Parental and childhood overweight in sedentary and active adolescents.

We studied whether the prevalence of overweight since age 2 years differed in sedentary and active adolescents (N=346). Further, we analyzed the energy intake of sedentary and active adolescents across 12 years. BMI was assessed annually since birth, energy intake since age 13 months and parents' BMI from the time their child was 7 months old in a longitudinal atherosclerosis prevention study. Data on physical activity were collected at age 13 years (N=560). Sedentary and Active groups were formed by upper and lower physical activity tertile cut-points. Girls Sedentary at 13 years were more often overweight than Active peers already since age 2 years (P=0.048). Activity habits were not associated with energy intake. Conversely, among boys, activity habits in adolescence were not associated with childhood overweight, while the energy intake of Active boys was higher than that of Sedentary boys (P=0.008). Parental overweight was not associated with the physical activity of children; however, Sedentary girls more often had an overweight mother than Active girls (P=0.021). In conclusion, overweight during early years of life is more common among girls who are Sedentary as adolescents than in Active peers. Overweight mothers more often have Sedentary daughters than normal-weight mothers. A healthy lifestyle right from early childhood requires active support.

A seven-year follow-up of a weight reduction programme in Finnish primary health care.

The study was carried out to assess the short- and long-term effects of a Finnish Social Insurance Institution (SII) weight reduction programme in overweight primary health care clients and the suitability of the programme for use in health centres. The treatment group consisted of 22 men and 71 women, mean body mass index (BMI) 34.3, divided into 8 subgroups. These subjects participated in a 6-week weight reduction course led by public health nurses. Afterwards, there were six follow-up sessions and weight measurements at about 2-month intervals. A control group of 20 men and 76 women, mean BMI 33.5, received no weight reduction instruction during the 1 year that they served as controls. The weights, serum and high-density lipoprotein (HDL) cholesterol levels as well as blood pressures of the subjects in both groups were measured at entry to the study and at the end of the 1-year period. At that time the treatment group showed a weight reduction of 10.9 kg in men and 5.4 kg in women. The control group showed a mean weight gain of 0.9 kg in men and 0.2 kg in women. HDL cholesterol increased in the treatment group. The blood pressure decreased significantly in the category of subjects with a weight loss exceeding 4 kg weight. At the end of the 7-year follow-up period the mean weight reduction in the treatment group was 8.7 kg in men and 3.5 kg in women. Of men 53% and of women 21% still weighed over 10 kg less than at baseline. Both the clients and public health nurses found the weight reduction programme useful and applicable to health centres, preferably with extended time. The programme has now been adopted nationwide in the Finnish primary health care system.

Weight reduction on lactovegetarian and mixed diets. Changes in weight, nutrient intake, skinfold thicknesses and blood pressure.

The purpose of this study was to investigate whether a weight reduction programme based on a lactovegetarian diet has any beneficial effects on the weight, nutrient intake, blood pressure and skinfold thickness of overweight subjects compared with a programme based on a balanced mixed diet. The subjects consisted of three groups of moderately overweight persons, with a mean age of 38 years and a mean overweight of 38 per cent. Two groups had a weight reduction programme for 1 year; group 1 (n = 31) had a 1200 kcal lactovegetarian diet and group 2 (n = 37) had an isocaloric mixed diet. Group 3 (n = 42) served as a control group which had no intervention. During the 1-year study period, group 1 lost 9.2 kg in weight, group 2 lost 10.4 kg and group 3 gained 1.6 kg in weight. Weight loss in both weight reduction groups was accompanied by a reduction in blood pressure, skinfold thickness and arm circumference. The results were slightly more favourable in the mixed diet group than in the lactovegetarian group. In the lactovegetarian group 7 persons were not able to follow the lactovegetarian diet throughout the whole year but ate some meat, fish and eggs during the latter part of the study year. The intake of fibre, vitamin C and calcium was greater and the intake of fat lower in the lactovegetarian than in the mixed diet group during the 1-year weight reduction period. The intake of most nutrients was above the recommended level in both weight reduction groups. The intake was somewhat below recommendations for niacin in the lactovegetarian group, for calcium in the mixed diet group and for iron for women in both groups. It seems desirable to recommend a low-calorie nutritionally well-balanced mixed diet, based on familiar foods and rich in vegetables, instead of a lactovegetarian diet, for long-term weight reduction of overweight persons. In the long term some nutrients may need to be supplemented in both diets.

Comparison of nutrient intake data calculated on the basis of two different databases. Results and experiences from a Swedish-Finnish study.

BACKGROUND AND OBJECTIVE: In international surveys of food consumption and nutrient intake, it is essential that the dietary data are comparable when different databases and calculation programs are used. The aim of the present analysis was to examine the comparability of nutrient intake data calculated on the basis of the Swedish food composition database PC-kost and the Finnish food composition database Nutrica. SUBJECTS AND METHODS: A total of 20 male adults currently living in Sweden were selected from a group of Finnish twins of the Finnish Twin Cohort Study. Food consumption data were collected by means of diet history interviews. The estimated intakes of 30 nutrients calculated on the basis of PC-kost were compared to the corresponding estimates calculated on the basis of Nutrica. The calculation procedures were standardised. RESULTS: No statistically significant differences were observed in the mean intakes of energy, total fat, saturated fat, carbohydrates, dietary fibre, alcohol, cholesterol, vitamin A, retinol, beta-carotene, vitamin D, alpha-tocopherol, riboflavin, niacin, vitamin B(12), vitamin C or phosphorus. PC-kost yielded a 20% higher intake (NS) for vitamin D and 23% higher intake (P<0.001) for thiamine than Nutrica, which is mainly attributed to the differences in the enrichment of foodstuffs between Sweden and Finland. Conversely, PC-kost yielded 53% lower values (P<0.001) for selenium than Nutrica, owing to the increased selenium content in many Finnish foodstuffs as a result of the addition of selenium to fertilisers. Statistically significant differences were found for protein, monounsaturated fatty acids, vitamin B(6), iron and sodium (5-9% higher values from PC-kost) and for polyunsaturated fatty acids, folate, zinc, calcium, magnesium and potassium (4-10% lower values from PC-kost). The variation in the intake of these nutrients between the two methods may be explained by the differences in foodstuff-specific nutrient values (eg product formulations), or differences in the sources of data, recipes or calculation procedures. The correlation coefficient was > or =0.81 for most nutrients. At least 85% of the subjects in each PC-kost quintile were classified into the same or adjacent Nutrica quintile for all nutrients. CONCLUSIONS: Our results indicate that, for a dominant part of the examined nutrients, the estimated intakes calculated by means of standardised procedures using the PC-kost and Nutrica databases are comparable between Sweden and Finland. Differences observed for some nutrients reflect either actual differences in foods between the two countries or methodological differences in the assessment of nutrient intakes.

Consumption of black currants, lingonberries and bilberries increases serum quercetin concentrations.

OBJECTIVE: To study serum quercetin concentrations of subjects consuming berries or habitual Finnish diets. DESIGN: Randomized parallel dietary intervention. SUBJECTS: Forty healthy men (age 60 y). INTERVENTION: Twenty subjects consumed 100 g/day of berries (black currants, lingonberries and bilberries) for 8 weeks. Twenty subjects consuming their habitual diets served as controls. Fasting blood samples were obtained 2 weeks prior to the study, at baseline, and at 2, 4 and 8 weeks. Intake of quercetin was assessed from 3 day food records collected at baseline and at 8 weeks. RESULTS: The serum quercetin concentrations were significantly higher in the subjects consuming berries compared to the control group (P=0.039 ANCOVA with repeated measures). During the berry consumption period the mean serum concentrations of quercetin ranged between 21.4 and 25.3 micro g/l in the berry group, which was 32-51% higher compared with the control group. According to 3 day food records, there was no difference in quercetin intake at baseline, but at 8 weeks the intake was 12.3+/-1.4 mg/day (mean+/-s.e.m.) in the berry group and 5.8+/-0.6 mg/day in the control group (P=0.001). CONCLUSIONS: The results indicate that the berries used in this study are a good source of bioavailable quercetin.

Nutritional guidelines for older people in Finland.

BACKGROUND: Ageing is associated with an increased risk of malnutrition, decreased nutrient intake, unintentional weight loss and sarcopenia, which lead to frailty, functional disabilities and increased mortality. Nutrition combined with exercise is important in supporting older people's health, functional capacity and quality of life. OBJECTIVE: To identify nutritional needs in various groups of older individuals and to present the nutritional guidelines for older people in Finland. DESIGN: A review of the existing literature on older people's nutritional needs and problems. The draft guidelines were written by a multidisciplinary expert panel; they were then revised, based on comments by expert organisations. The guidelines were approved by the National Nutritional Council in Finland. RESULTS: The heterogeneity of the older population is highlighted. The five key guidelines are: 1. The nutritional needs in different age and disability groups should be considered. 2. The nutritional status and food intake of older individuals should be assessed regularly. 3. An adequate intake of energy, protein, fiber, other nutrients and fluids should be guaranteed. 4. The use of a vitamin D supplement (20 µg per day) recommended. 5. The importance of physical activity is highlighted. In addition, weight changes, oral health, constipation, obesity, implementing nutritional care are highlighted. CONCLUSIONS: Owing to the impact that good nutrition has on health and well-being in later life, nutrition among older people should be given more attention. These nutritional guidelines are intended to improve the nutrition and nutritional care of the older population.

Migration and differences in dietary habits-a cross sectional study of Finnish twins in Sweden.

OBJECTIVE: To compare dietary habits between Finnish twin migrants to Sweden and their co-twins always living in Finland, and to analyse how migration influenced food consumption patterns in the migrants. SUBJECTS/METHODS: Same-sexed twin pairs born in Finland below 75 years of age, with at least one twin migrating to Sweden (n=1083 pairs). Dietary habits were assessed by a food frequency questionnaire included in a comprehensive mailed questionnaire (response rate 71%). For 76 male twin pairs, information was also collected by a dietary history interview inquiring the habitual diet during the previous year. RESULTS: Migrant twins in Sweden had a lower intake of typical Finnish foods like dark bread and berries, and an increased consumption of fresh fruit compared with co-twins living in Finland. The migrants consumed less potatoes and more rice and pasta. Sweet pastries were consumed less often by the migrants and they also tended to more often cut out visible fat of meat and on the other hand add salt to dishes. Among men the migrants had a lower alcohol intake than their co-twins living in Finland. CONCLUSIONS: Migration from Finland to Sweden is associated with differences in the food pattern that reflect population differences in eating habits between the two countries. The differences include a reduced consumption of typical Finnish foods like dark bread and berries and are of bidirectional nature from the point of view of cardiovascular health.

Leisure-time physical activity of 13-year-old adolescents.

The leisure-time physical activity of 13-year-old Finnish adolescents was assessed in the prospective STRIP study. A self-administered questionnaire (N=565) was used. The leisure-time physical activity index (PAI; MET h/week) was calculated on the basis of reported exercise intensity, duration and frequency (N=558; 53% boys). The participants were divided into Sedentary, Moderately Active and Active groups by PAI tertiles. A subpopulation (N=197) also used a heart rate monitor (3 days, >/=8 h/day) to assess the time spent on different activity intensities. The median male PAI was 31.3 (inter-quartile range (IQR) 44.2) MET h/week and female 19.5 (IQR 26.3) MET h/week (P=0.0002). The cutoff points of the PAI tertiles were similar for the Active girls (31.3 MET h/week) and boys (32.6 MET h/week), but for the Sedentary boys it was 19.5 MET h/week and only 5.0 MET h/week for the Sedentary girls. High self-reported leisure-time physical activity associated poorly with time spent on moderate or vigorous exercise measured by heart rate monitoring. Active mothers had more often Active daughters or sons. In conclusion, the amount of leisure-time physical activity of one-third of 13-year-old girls is extremely low. Sedentary adolescents, especially girls, should therefore be put into focus for active efforts to increase their leisure-time physical activity. Parental models may be important.

Weight reduction programmes at a rehabilitation centre and a health centre based on group counselling and individual support: short- and long-term follow-up study.

The objective of this study was to evaluate the effects of two weight reduction programmes on moderately and severely obese subjects over a period of five years. The subjects were randomly divided into a rehabilitation centre group (RC group) and a health centre group (HC group). Treatment in the RC group consisted of a three-week in-patient weight reduction programme at a rehabilitation centre and in the HC group of a ten-week out-patient weight reduction course at a health centre. Treatment in both groups continued for up to 24 months with an individual follow-up at 1-2-month intervals by a general practitioner (GP) at the health centre. The subjects were 42 women and 10 men. The mean weight of women at the onset of the study was 104 kg and the mean BMI 39.5 kg/m2 and the respective means of men 121 kg and 40.1 kg/m2. The mean age of both sexes was 40 years. In the RC group the mean weight loss at 6, 12 and 24 months was 11.5, 9.1 and 5.9 kg in women, and 19.0, 18.3 and 11.2 kg in men, respectively. In the HC group the respective values were 5.5, 4.8 and 3.2 kg in women and 12.2, 6.7 and 2.8 kg in men. At the five-year follow-up the mean weight change from baseline was -6.8 kg in the men and $0.3 kg in the women of the RC group. In the HC group the mean weight returned to baseline level in both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Apical curettage as a treatment of acute periapical inflammation.

In 16 incisors, one canine, and one premolar with an acute periapical infection which had perforated the cortical bone, an apical curettage was carried out. During the treatment and the following 5 days, the patients were protected with antibiotic therapy. The curettage was performed through a slightly arched incision, convex toward the gingival margin. At the same sitting, a guttapercha root filling was made in the conventional way. Irrespective of operation, which involved a somewhat larger than normal incision, no spread from local to general infection was found in any of the cases. The patients were free from pain and other symptoms of infection after one treatment. In the radiographic examinations carried out from 6 to 12 months and 3 years later, it was found that 50% of curetted roots showed complete healing, 33% were uncertain and 17% were unsatisfactory. Bone formation was most rapid during the first postoperative year, after which it decreased. The bone formation was also most rapid in larger lesions but decreased, even in these, when it advanced to the vicinity of the root.

Comparison between two fibrescopes with different diameter insertion cords for fibreoptic intubation.

Two fibreoptic bronchoscopes with insertion cords of different diameters (3.7 and 5.0 mm) were compared during fibreoptic intubation in 84 adult patients (ASA 1-2) undergoing orotracheal intubation under general anaesthesia. The fibrescope used was randomly selected. The incidence of resistance to passage of the tracheal tube through the vocal cords was higher using the thinner fibrescope, 14/40 (35%) as compared with the thicker fibrescope, 5/44 (11%) (p < 0.05). Intubation failed with the thinner fibrescope in 8/40 (20%) of patients, whereas all intubations with the thicker fibrescope were successful in six patients after manipulation of the tracheal tube (p < 0.01). With the thinner fibrescope manipulation of the tracheal tube after impingement led to intubation of the trachea in 6/14 (43%) patients. The duration of intubation was significantly shorter with the thicker fibrescope (p < 0.05). There were two instances of oesophageal intubation with the thinner fibrescope. A fibrescope with a thicker insertion cord is more suitable for orotracheal fibreoptic intubation in adult patients.

Intubation difficulties in patients with rheumatoid arthritis. A retrospective analysis.

BACKGROUND: Fibreoptic intubation has been suggested to be the best method to manage a compromised airway. This retrospective study was designed to compare endotracheal intubation with the help of a rigid laryngoscope or a fibrescope in patients with rheumatoid arthritis. METHODS: Intubation difficulties with the laryngoscope and the fibrescope in patients with rheumatoid arthritis were investigated during a period of five and a half years. The anaesthesia records were used for analysis. The patients were divided into two groups (group I with 41 patients and group II with 37 patients) reflecting the change in the routine airway management in patients with rheumatoid arthritis in our hospital from the beginning of 1993. Before that time the patients were usually intubated orotracheally under general anaesthesia, but since 1993 rheumatoid patients with anticipated difficulties in endotracheal intubation have been preferably intubated fibreoptically awake under sedation and topical anaesthesia with a fibrescope. RESULTS: Major difficulties in endotracheal intubations were encountered in 13% of patients in group I and in 8% in group II. On two occasions in group I tracheostomy was needed. In one of these patients, emergency tracheostomy was performed. In the latter group, the main reason for prolonged fibreoptic intubations was lack of experience. CONCLUSION: The introduction of fibreoptic intubation technique has had a favourable influence on the safety in the airway management of surgical patients with rheumatoid arthritis.

Long-term effects on lipid metabolism of weight reduction on lactovegetarian and mixed diet.

The effects of two dietary weight reduction programmes (1200 kcal/day) on lipid metabolism were followed for one year in moderately obese subjects. The groups consisted of lactovegetarian (n = 31), mixed diet (n = 37) and control (n = 42) groups. Serum triglyceride levels decreased rapidly during the first two weeks (46 per cent on average) especially in the mixed diet group, and this change was still statistically significant at 6 and 12 months after the beginning of the study. Serum total cholesterol levels also decreased rapidly in the beginning, but at 6 and 12 months the change was no longer statistically significant. After a small initial decrease HDL cholesterol levels appeared to increase towards the end of the study year. This increase was more marked in men (18.6 per cent at 6 months) than in women, and in the mixed diet group than in the lactovegetarian group (P less than 0.05 between the groups). The HDL/total cholesterol ratio increased rapidly in the beginning of the weight reduction and practically remained at the elevated (12-16 per cent) level during the whole follow-up. This increase was also more apparent in men than in women, and in the mixed diet group than in the lactovegetarian group. The changes in HDL subfractions, HDL2 and HDL3, paralleled those seen in the HDL cholesterol levels. Similarly the alterations in apolipoproteins A-I and B resembled those of the HDL and total cholesterol levels. The activity of adipose tissue lipoprotein lipase decreased drastically (about 50 per cent) at the beginning of the weight reduction, while at 6 and 12 months the mean activities were higher than the initial levels. This was also seen in the LPL activity when measured in post-heparin plasma. The activity of post-heparin plasma hepatic lipase decreased clearly at both 6 (P less than 0.001) and 12 months (P less than 0.01) in the mixed diet group, whereas no change was found in the lactovegetarian group. The ratio of subscapular to triceps skinfold reduced significantly (P less than 0.01) in women but not in men during the intervention period. Our study shows that in moderately overweight subjects weight reduction with the aid of a low-calorie dietary programme results in favourable responses in lipid metabolism many months after the cessation of the weight reduction programme. These responses appear to be stronger in subjects following mixed diet than in those attempting to follow a lactovegetarian diet.

Cranial manifestations of hypophosphatasia in childhood nephrotic syndrome.

A 7-year-old boy was referred to the children's hospital because of gross oedema and tiredness. Massive proteinuria was found and the condition was diagnosed as a childhood nephrotic syndrome. Concomitantly, pathologically low levels of serum alkaline phosphatase were recorded, and this, together with generalized osteoporosis and premature synostosis of cranial sutures, led to a second diagnosis: hypophosphatasia. The patient's family history further confirmed this condition of a heritable defect of metabolism. Dental inspection revealed very carious teeth with characteristically enlarged pulp chambers in molars. Histological examination of an extracted tooth revealed an unusually wide zone of predentine with some other dentinal irregularities. No cement layer was found. The skeletal age and exfoliation of primary teeth, however, were normal, unlike most reported cases of hypophosphatasia. The patient's renal disease was treated mainly with corticosteroids. There is no treatment for hypophosphatasia.

Comparison between the Ovassapian intubating airway and the Berman intubating airway in fibreoptic intubation.

The most common indication for employing the fibreoptic technique for intubation is when a difficult intubation is anticipated. It may also be used when intubation unexpectedly proves difficult with a rigid laryngoscope in anaesthetized patients. However, failures with orotracheal fibreoptic intubation have been reported in up to 9.5% of cases, although only two possible equipment related causes of intubation difficulties have been identified. The Berman intubating airway and the Ovassapian intubation airway in fibreoptic orotracheal intubation have been compared in 65 patients. The study was randomized and for fibreoptic endoscopy each patient served as his or her own control. The results indicate that both airways can be used for orotracheal fibreoptic intubation in anaesthetized patients. The Berman airway offers easier visualization of the vocal cords than the Ovassapian airway, provided that the Berman airway is of an adequate size and positioned in the midline. Upon impingement of the intubation tube, completing the tracheal intubation is more difficult with the Berman airway than the Ovassapian airway.

Laryngoscopy and fibreoptic intubation in acromegalic patients.

Acromegaly is recognized as a cause of difficulty in airway management and tracheal intubation. We evaluated prospectively the conditions for laryngoscopy and fibreoptic intubation in 15 acromegalic patients. Each patient served as his or her own control. Ventilation of the lungs with a face mask was successful in all patients. In five of 15 patients the vocal cords could not be seen using the Macintosh laryngoscope with a size 5 blade. Difficult laryngoscopy was associated significantly with the number of attempts required to see the vocal cords with the fibrescope (P < 0.01, Spearman rank correlation). The larynx could not be seen with both techniques in one patient, and the trachea was intubated blindly with the help of an introducer. Our results showed that fibreoptic intubation may prove difficult or fail in acromegalic patients. Difficulties in seeing the vocal cords with a fibrescope were present most often in patients who also had probable intubation difficulties with a rigid laryngoscope.

Comparison between tracheal tubes for orotracheal fibreoptic intubation.

We have compared impingement of the tracheal tube against the larynx using a standard preformed tube, warmed preformed tube or two flexible spiral-wound tracheal tubes with different tip designs, in 100 adult patients undergoing orotracheal fibreoptic intubation under general anaesthesia, in a prospective, randomized study. The rates of impingement were 20 of 30 with the standard tube, 12 of 30 with the warmed standard tube (P = 0.07) and eight of 20 with both spiral tubes. However, impingement with the spiral tubes took longer to overcome if a sharp tipped rather than an obtuse tipped tube was used. Manipulations after impaction led to oesophageal intubation in one patient, and in one patient fibreoptic intubation failed. We conclude that resistance to the tracheal tube occurred frequently when the spiral-wound tubes were used.

Partial resistance of low density lipoprotein to oxidation in vivo after increased intake of berries.

BACKGROUND AND AIM: The health-promoting effects of fruit- and vegetable-based diets are known to be associated with their antioxidative components. We found in our preliminary in vitro laboratory tests that extracts of many common Finnish edible berries are potent scavengers of peroxyl radicals and inhibitors of lipid peroxidation. We therefore designed the current study to evaluate both the long-term (8 weeks) and short-term (5 hours) effects of increased intake of three berries on antioxidant potential and lipid peroxidation. METHODS AND RESULTS: Healthy 60-year-old men were randomized to berry, supplement and control groups (20 men in each group). The berry group ate, in addition to their normal diet, a 100 g portion of deep-frozen berries (bilberries, lingonberries, or black currants) daily for 8 weeks. The other groups ingested daily 100 mg of alpha-tocopherol and 500 mg of ascorbic acid (supplement group) or 500 mg of calcium gluconate (control group). In the short-term experiment 6 men ate 80 g of each of the three berries in one go. Serum ascorbate concentrations increased significantly in both the berry and the supplement group. Serum alpha-tocopherol levels and the antioxidant potential (TRAP) in low density lipoprotein (LDL) increased in the supplement group only. In the berry group, slightly lowered LDL diene conjugation (p = 0.074) and slightly increased total serum TRAP (p = 0.084) values were observed. No changes were found in these measures in the supplement or the control group. In the short-term experiment, LDL TRAP showed a small increase (about 10%, p = 0.039) during five hours after the intake of 240 g berries. CONCLUSIONS: The effects of consumption of berries on antioxidant potential and diene conjugation in LDL particles in vivo appear to be small.

Orotracheal fibreoptic intubation in children under general anaesthesia.

Orotracheal fibreoptic intubation under general anaesthesia in children was studied in eleven consecutive patients of three months to eight-years-of-age without anticipated intubation difficulties. One case report is also included. Three fibrescopes with a different diameter were used in the study. The fibrescope used was chosen so that it fitted snugly in the tracheal tube. The fibreoscopy was prolonged in one patient due to mucus and two tries were needed. Resistance to the tracheal tube upon intubation was encountered in five patients, only one of these patients was older than two years. Fibreoptic intubation succeeded in nine patients. Two patients were intubated with the Macintosh laryngoscope. The problems encountered in children during orotracheal fibreoptic intubation under general anaesthesia are the same as with adults: easy fibreoscopy is not always followed by easy tracheal intubation, there may be prolonged fibreoscopy and failed intubations. Manipulation of the tracheal tube can lead to successful tracheal intubation and resistance to the tube is more common in smaller children.