Prevalence of obesity and disturbances in glucose homeostasis in HIV-infected subjects and general population - missed diagnoses of diabetes?

OBJECTIVES: Comparative data on glucose disorders using fasting blood samples between people living with HIV (PLWH) and the general population are lacking. The objective of this study was to compare the prevalence and risk factors of obesity and disturbances in glucose homeostasis between PLWH treated with modern antiretroviral therapy and the general population. METHODS: Adjusted prevalence of obesity, features of insulin resistance (triglyceride:high-density lipoprotein cholesterol ratio and alanine aminotransferase), impaired fasting glucose (IFG), diabetes mellitus (DM) and combined dysglycaemia (presence of IFG or DM) were determined using fasting blood samples among 1041 PLWH and 7047 subjects representing the general population. RESULTS: People living with HIV had a lower prevalence of obesity [18.2%, 95% confidence interval (CI): 15.1-21.2 vs. 23.9%, 95% CI: 22.4-25.4], but a higher prevalence of insulin resistance and IFG (20.0%, 95% CI: 16.6-23.4 vs. 9.8%, 95% CI: 8.7-10.8) than the general population. Fasting glucose concentration was higher, but glycated haemoglobin (HbA1c) was lower, among PLWH. Prevalence of dysglycaemia for a given body mass index (BMI) was higher in PLWH than in the general population. The prevalence of DM did not differ between PLWH (13.2%, 95% CI: 10.2-15.9) and the general population (14.5%, 95% CI: 13.6-15.4). CONCLUSIONS: The prevalence of obesity was lower, but the risk of dysglycaemia for a given BMI was significantly higher, among PLWH, highlighting the importance of prevention and treatment of obesity among HIV-infected subjects. Regardless of the increased prevalence of insulin resistance and IFG, DM was surprisingly not more common among PLWH, raising concern about the under-diagnosis of DM, possibly due to low sensitivity of HbA1c in this patient population.

Risk factors for asthma after infant bronchiolitis.

BACKGROUND: Five studies carried out after bronchiolitis at less than 24 months of age, with a follow-up of more than 10 years, reported that atopic dermatitis, family asthma, early-life exposure to tobacco smoke and rhinovirus aetiology were early-life risk factors for later asthma. This study evaluated the long-term outcome at 11-13 years of age of children who were hospitalized for bronchiolitis in early infancy. METHODS: We previously prospectively followed 166 children hospitalized for bronchiolitis at less than 6 months of age until 5-7 years of age. The current study included a structured questionnaire, parental interviews, clinical examinations and bronchodilation test of 138 of those children at 11-13 years of age. RESULTS: Respiratory syncytial virus caused 66% of the bronchiolitis cases, and nearly half of the patients were exposed to tobacco smoke in early life. Doctor-diagnosed asthma was present in 13% of the former bronchiolitis patients at 11-13 years of age. Maternal asthma was the only independently significant risk factor in early life (adjusted OR 3.45, 95% CI 1.07-11.74), as was allergic rhinitis at 5-7 years of age (adjusted OR 4.06, 95% CI 1.35-12.25). CONCLUSIONS: After bronchiolitis at less than 6 months of age, the risk of doctor-diagnosed asthma at 11-13 years was about twice that of the general Finnish population. Maternal asthma was the only independently significant early-life risk factor for current asthma at 11-13 years of age.

The ethnic gap in mobility: a comparison of Russian, Somali and Kurdish origin migrants and the general Finnish population.

BACKGROUND: Many ethnic minority populations have poorer health than the general population. However, there is limited knowledge on the possible ethnic gap in physical mobility. We aim to examine the prevalence of mobility limitations in working-age Russian, Somali and Kurdish origin migrants in comparison to the general population in Finland. We also determine whether the association between ethnic group and mobility limitation remains after taking into account socio-economic and health-related factors. METHODS: We used data from the Finnish Migrant Health and Wellbeing Study (Maamu) and the Finnish Health 2011 Survey. The participants comprised 1880 persons aged 29-64 years. The age-adjusted prevalence of difficulties in various mobility tasks was calculated using predictive margins. Logistic regression analysis was used to examine the association between socio-economic, health- and migration-related factors and mobility limitation (self-reported difficulty in walking 500 m or stair climbing). The association between ethnic group and mobility limitation was calculated using logistic regression analysis. RESULTS: Mobility limitations were much more prevalent among Somali origin women (46 %) and Kurdish origin men (32 %) and women (57 %) compared to men and women in the general Finnish population (5-12 %). In Russian origin men and women, the prevalence of mobility limitation (7-17 %) was similar to the general Finnish population. Socio-economic and health-related factors, but not migration-related factors (time lived in Finland and language proficiency in Finnish or Swedish), were found to be associated with mobility limitation in the studied populations. Somali and Kurdish origin migrants were found to have increased odds for mobility limitation compared to the general Finnish population, even after adjusting for socio-economic and health-related factors (Somalis odds ratio [OR] 3.61; 95 % confidence interval [CI] 2.07-6.29, Kurds OR 7.40; 95 % CI 4.65-11.77). CONCLUSIONS: This study demonstrates a functional disadvantage in Somali and Kurdish origin populations compared to the general Finnish population, even after adjusting for socio-economic and health-related factors. The high prevalence of mobility limitation among Somali origin women and Kurdish origin men and women in Finland demonstrates an acute need to promote the health and functioning of these populations.

Preschool asthma after bronchiolitis in infancy.

Asthma risk is lower after wheezing associated with respiratory syncytial virus (RSV) than with non-RSV infection in infancy. RSV is the main wheezing-associated virus in infants aged <6 months. We evaluated the outcome of children hospitalised for bronchiolitis at <6 months of age, with special focus on viral aetiology and early risk factors. Out of 205 infants hospitalised for bronchiolitis at <6 months of age, 127 (62%) attended a control visit at a mean age of 6.5 yrs and the parents of an additional 39 children were interviewed by telephone. Thus, follow-up data collected by identical structured questionnaires were available from 166 (81%) children. Viral aetiology of bronchiolitis, studied on admission by antigen detection or PCR, was demonstrable in 97% of cases. Current asthma was present in 21 (12.7%) children: 8.2% in the 110 former RSV patients versus 24% in non-RSV patients (p=0.01). 45 (27%) children had ever had asthma. In adjusted analyses, atopic dermatitis, non-RSV bronchiolitis and maternal asthma were independently significant early-life risk factors for asthma. The risk of asthma was lower after RSV bronchiolitis than after bronchiolitis caused by other viruses in children hospitalised at <6 months of age.

Hormonal contraception and mental health: results of a population-based study.

BACKGROUND: The effects of oral contraceptives (OCs) on mental health are not clear, and no study has been focused on the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on mental health. The aim of this study was to analyse the association between the use of OCs and the LNG-IUS and psychological well-being and psychopathology. METHODS: The associations between the current use of OCs and the LNG-IUS, and their duration versus mood symptoms [Beck Depression Inventory (BDI)], psychological well-being [(General Health Questionnaire-12 (GHQ-12)] and recent psychiatric diagnoses [(Composite International Diagnostic Interview (CIDI)] were examined among women who participated in the Finnish-population-based Health 2000 study. Analyses were performed on the 30- to 54-year-old sample (n = 2310); some of the analyses were extended to include the younger age group (18- to 54-year-old sample; n = 3223). RESULTS: Overall, hormonal contraception was well tolerated with few significant effects on psychological well-being. The length of OC use was inversely associated with some BDI items ('dissatisfaction, irritability, lost interest in people, earlier waking and lost interest in sex'), and directly associated with 'worries about one's health' (BDI) and with a current diagnosis of 'alcohol dependence' (CIDI). The current use of the LNG-IUS was inversely associated with 'earlier waking' (BDI) and with 'impaired concentration' (GHQ), while the length of LNG-IUS use was inversely associated with 'strain' (GHQ). CONCLUSIONS: The influence of hormonal birth control on mental health is modest and mainly favourable. The length of current OC use seems to have some beneficial effects on mood although the longer the duration of use, the greater the association with a diagnosis of alcohol dependence. Knowledge of the use of hormonal contraception might be of value when assessing psychopathology in women. The cross-sectional design, with partly retrospective data collection, precludes any causal conclusions.

Effects of ultraviolet-B radiation and larval growth on toxicokinetics of waterborne bisphenol A in common frog (Rana temporaria) larvae.

In 1989, researchers discovered that amphibians, particularly frogs and toads from many parts of the world, appeared to be declining. In many ecosystems amphibians play a central role in ecosystem energy flow and nutrient cycling, and they act as keystone species. The recent increase in solar ultraviolet-B radiation (UVB, 280-320nm) has been thought to be one stressor responsible for the decline in amphibian populations. Along with other stressors, such as habitat destruction, anthropogenic influences and natural causes, UVB radiation could contribute to adverse effects among amphibians. Amphibians provide a good model for examining the effects of environmental stressors, because both lethal and sub-lethal responses are well documented in a range of studied xenobiotics in many species. In this experiment, the effects of UVB radiation on the accumulation and depuration kinetics of bisphenol A (BPA) were studied. Additionally, the accumulation was further modeled with correction for growth dilution. The results indicate that UVB radiation did not affect the toxicokinetics of BPA, and that the applied growth correction had only a negligible influence on the toxicokinetic estimations in this experiment. However, BCFs values calculated as k(u)/k(e) where closer to C(a)/C(w) calculated values when growth dilution was incorporated in the model. This method can be used in other experiments, where the growth dilution can affect toxicokinetic estimations.

Contribution of sociodemographic and lifestyle-related factors to the differences in metabolic syndrome among Russian, Somali and Kurdish migrants compared with Finns.

BACKGROUND: Metabolic syndrome (MetS) is associated with a substantially increased risk for cardiovascular disease and diabetes. We examined the contribution of length of residence, socioeconomic position and lifestyle-related factors to the differences in the prevalence of MetS among migrants compared with Finns. METHODS: Cross-sectional data from randomly sampled 30-64year-old health examination participants (318 Russian, 212 Somali, and 321 Kurdish origin migrants) of the Migrant Health and Wellbeing Survey (2010-2012) were used. Health 2011 Survey participants (n=786) were the reference group. RESULTS: Compared with Finns, prevalence of MetS was significantly higher among all migrants except for Somali men. Among men, age-adjusted prevalence ratio (PR) of MetS compared with Finns was 1.71, 95% confidence interval (CI) 1.19-2.46 for Russians, PR 0.95 (95% CI 0.54-1.67) for Somali, and PR 2.10 (95% CI 1.51-2.93) for Kurds. Among women, respective PRs were 1.45 (95% CI 1.08-1.97) for Russians, PR 2.34 (95% CI 1.75-3.14) for Somali and PR 2.22 (95% CI 1.67-2.97) for Kurds. Adjustment for sociodemographic and lifestyle-related factors attenuated the differences in MetS among women but not men. CONCLUSIONS: Further studies should aim at identifying factors related to elevated risk for MetS among Russian and Kurdish men. Interventions aiming at improving lifestyle-related factors are needed for reducing inequalities in the prevalence of MetS among migrant women. Effectiveness of interventions focusing on reducing overweight and obesity among Somali and Kurdish women should be evaluated.

Do young women have specific problems in contraceptive use and counselling?

OBJECTIVES: To find out if young women have specific problems with the use of contraception or contraceptive services. STUDY DESIGN: A national postal survey was conducted, RR 74%. Women aged 18-34 years (with experience of contraceptive use) were included in this report (n=1239). RESULTS: Weekly need for contraception was highest in the age group 18-24 years (61%), oral contraception being the most widely used method regardless of parity. Condoms were used by 35-37% in all age groups, either alone or combined with oral contraceptives (17% of young nulliparas). Women aged 18-24 years had mainly used public or subsidized services (79%). Of quality characteristics, only satisfaction with the kindness of the service provider varied significantly by age. The cost of contraception was highest in the youngest age group. CONCLUSIONS: The study did not point at any serious problems in family planning among young women, but it did produce several clues for the development of family planning services in general.

Quality of contraceptive services in Finland.

OBJECTIVE: To investigate whether the quality of contraceptive services in Finland varies by the type of care provider. DESIGN: A cross sectional questionnaire survey. PARTICIPANTS: A random sample of 3000 Finnish women aged 18-44 years (response rate 74%) in 1994. RESULTS: Almost all women (94%) had used contraception at some time and 75% were current users. Although self care was common (29% had obtained their latest method outside the health services), 83% had sometimes used the health services for contraception. For their last visit, 55% of women had chosen a health centre (a publicly administered and funded health service), and 33% a private unit. In the health centre, the care provider was usually a general practitioner or a public health nurse, whereas in private care the providers were gynaecologists. Women who used private care were more likely to be from higher social classes and urban areas. After adjustment for a women's background, the two groups were similar for most indicators of the quality of care, but access to care and woman's experiences of treatment were better with private care. CONCLUSIONS: In terms of availability and choices the current system of contraceptive services in Finland is adequate. It is not always an integral part of municipal primary health care, and many women prefer private care for gynaecological services; this may case problems of comprehensiveness and equality of care.

Health and life style among infertile men and women.

OBJECTIVE: Lifetime prevalence of infertility among couples is approximately 10-15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility. DESIGN: Cross-sectional survey. SETTING: Finland. POPULATION AND METHODS: Data from a population-based survey (n=7021) was utilized. Life style of infertile men (n=289) and women (n=155) were compared to other men and fertile women. MAIN OUTCOME MEASURES: Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms. RESULTS: After adjusting for age, area and education, infertile women under 50 years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03-1.46), less saturated fat (OR 0.83, 95% CI 0.74-0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00-1.05) than fertile women. Infertile men under 50 years consumed more total fat (OR 1.06, 95% CI 1.03-1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05-1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06-1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50 years were more often current smokers than fertile women, but the differences in other age-groups were not significant. CONCLUSIONS: Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

Community nursing in Finland: the division of fields of activity and patterns of care--comprehensive or specialized care?

The aim of this study was, first, to describe the changes taking place in the division of fields of activity in Finnish community nursing during a national project on primary health care; second, to describe and analyze patterns of care by categorizing different points of view in nurses' personal experiences. Data on the division of fields of activity in all project areas were collected in a survey and in annual registrations of public health nurses' tasks (n = 87-113). Care patterns were discerned in focused interviews with public health nurses (n = 18). Three types of division of fields of activity were identified: the comprehensive, semi-comprehensive and specialized model. The comprehensive and semi-comprehensive models became more common during the project and the specialized one less common. Patterns of care were classified into four main categories: structural, individualistic, family-centred and community-centred. The division of fields of activity was not always compatible with the care patterns. The study identified several issues that should be considered in the definition and implementation of comprehensive and specialized care.

[Young persons's personal experiences in student counseling and health care]. / Nuorten elämäntilanteiden tarkastelu oppilashuollossa.

The aim of the study was to clarify the present student counseling and school health care of young people who have experienced difficulties at school. The aim was to enlighten the multidimensionality of their personal experiences and to understand the fundamentals of student counseling and school health care from this perspective. The theoretical basis of the study was in Rogers' and Parse's theories of nursing. In these theories man is viewed as a unitary being in continuous mutual interrelationship with the environment. The research method was phenomenological and the research material consists of theme interviews. Nine young people, aged 15-16 years, who had experienced difficulties at school and the student counselors and the health care personnel at their school were interviewed. Many difficulties were entangled together in the young peoples lives. The professionals had different viewpoints on the personal experiences of the young people based on their different beliefs about man. It was not possible to differentiate exactly the tasks of the different professions. The study gives evidence of the importance of observating the personal experiences of the young people in their entirety in school nursing and in student counseling. From this basis health promotion could be possible.

Practice patterns of Finnish public health nurses.

The aim of this study was to: (i) describe the practice patterns of Finnish public health nurses during the development of primary health care based on the 'population responsibility' principle; and (ii) to identify the relation of public health nurses' task division models and types of community (rural/town) to their practice patterns. A detailed recording of public health nurses' home and clinic visits was developed and used during three annual study periods in 8-9 health centers by 93-118 public health nurses. The total number of recorded visits varied annually from 4842 to 6841. Statistical significance was determined by Chi-squared. Significant differences were found between the three study periods and also in the practice patterns of public health nurses (PHN) with different task division models and of PHN working in different types of community. However, the short study periods limited the practical importance of these findings.

A survey on the use of alternative drugs during pregnancy.

OBJECTIVE: To describe the use of alternative drugs during pregnancy. DESIGN: A trial including 3 surveys on drug use during pregnancy in maternity centers in one area of Finland in 1985-86 (study 1), and a retrospective survey in 2 maternity hospitals in Finland in 1988 (study 2). PATIENTS AND METHODS: Study 1: 2912 pregnant women (about 94% of pregnant women in the area during the study period); 97-88% returned questionnaires. Study 2: 180 out of 181 consecutive women giving birth. In study 1, drug use (including drug-like products) in the last two weeks was asked by questionnaires around 12th, 28th, and 36th gestation weeks. In study 2, women were interviewed 2-3 days after birth asking about any drugs used during pregnancy. Due to the method of asking, our studies underestimate the level of using alternative drugs. RESULTS: In study 1, a total of 97 (3.6%) pregnant women reported use of alternative drugs. Most drugs were dietary supplements, and by current knowledge harmless. But a few women had used (potentially) dangerous drugs. The users were from the higher social class and they had also used pharmaceutical specialties more often than non-users. In study 2, 14% had used alternative drugs at some time during pregnancy. CONCLUSION: Because our surveys showed that alternative drugs are used, possibly with increasing frequency, during pregnancy, further studies on safety are needed.

Population views on access to community nursing services in Finland.

The aim of this study was to evaluate potential access to personal community nursing services and the desirability of these services from the point of view of different population groups. Potential access to personal community nursing services was defined as having one or more particular nurses to contact when needing help and advice in health matters. The desirability of these services was defined as the respondents' estimation of how useful they considered it to be for them to have access to personal community nursing services. A computer-assisted telephone interview for the population living in the catchment areas of 10 health centres in Finland was conducted. A random sample of the total population aged 16-79 years was drawn from the population register. Logistic regression revealed that gender, type of community and employment status had best explanatory power in having potential access to personal nursing services and in considering these services desirable. However, many of those who considered personal nursing services very desirable, indicated that they did not have potential access to such services. Most of these persons were elderly and had a chronic disease or disability. Developing access to personal community nursing services particularly for these population. groups appears to be needed.

Finnish public health nurses' experiences of primary health care based on the population responsibility principle.

Implementation of a 'population responsibility' principle in Finnish health centres began in the late 1980s. The aim of this study was to describe public health nurses' (PHNs') experiences of primary health care based on this principle and to identify contextual and personal factors related to their experiences. The sample consisted of PHNs in 10 health centres. A questionnaire was developed based on a qualitative study. The survey was conducted in 1990 and repeated in 1992. The response rate was 84% for the 1990 sample (n = 102) and 91% for the 1992 sample (n = 131). In the multivariate analysis of variance type of community (urban/rural), size of the target population, task division model and existence of regular teamwork between social and health care personnel were chosen as contextual factors studied. Age, length of professional experience and having specialist education in midwifery were chosen as personal factors. Dependent variables were subscales on: experiences of planning and implementation, perceived influence of population responsibility on nurse-client relationships, comparison with previous experiences, views and experiences on comprehensiveness of care and job satisfaction. The majority of the PHNs experienced only minor changes in their work after the implementation of population responsibility. They were most critical about the way these changes were planned and implemented. Changes were mainly perceived as positive. There were some differences in the two samples, reflecting a shift from both positive and negative responses towards more neutral or more positive responses. Several contextual factors were multi-dimensionally related to the PHNs' experiences.

Iron supplementation during pregnancy--experiences of a randomized trial relying on health service personnel.

This article reports the design and feasibility of a randomized controlled trial of the benefits of routine iron prophylaxis during pregnancy. The multicenter trial, supported by a small budget, relied on health service personnel in Finnish maternity centers. Iron prophylaxis has had an established position in Finnish maternity care, and iron is freely available. This contributed to our decision to ask for informed consent after randomization. During a year, 2960 mothers were recruited by midwives in 27 maternity health centers and randomized into two groups: selective and routine iron supplementation. Mothers were followed until the postpartum checkup, and data were collected by five different questionnaires and abstracted from the infant's patient record. Adherence of the midwives to the study protocol was satisfactory, as was mothers' compliance with recommended treatments. However, because the study was designed to compare two treatment policies, problems of nonmasking hamper of the biologic effects of iron. This trial encourages the use of existing health services and their personnel in evaluation of medical technology.

Variation in obstetric interventions by midwife.

This paper reports variation in birth interventions by 25 midwives among 2,135 births in a Finnish hospital. The rate of cesarean sections varied from 0 to 18%, and that of instrumental deliveries from 0 to 8%. Mother's and infant's characteristics and rates of vaginal breeches suggest that a low rate of cesarean sections was not explained only by selection to easy births. This study suggests that the skills, attitudes and routines of midwives may explain part of the variation found in birth interventions.