Determinants of pain and functioning in hip osteoarthritis - a two-year prospective study.

OBJECTIVE: To identify predictors of pain and disability in hip osteoarthritis. DESIGN: A prospective analysis of determinants of pain and functioning in hip osteoarthritis. STUDY SETTING: Rehabilitation clinic in a central hospital. PATIENTS: A total of 118 men and women aged 55-80 years who had radiologically diagnosed hip osteoarthritis and associated clinical symptoms and participated in a randomized controlled trial. MAIN MEASURES: The self-reported disease-specific pain and physical function were assessed using the pain and functioning subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis index. The self-reported generic physical and mental functioning were assessed by using the Finnish-validated SF-36-item Health Survey RAND-36 subscales for function and physical and mental component summary scores. Outcome measures were recorded at 0, 3, 6, 12, 18 and 24 months. RESULTS: Multivariate linear mixed model analyses revealed that lower disease-specific pain score and better functioning (WOMAC) were predicted by higher educational level (9.61 (3.15 to 16.07); 9.07 (2.05 to 16.09)), supervised exercise training (-10.13 (-17.87 to -2.39); -11.58 (-19.40 to -3.77)), habitual conditioning physical activity (-0.48 (-0.96 to -0.01); -0.39 (-0.84 to 0.05)), absence of comorbidities (-6.30 (-12.35 to -0.24); -7.87 (-14.45 to -1.30)) and absence of additional knee osteoarthritis (-7.62 (-13.87 to -1.36); -8.02 (-14.81 to -1.23)), respectively. The same factors, except for the comorbidities, also predicted general physical functioning score (RAND-36). CONCLUSIONS: Higher education, absence of knee osteoarthritis and comorbidities, supervised exercise training and habitual conditioning physical activity predicted a lower presence of pain and better functional status in patients with hip osteoarthritis.

Medication-free colonoscopy--factors related to pain and its assessment.

AIM: This paper is a report of a study conducted to determine the possibility of performing colonoscopy without medication, elucidate the factors related to a painful colonoscopy experience and compare colonoscopy patients' reported pain assessment to nurses' and endoscopists' observations. BACKGROUND: Sedation and pain medication are routinely administered for colonoscopies in many countries. However, medication-free colonoscopies have attracted attention because the use of medication requires a time commitment from patients and increases complications. Earlier studies show that, for instance, gender, age and pelvic operations may increase the risk of painful colonoscopy and those healthcare professionals and patients appear to assess pain differently. METHOD: A cross-sectional descriptive study was conducted in a Finnish university hospital using questionnaires developed for this study and analysed statistically. The sample of 138 colonoscopy patients, 11 nurses and 11 endoscopists was recruited in 2006. RESULTS: Over three-quarters of patients reported mild pain or no pain at all. Patients' nervousness is a risk factor for experiencing pain during colonoscopy. Both nurses and endoscopists slightly underestimated the intensity of pain experienced by patients. CONCLUSION: It is possible to perform colonoscopy without medication with most patients and focus sedation and pain medication on at-risk patients, especially those who are nervous. Before the procedure, nurses must devote time to discovering which patients are nervous and at risk of having a painful colonoscopy to present them for sedation. To improve pain management for patients having colonoscopy, endoscopists and nurses should participate systematically in pain education and use pain scales.

Models for predicting type 1 diabetes in siblings of affected children.

OBJECTIVE: To generate predictive models for the assessment of risk of type 1 diabetes and age at diagnosis in siblings of children with newly diagnosed type 1 diabetes. RESEARCH DESIGN AND METHODS: Cox regression analysis was used to assess the risk of progression to type 1 diabetes, and multiple regression analysis was used to estimate the age at disease presentation in 701 siblings of affected children. Sociodemographic, genetic, and immunological variables were included in the analyses. Subanalyses were performed in a group of 77 autoantibody-positive siblings with additional metabolic data. RESULTS: A total of 47 siblings (6.7%) presented with type 1 diabetes during the 15-year observation period. Young age, an increasing number of detectable diabetes-associated autoantibodies at initial sampling and of affected first-degree relatives, and HLA DR-conferred disease susceptibility predicted progression to type 1 diabetes. In the subgroup of 77 autoantibody-positive siblings, young age, HLA DR-conferred susceptibility, an increasing number of autoantibodies, a reduced first-phase insulin response, and decreased insulin sensitivity in relation to first-phase insulin response were associated with increased risk of progression to type 1 diabetes. Age at diagnosis was predicted by age, insulinoma-associated protein 2 antibody levels, and number of autoantibodies at initial sampling (R(2) = 0.76; P < 0.001). In the smaller cohort of autoantibody-positive subjects, first-phase insulin response and HLA DR-conferred susceptibility were additional predictors of age at diagnosis. CONCLUSIONS: Information on autoantibody status and levels, HLA-conferred disease susceptibility, and insulin secretion and sensitivity seems to be useful in addition to age and family history of type 1 diabetes when assessing risk of progression to type 1 diabetes and time to diagnosis in siblings of children with newly diagnosed type 1 diabetes.

Methodologic considerations in the measurement of glycemic index: glycemic response to rye bread, oatmeal porridge, and mashed potato.

BACKGROUND: Methodologic choices affect measures of the glycemic index (GI). The effects on GI values of blood sampling site, reference food type, and the number of repeat tests have been insufficiently determined. OBJECTIVE: The objective was to study the effect of methodologic choices on GI values. Comparisons were made between venous and capillary blood sampling and between glucose and white bread as the reference food. The number of tests needed for the reference food was assessed. Rye bread, oatmeal porridge, and instant mashed potato were used as the test foods. DESIGN: Twelve healthy volunteers were served each test food once and both reference foods 3 times at 1-wk intervals in a random order after they had fasted overnight. Capillary and venous blood samples were drawn at intervals for 3 h after each study meal. RESULTS: GIs and their CVs based on capillary samples were lower than those based on venous samples. Two tests of glucose solution as the reference provided stable capillary GIs for the test foods. The capillary GIs did not differ significantly when white bread was used as the reference 1, 2, or 3 times, but the variation was lower when tests were performed 2 and 3 times. Capillary GIs with white bread as the reference were 1.3 times as high as those with glucose as the reference. The capillary GIs of rye bread, oatmeal porridge, and mashed potato were 77, 74, and 80, respectively, with glucose as the reference. CONCLUSIONS: Capillary blood sampling should be used in the measurement of GI, and reference tests with glucose or white bread should be performed at least twice.

Patterns and 14-year trends in mortality among illicit drug users in Finland: the HUUTI study.

BACKGROUND: Although mortality is a known complication of illicit drug use, robust epidemiological studies on drug-related mortality in Finland are scarce. We examined all deaths, specific causes of death, and trends in mortality among a large number of illicit drug users in Finland during a 14-year period. METHODS: Details of 4817 clients who sought treatment for drug use at Helsinki Deaconess Institute between 1997 and 2008 were linked to national cause of death register to identify all deaths and causes of death. Standardised mortality ratios (SMRs) were calculated to compare all-cause deaths in our study cohort with those in the general population. Trends in mortality rates were assessed using Poisson (log-linear) regression. RESULTS: A total of 496 deaths occurred during 41,567.5 person-years with crude mortality rate of 1193.2 per 100,000 person-years. Mean follow-up was 8.6 years and the mean age at death was 33.8 years. Most deaths (84.1%) occurred among male clients, 189 deaths occurred in the 25-34 age-group and all-cause SMR was 8.9 [95% confidence interval (CI)=8.1-9.7]. Two-thirds (64.9%) were deaths from external causes and 35.1% from disease-related causes. The four leading causes of death were accidental poisoning/overdose (n=165), suicide (n=108), mental and behavioural disorders (n=49) and circulatory system diseases (n=45). Younger clients died from acute effects of drug use while older clients died more from chronic health conditions. A decline in annual rates was noted for all-cause mortality (P=0.01), deaths from mental and behavioural disorders (P<0.001) and suicides (P<0.001). CONCLUSION: The four leading causes of death among illicit drug users are preventable. Overdose management training, drug education and other preventive measures could help reduce mortality.

Elevated head circumference-to-height ratio is an early and frequent feature in children with neurofibromatosis type 1.

BACKGROUND/AIMS: Children with neurofibromatosis type 1 (NF1) tend to be macrocephalic and short. Our aim was to define the incidence and diagnostic accuracy of elevated head circumference-to-height ratio (HCHR) in children with NF1 and to assess if elevated HCHR would facilitate early diagnosis of NF1. METHODS: Retrospective analysis of growth and health data of 80 NF1 patients aged 0-7 years was performed. The incidence and diagnostic accuracy of elevated HCHR for NF1 was analyzed using receiver operating characteristic curves. RESULTS: The median age when the first elevated (≥2.0 SDS) HCHR value was detected was 0.3 years (range 0.0-5.3). At the median age of diagnosis (3.6 years), 53.8% of NF1 children exhibited elevated HCHR. The diagnostic accuracy of HCHR alone was 0.78 (95% CI 0.72-0.84), but in comparison with the seven National Institutes of Health diagnostic criteria for NF1, elevated HCHR was the second most prevalent feature. CONCLUSION: Elevated HCHR is an early and frequent feature in NF1 children. Taking HCHR into account would facilitate the early detection of NF1.

New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks.

BACKGROUND AND OBJECTIVES: Birth size curves are needed for clinical and epidemiological purposes. We constructed birth weight (BW), length (BL), and head circumference (BHC) references, assessed effects of twinness and parity, and defined cut-off points for small, appropriate, and large for gestational age. MATERIALS AND METHODS: Birth register data of all 753,036 infants born in 1996-2008 in Finland were cleaned to create references reflecting optimal intrauterine growth. The final data included 533,666 singletons and 15,033 twins (median gestation weeks (gws) 40.0 and 37.1, respectively, 41.6% primiparous). Sex-specific BW, BL, and BHC references were constructed from 23 to 43 gws separately for singletons and twins born to primiparous or multiparous mothers. GAMLSS method was used for modelling. RESULTS: In singletons from 36 gws onwards, increased BW and BL were observed in comparison to previous reference from 1979-1983. Twins diverged from singletons from 30 gws onwards. At 37.0 gws, mean BW was 400 g lower and mean BL 1.2 cm shorter than in singletons. From 30 gws onwards, birth size was larger in infants of multiparous than primiparous mothers. CONCLUSIONS: Population-based birth size references are available for the evaluation of birth size. Accounting for plurality and parity improves the accuracy of birth size evaluation.

New Finnish reference for head circumference from birth to 7 years.

BACKGROUND AND OBJECTIVES: In the evaluation of the growth of head circumference (HC), charts depicting normal growth are of paramount importance. Current Finnish HC growth charts are based on data from only 130 children born 1953-1964. As a secular trend in HC growth has been reported, we updated the HC charts using a large sample of contemporary HC data. MATERIAL AND METHODS: Mixed cross-sectional HC data of 19,715 healthy subjects aged 0-7 years were collected from primary health care providers. References for HC for age and HC/height ratio for age were fitted using generalized additive models for location, scale, and shape (GAMLSS). RESULTS: Increased HC for age was seen particularly after 2 years of age in both genders compared to the 1953-1964 reference. The SD for HC was remarkably larger in the 1953-1964 reference. The proportion of 1986-2008 reference subjects exceeding the +2 SD limit of the 1953-1964 reference was much bigger than the proportion below -2 SD. CONCLUSIONS: Because of the secular change in HC growth, the HC reference has to be renewed periodically. The new Finnish reference for HC for age should be implemented for monitoring HC growth of children in Finland.

Screening of turner syndrome with novel auxological criteria facilitates early diagnosis.

CONTEXT: Screening criteria for abnormal growth in children are traditionally based on height-for-age, height distance from target height (TH), and change in growth rate. However, there is no consensus on the optimal screening limits. OBJECTIVE: Our objective was to first develop new population-based and age-specific cutoffs for these three screening parameters and, second, to validate their performance in screening by using Turner syndrome (TS) as a model. DESIGN, PATIENTS, AND MAIN OUTCOME MEASURE: Reference values for the height distance from TH and growth rate were defined in a total of 14,189 healthy girls aged 0-18 yr with 147,469 height measurements. The best formula for TH calculation was TH sd score = 0.79 × mid-parental height sd score - 0.15. We also calculated age-specific limits for the distance from TH and limits for growth rate that were freely scalable between age range 0-12 yr. Longitudinal growth data of a cohort including 124 TS girls were evaluated with receiver operating characteristic analysis against the reference population. RESULTS: The screening accuracy for TS was excellent when we combined all three screening parameters. Sensitivity was 97% and specificity 96% for all TS girls and 100% and 95% for 45,XO TS girls, respectively. The detection rate was 68% for all and 76% for 45,XO TS girls with 99% specificity by the age of 2 yr. CONCLUSION: These new population-based screening rules for TS are sensitive and specific, but their use is complex, and therefore their efficient use requires computerization.

New Finnish growth references for children and adolescents aged 0 to 20 years: Length/height-for-age, weight-for-length/height, and body mass index-for-age.

BACKGROUND AND OBJECTIVES: Growth curves require regular updates due to secular trends in linear growth. We constructed contemporary growth curves, assessed secular trends in height, and defined body mass index (BMI) cut-off points for thinness, overweight, and obesity in Finnish children. MATERIAL AND METHODS: Mixed cross-sectional/longitudinal data of 73,659 healthy subjects aged 0-20 years (born 1983-2008) were collected from providers in the primary health care setting. Growth references for length/height-for-age, weight-for-length/height, and BMI-for-age were fitted using generalized additive models for location, scale, and shape (GAMLSS). BMI percentile curves passing through BMIs 30, 25, 18.5, 17, and 16 kg/m(2) at the age of 18 years were calculated to define limits for obesity, overweight, and various grades of thinness. RESULTS: Increased length/height-for-age was seen in virtually all age-groups when compared to previous Finnish growth data from 1959 to 1971. Adult height was increased by 1.9 cm in girls and 1.8 cm in boys. The largest increases were seen during the peripubertal years: up to 2.8 cm in girls and 5.6 cm in boys. Median weight-for-length/height had not increased. CONCLUSIONS: New Finnish references for length/height-for-age, weight-for-length/height, and BMI-for-age were constructed and should be implemented to monitor growth of children in Finland.

Fatty fish intake decreases lipids related to inflammation and insulin signaling--a lipidomics approach.

BACKGROUND: The evidence of the multiple beneficial health effects of fish consumption is strong, but physiological mechanisms behind these effects are not completely known. Little information is available on the effects of consumption of different type of fish. The aim of this study was to investigate how fatty fish or lean fish in a diet affect serum lipidomic profiles in subjects with coronary heart disease. METHODOLOGY AND PRINCIPAL FINDINGS: A pilot study was designed which included altogether 33 subjects with myocardial infarction or unstable ischemic attack in an 8-week parallel controlled intervention. The subjects were randomized to either fatty fish (n = 11), lean fish (n = 12) or control (n = 10) groups. Subjects in the fish groups had 4 fish meals per week and subjects in the control group consumed lean beef, pork and chicken. A fish meal was allowed once a week maximum. Lipidomics analyses were performed using ultra performance liquid chromatography coupled to electrospray ionization mass spectrometry and gas chromatography. Multiple bioactive lipid species, including ceramides, lysophosphatidylcholines and diacylglycerols, decreased significantly in the fatty fish group, whereas in the lean fish group cholesterol esters and specific long-chain triacylglycerols increased significantly (False Discovery Rate q-value <0.05). CONCLUSIONS/SIGNIFICANCE: The 8-week consumption of fatty fish decreased lipids which are potential mediators of lipid-induced insulin resistance and inflammation, and may be related to the protective effects of fatty fish on the progression of atherosclerotic vascular diseases or insulin resistance. TRIAL REGISTRATION: ClinicalTrials.gov NCT00720655.

Development of a model for optimal food fortification: vitamin D among adults in Finland.

BACKGROUND: Average vitamin D intake is low in Finland. Even though almost all retail milk and margarine are fortified with vitamin D, the vitamin D intake is inadequate for a significant proportion of the population. Consequently, expanded food fortification with vitamin D would be motivated. However, there is a risk of unacceptably high intakes due to the rather narrow range of the adequate and safe intake. Therefore, a safe and efficient food fortification practice should be found for vitamin D. AIM OF THE STUDY: To develop a model for optimal food fortification and apply it to vitamin D. METHOD: The FINDIET 2002 Study (48-h recall and data on supplement use (n = 2007), and 3 + 3 days' food records, n = 247) was used as the test data. The proportion of the population whose vitamin D intake is between the recommended intake (RI) and the upper tolerable intake level (UL) was plotted against the fortification level per energy for selected foods. The fortification level that maximized the proportion of the population falling between RI and UL was considered the optimal fortification level. RESULTS: If only milk, butter milk, yoghurt and margarine were fortified, it would be impossible to find a fortification level by which the intake of the whole population would lie within the RI-UL range. However, if all potentially fortifiable foods were fortified with vitamin D at level 1.2-1.5 microg/100 kcal, the intake of the whole adult population would be between the currently recommended intake of 7.5 microg/d and the current tolerable upper intake level of 50 microg/day (model 1). If the RI was set to 40 microg/day and UL to 250 microg/day, the optimal fortification level would be 9.2 microg/100 kcal in the scenario where all potentially fortifiable foods were fortified (model 2). Also in this model the whole population would fall between the RI-UL range. CONCLUSIONS: Our model of adding a specific level of vitamin D/100 kcal to all potentially fortifiable foods (1.2-1.5 microg/100 kcal in model 1 and 9.2 microg/100 kcal in model 2) seems to be an efficient and safe food fortification practise.

Efficacy and safety of food fortification with calcium among adults in Finland.

OBJECTIVE: To examine the efficacy and safety of foods fortified with calcium in the adult population in Finland. DESIGN: A simulation study based on the FINDIET 2002 Survey, which estimated habitual food consumption, dietary supplement use and nutrient intakes using 48-hour recall and two 3-day food records, and an Internet survey of the consumption of fortified foods and dietary supplements. SETTING/PARTICIPANTS: Participants of FINDIET 2002 were 25-64 years old from five areas (n = 2007). Participants of the Internet-based survey (n = 1537) were over 15 years of age from all over the country. RESULTS: If all potentially fortifiable foods were to be fortified with calcium, the proportion of participants with calcium intake below the recommended level (< 800 mg day(-1)) would decrease from 20.3% to 3.0% in men and from 27.8% to 5.6% in women compared with the situation where no foods were fortified. At the same time, the proportion of participants with calcium intake above the tolerable upper intake level (UL, > 2500 mg day(-1)) would increase from 0.6% to 12.7% in men and from 0.1% to 3.8% in women. However, in a probability-based model (11% of all fortifiable foods to be fortified with calcium) the proportion of participants with calcium intake below the recommended level would be 15.7% in men and 23.2% in women. The proportion with intake above the UL in this model would be 1.2% in men and 0.7% in women. CONCLUSIONS: Food fortification would be a relatively effective and safe way to increase the calcium intake of the Finnish adult population.

Relative validity of a dietary interview for assessing infant diet and compliance in a dietary intervention trial.

The objective of this study was to assess the relative validity of a dietary interview method for use in an infant population. A dietary interview covering a 1-month period was completed during a study visit at 3 or 6 months of age. It included structured questions and a short food frequency questionnaire (FFQ). The information was compared with data from two 48-h recall interviews conducted during the month previous to the study visit. The agreement between the FFQ and 48-h recalls was analysed as proportion of subjects classified into the same categories of consumption frequency and by the kappa analysis. A total of 100 subjects, at the age of 2-3 months (n = 50) and 5-6 months (n = 50), were included. The kappa values for breastmilk and study formula ranged from 0.82 to 0.95, indicating very good agreement. The agreement for other foods and vitamin D supplementation ranged from fair to very good. We also found a strong correlation for the reported amount of study formula consumed per feeding at 3 months (r(s) = 0.87, n = 24) and 6 months of age (r(s) = 0.73, n = 35) between the questionnaire and 48-h recall data. However, the average amount of study formula per feeding was significantly higher when estimated for a 1-month period, compared with a mean calculated from the two 48-h recalls. As a conclusion, the interview was found to be a useful tool for assessing diet and compliance in a dietary intervention for infants.