higher frequency of severe intestinal complications (12.4%) than patients receiving X-ray therapy (6.0%); the difference was not, however, statistically significant. The same is true concerning the treatment groups of ovarian cancer (4.8% and 0% respectively) and those of endometrial carcinoma (5.2% and 1.2%). However, if all the patients as a group are considered and also those with urological complications, the difference was significant (p less than 0.05), the frequency of complications being 7.6% for patients treated with tele-Cobalt and 4.2% for those treated with X-ray therapy. One must take into account that in all cases the most difficult complications were seen in patients treated with tele-Cobalt, where surgical treatment was necessary in 29%.