Initial treatment strategy and clinical outcomes in Finnish MS patients: a propensity-matched study.

BACKGROUND: The optimal treatment strategy with disease-modifying therapies (DMTs) in relapsing-remitting multiple sclerosis (RRMS) remains uncertain. OBJECTIVE: To compare outcomes of initial treatment with infusion therapies and starting therapy with medium efficacy therapy in a propensity-matched cohort of Finnish RRMS patients. METHODS: A total of 154 RRMS patients initiating natalizumab, alemtuzumab, ocrelizumab or rituximab as first DMT (high efficacy DMT, heDMT group) and 1771 patients initially treated with injectable therapies, teriflunomide or dimethylfumarate and escalated based on disease activity (moderate efficacy DMT, meDMT group) were identified from the Finnish MS registry. Nearest neighbor propensity matching (1:1, caliper 0.1) was performed for age, sex, baseline Expanded Disability Status Scale (EDSS), annual relapse rate (ARR) one year prior DMT and time since MS symptom onset. Primary outcome was time to 6-month confirmed EDSS progression and the secondary outcome time to first relapse. RESULTS: In the propensity-matched group comparisons, the probability of 6-month confirmed disability progression (CDP) at 5 years after DMT start was 28.4% (95% CI 15.7-39.3) in the heDMT group (n = 66) and 47.0% (95% CI 33.1-58.1) in meDMT group (n = 66), p = 0.013. Probability of relapse at 5 years was 34.6% (95% CI 24.1-43.6) for heDMT (n = 105) and 47.2% (95% CI 36.6-56.1) for meDMT (n = 105), p = 0.019. CONCLUSIONS: Initiating MS-therapy with heDMT significantly reduced the risk of 5-year disability progression and relapse compared to using meDMT as first DMT choice in propensity-matched groups of Finnish MS-patients.

Common comorbidities and survival in MS: Risk for stroke, type 1 diabetes and infections.

BACKGROUND: Survival in MS has increased during the era of disease modifying therapies, but life expectancy in MS patients is still reduced by several years. Increased risk for common comorbidities related to brain health, such as risk for circulatory diseases have been reported in MS and could affect survival. In this paper, we studied age- and gender adjusted risks for circulatory diseases and related disorders, and their impact on overall MS survival in population of Southwest Finland. MATERIALS AND METHODS: The ICD-10 codes for hospital visits were searched from the administrative data pool from 1.1.2004 up to 31.12.2012 for the resident MS and control cases at the Hospital District of Southwest Finland. The MS population under study consisted of prevalent cases in 1.1.2004 and new cases from 1.1.2004 followed up to death or 31.12.2012. Patient documents were scrutinized to confirm the MS diagnosis (G 35) by the McDonald´s criteria and to confirm the diagnoses and causes of death for the cerebro- and cardiovascular diagnoses under study. The randomly chosen 10-fold control population was matched by birth year and gender to calculate the coincident risks (odds ratio, OR) with 95% confidence intervals (95% CI) and another separate control population from the same patient pool was used to verify the stability of the results. P-values were calculated using Pearson's χ2 test. The Kaplan- Meier analysis log rank test was applied to study survival. RESULTS: During the follow-up 1074 confirmed MS cases were treated in the hospital district, including the deceased cases after 1.1.2004 (5.9%). The probability of survival was 82.4 years among MS and 85.6 years among the control cases, log rank p < 0.001. The survival disadvantage within MS was associated with comorbidity for circulatory disease codes in ICD -10: I06-I71, log rank p < 0.001. The specific risk for ischemic and haemorrhagic stroke was significant with high OR of 1.49 (95% CI 1.03- 2.35) and 2.5 (1.24-5.06) respectively. The two-fold risk for type 1 diabetes in MS was significant, OR 2.1 (1.3-3.36). The main causes of death among the MS cases were infections and the coincident high risk for several infections was significant. There was no difference in the risk for acute myocardial infarct, transient ischemic attack, atrial fibrillation, hypertension, or obesity in comparison with the control cases. CONCLUSIONS: Given the high risk for stroke in this MS population and the observed complexity among the coincident common risk factors for circulatory diseases, the high risk for type 1 diabetes and common infections raise a need to recognize patients at risk with these conditions and with the other known risk factors such as metabolic syndrome and smoking. The survival disadvantage related to circulatory diseases observed in general population is true also in MS and should be recognized to reduce the burden of disease and premature mortality in MS.

Risk of osteoporotic fractures in multiple sclerosis patients in southwest Finland.

OBJECTIVES: Increased risk of osteoporotic fractures in multiple sclerosis (MS) patients compared with general population has been reported. The purpose of this study was to assess the risk of osteoporotic and other low-energy fractures in an MS cohort from a large hospital district in southwest Finland. Age-adjusted total and gender-specific prevalence for definite MS per 100 000 in a population of 472 139 was calculated as a point prevalence in December 31, 2012. MATERIALS AND METHODS: Patients with MS and comorbid fractures were identified by searching for ICD-9 and ICD-10 codes during a period from 2004 to 2012 from hospital administrative data in Turku University Hospital (TYKS) in southwest Finland Case ascertainment was performed by review of medical records. Osteoporotic fracture was defined as a low-energy fracture of the pelvis, hip, femur, tibia, humerus, collar bone, ulna/radius, vertebrae, or rib. The control population was a 10-fold age- and gender-matched population. RESULTS: The point prevalence (N 1004) of MS was 212.6/105 (CI 199.5-225.8) in December 31, 2012. A total of 100 (9.9%) of 1004 confirmed MS cases experienced at least one fracture during the study period. Relative risks (RRs) for all fractures (1.33, 95% CI 1.10-1.60) and osteoporotic fractures (1.50, 95% CI 1.18-1.90) were significantly increased in patients with MS compared with controls. In particular, RRs for hip fractures (5.00, 95% CI 2.96-8.43) and fractures of humerus (2.36, 95% CI 1.32-4.42) were elevated in patients with MS vs controls. CONCLUSIONS: We observed high prevalence of MS in southwest Finland and confirmed increased age-adjusted comorbid risk for osteoporotic fractures and other low-energy fractures compared with individually matched controls.

Effect of commercial mineral-based additives on composting and compost quality.

The effectiveness of two commercial additives meant to improve the composting process was studied in a laboratory-scale experiment. Improver A (sulphates and oxides of iron, magnesium, manganese, and zinc mixed with clay) and B (mixture of calcium hydroxide, peroxide, and oxide) were added to source-separated biowaste:peat mixture (1:1, v/v) in proportions recommended by the producers. The composting process (T, emissions of CO(2), NH(3), and CH(4)) and the quality of the compost (pH, conductivity, C/N ratio, water-soluble NH(4)-N and NO(3)-N, water- and NaOH-soluble low-weight carboxylic acids, nutrients, heavy metals and phytotoxicity to Lepidium sarivum) were monitored during one year. Compared with the control, the addition of improver B increased pH by two units, led to an earlier elimination of water-soluble ammonia, an increase in nitrates, a 10-fold increase in concentrations of acetic acid, and shortened phytotoxicity period by half; as negative aspect it led to volatilization of ammonia. The addition of improver A led to a longer thermophilic stage by one week and lower concentrations of low-weight carboxylic acids (both water- and NaOH-extractable) with formic and acetic of similar amounts, however, most of the aspects claimed by the improver's producer were not confirmed in this trial.

RGS4 genotype is not associated with antipsychotic medication response in schizophrenia.

The aims of the present study were to compare the allele frequencies of a common single nucleotide polymorphism located upstream of the regulator of G-protein signaling 4 (RGS4) gene (T > G, Rs 951436) in 219 Finnish patients with schizophrenia and in 389 control subjects, to analyze corresponding frequencies between two different subtypes of 93 schizophrenia patients according to their medication response, and to study the effect of this SNP on age at onset in schizophrenia. The RGS4 (T > G, Rs 951436) genotype was not associated with incidence or age at onset in schizophrenia. Neither was the RGS4 genotype associated with medication response with two different subpopulations with schizophrenia.

Concentrations of monosaccharides in humic substances in the early stages of humification.

Deteriorated liquid packaging board (LPB) and biowaste compost are matrices, mainly consisting of cellulose, in the early stages of humification. Degradative studies on these matrices allow an examination of the role of carbohydrates in the synthesis of humic substances. Samples of different age were collected and divided by extraction into hot water extract (HWE), bitumen, humic acid (HA), fulvic acid (FA) and humin or residual fibre fractions. The following monosaccharides were identified in these fractions: L-arabinose, D-ribose, D-xylose, L-fucose, D-mannose, D-fructose, D-galactose, D-glucose, L-rhamnose and xylitol. The main component in all fractions was glucose. The concentrations of monosaccharides in humic acids (HAs) of LPB ranged from 67 to 503 mg/g of organic matter, and the concentrations in HAs of compost from 52 to 101 mg/g. As a general trend, the concentrations of monosaccharides decreased during LPB degradation and composting in all fractions. At the same time the relative amounts of D-xylose, D-mannose and D-galactose increased in HAs of compost samples.

Process analysis of fluidized bed granulation.

This study assesses the fluidized bed granulation process for the optimization of a model formulation using in-line near-infrared (NIR) spectroscopy for moisture determination. The granulation process was analyzed using an automated granulator and optimization of the verapamil hydrochloride formulation was performed using a mixture design. The NIR setup with a fixed wavelength detector was applied for moisture measurement. Information from other process measurements, temperature difference between process inlet air and granules (T(diff)), and water content of process air (AH), was also analyzed. The application of in-line NIR provided information related to the amount of water throughout the whole granulation process. This information combined with trend charts of T(diff) and AH enabled the analysis of the different process phases. By this means, we can obtain in-line documentation from all the steps of the processing. The choice of the excipient affected the nature of the solid-water interactions; this resulted in varying process times. NIR moisture measurement combined with temperature and humidity measurements provides a tool for the control of water during fluid bed granulation.

Cardiac decompensation during an ischemic event weakens the predictive power of myocardial injury markers.

Our objection was to find determinants of long-term outcome in routine data collected for differential diagnosis of suspected acute myocardial infarction. Study population consisted of 263 discharged patients who were initially hospitalized for differential diagnosis of suspected acute myocardial infarction between October 1992 and January 1993. Follow-up time for all cause and cardiac mortality was 5 years. The variables studied as predictors of outcome were computerized ECG, peak creatine kinase isoenzyme MB, peak troponin I, radiographic evidence of pulmonary congestion (cardiac decompensation), treatment for hyperlipidemia, hypertension or diabetes, smoking, previous myocardial infarction, age and gender. Total mortality was 32% at 5 years, of which 77% (64/83) was of cardiac origin. Pulmonary congestion in chest X-ray was the most powerful predictor of outcome (RR=3.3, 95% CI=2.0-5.2, P<0.001). In multivariate analysis congestion (RR=3.3, CI=2.0-5.2) was the only independent predictor of 5-year total mortality in addition to age (RR=1.06, CI=1.04-1.08). These two variables together with previous myocardial infarction (RR=1.9, CI=1.2-3.1) and hyperlipidemia (RR=2. 0, CI=1.1-3.5) were independent predictors of cardiac mortality. Radiographic evidence of cardiac decompensation during hospitalization is a strong and independent predictor of long-term outcome in unselected patients with suspected AMI. The predictive power of cardiac markers is confined to patients without pulmonary congestion.

Is routine echocardiography useful in patients hospitalized for chest pain? Evidence of areal myocardial dysfunction detected only by echocardiography.

To assess the diagnostic value of routine two-dimensional echocardiography in the coronary care unit setting, we studied 81 unselected patients admitted for acute chest pain. Using electrocardiography (ECG), clinical history and serum markers of myocardial injury, the patients were retrospectively diagnosed as having had definite acute myocardial infarction (AMI) with (n=13) or without (n=31) previous infarction, possible AMI with (n=14) or without (n=15) previous infarction, and non-coronary cardiac or other causes of chest pain (n=8). Abnormal wall motion was observed in 75/77 patients with a cardiac origin of symptoms (sensitivity 97%), and there were no false-positive wall motion findings. In the 73 patients who were finally diagnosed with coronary artery disease (CAD), echocardiography showed wall motion abnormality in at least one additional coronary territory area in which there were no diagnostic ECG changes for 56% of patients with CAD (41/73) (P<0. 001). These areas were considered to be indicative of the presence of myocardium at risk for future cardiac events. We conclude that in addition to being a sensitive and accurate tool for detection of ischaemic wall motion abnormalities, two-dimensional echocardiography can give valuable information about the area of myocardium at risk. Therefore, therapeutic decisions can be affected by the findings of the routine echocardiographic examination, which is recommended even in unselected coronary care unit patients.

Computer-assisted electrocardiography in structured diagnosis of acute myocardial infarction.

The purpose of this study was to investigate the applicability of computerized electrocardiogram interpretation in classifying patients with suspected acute myocardial infarction. Computerized acquisition and analysis of the 12-lead electrocardiogram can increase the consistency and reduce the workload of patient classification. The serial electrocardiograms of 311 consecutive patients with suspected myocardial infarction were studied and a new computerized myocardial infarction (CMI) electrocardiographic classification was developed and compared with one commercially available and two manual codes. Statistically, there was almost no correlation between the four ECG codes. Compared with the WHO enzymatic criteria, the sensitivity of the CMI code toward detecting definite and possible infarction was 69.2% and 29.8% with a specificity of 62.1% and 79.7%, respectively. In subjects without previous infarction (n = 214) the sensitivity of the CMI code for definite enzymatic infarction was 71.9% and specificity 77.6%. Substituting the CMI for the Minnesota code had no effect on patient classification by the WHO MONICA criteria in 78% of patients with first infarction. Judged by cardiac macromolecular leakage, all electrocardiographic classifications of possible infarction were poorly correlated with myocardial tissue injury. We have developed a new computerized coding system to detect electrocardiographic myocardial infarction. The structure of the code allows interactive redefinition of criteria to meet user-defined needs. However, because of the weak relationship between electrocardiographic and biochemical criteria of myocardial injury, the role of ECG in the diagnostic classification of acute ischemic syndromes should be re-evaluated.

Polymorphisms of the interleukin-1 gene complex in schizophrenia.

Activation of the inflammatory response system has been related to the pathophysiology of schizophrenia by several recent studies. Schizophrenic patients have varied levels of proinflammatory cytokines, such as interleukin (IL)-1, -6, and tumor necrosis factor (TNF)alpha in their peripheral blood or cerebrospinal fluid. These cytokines can modify the metabolism of neurotransmitters, influence neural development, and IL-1 has been implicated in acute, and, on the other hand, chronic neurodegeneration. They could therefore be of primary pathogenic importance, either in the acute disease or during those stages of brain development which possibly influence the sensitivity of a person to schizophrenia in later life. The cytokine regulation of brain development and its possible neuroimmune involvement in the pathogenesis of schizophrenia has been raised. One indication of the pathogenic role of IL-1 in schizophrenia would be a demonstration of the difference between schizophrenic patients and healthy controls at the gene level. Therefore we analyzed the polymorphism of the IL-1 gene complex in 50 schizophrenic patients and in 400 healthy blood donors. The following allelisms were analyzed: IL-1beta gene: base exchange polymorphisms at the positions -511 (relative to the transcriptional start site); IL-1alpha gene: base exchange polymorphism at the position -889; IL-1 receptor antagonist (IL-1RA) gene: variable numbers of 86-base pair tandem repeats in intron 2. The frequencies of the IL-1beta (-511) allele 1, IL-1alpha (-889) allele 2, and IL-1RA allele 1 were somewhat, but not significantly, higher in the schizophrenic patients as compared to the controls. These alleles are known to be located on the same haplotype. The number of carriers of this haplotype was significantly higher in the schizophrenia patients (17/50 vs 81/400) than in the controls (P=0.026, chi2). The frequencies of this haplotype were 0.38 and 0.27, respectively (P=0.0266, chi2). The number of homozygotes of this haplotype was significantly higher in the schizophrenia patients (P=0.0006, chi2). These data suggest that the cytokine aberrations in schizophrenia are, at least partly, genetically determined.

Biodeterioration of cardboard-based liquid containers collected for fibre reuse.

Liquid packaging board (LPB) collected in Germany is processed in Finland as recycled fibre and as plastic reject for incineration. The chemical, biological and physical changes occurring in recycled LPB bales were monitored during storage of six and 18 months. The moisture content in the core of the bales ranged from 7% to 53%, and pH values varied from 6.0 to 8.5. The average amount of mesophilic bacteria per container was 1.5 x 10(7) - 5 x 10(8), which means that recycled LPB pulp cannot be recommended for sanitary use. The concentration of CO2 inside the bale is an indicator of the activity of aerobic microorganisms and might be suitable for identifying deteriorated bales and removing them from the production line. Insects were found in some bales and the more deteriorated the bale was the more species of insects were found. The results showed the conversion of cellulose into humic acids to be clearly underway in some recycled LPB bales. The bale samples were extracted into hot water and into fulvic acids and humic acid (HA) fractions. The concentration of the humic acid fraction varied in the range 0.3-0.6% of the organic matter in fresh bales and 2.2% in one old bale. During aging nitrogen was enriched in all fractions.

Pyrolysis of humic acids from digested and composted sewage sludge

Humic acids (HAs) were extracted from four digested sewage sludge samples composted for four months, one, two and four years. HAs were pyrolyzed at three different temperatures applying both conventional and in situ methylation (ISM) pyrolysis. The pyrolysates were analyzed using gas chromatography-mass spectrometry (GC/MS). Derivatization (ISM) and pyrolysis temperature had dramatic effects on the composition and relative amounts of the pyrolysates. Among the derivatized HA fragments aliphatic compounds prevailed under all the pyrolysis conditions tested. Aromatic substances consisting mainly of guaiacyl-type compounds were detected in higher abundances only at elevated temperatures. Without ISM the contribution of aromatic structures to the total pyrogram was considerably greater than that of the aliphatics. Increase of the pyrolysis temperature from 450 degrees C to 600 degrees C had smaller effect on the proportions and composition of the compounds studied than increase from 350 degrees C to 450 degrees C.

Socioeconomic variation in back and joint pain in Finland.

UNLABELLED: Differences in the prevalence of back and joint pain by occupational class and education were studied in surveys representative of adult Finns. The effects of lifestyle factors and mental distress on these differences were also analysed. The material comprised 3915 women and 3629 men, all occupationally active. Occupational class and level of education were associated with back and joint pain; the associations were more obvious in men than in women. Among men, the age-adjusted odds ratio of joint pain in farmers was 3.2 (95% CI: 2.1-5.0), in manual workers 2.6 (1.9-3.6), in entrepreneurs 2.4 (1.5-3.7) and in lower white-collar workers 1.7 (1.1-2.4) as compared with upper white-collar employees. Similar odds ratios of back pain were 2.1 (1.6-2.9) in farmers, 1.8 (1.5-2.3) in manual workers, 1.7 (1.2-2.4) in entrepreneurs and 1.4 (1.1-1.7) in lower white-collar workers. Most of the associations persisted in multivariate analyses, in which height, marital status, lifestyle (smoking, leisure-time physical activity and body mass index (BMI)) and mental distress were considered; in these models, mental distress was consistently associated with pain. Back pain was associated with smoking in men and with BMI in women; BMI was also associated with joint pain in both sexes. In women, height showed an association with back pain for which a doctor had been consulted. Marital status, alcohol consumption, leisure-time physical activity and the urbanization level of the community were not important as determinants of pain. CONCLUSION: Obvious differences occurred in back and joint pain by indicators of social class that were not due to socioeconomic differences in lifestyle, height or mental distress.

Characterization of the humic material formed by composting of domestic and industrial biowastes. Part 1. HPLC of the cupric oxide oxidation products from humic acids.

The changes induced by humification of anaerobically digested sewage sludge, source separated biowaste, and pulp mill biosludge were determined by extracting the fractions of bitumen and humic and fulvic acids from the samples of fresh and humified composts. In all cases, a distinct decrease in the amount of bitumen could be detected during humification. The amount of humic acids increased in sewage sludge and biowaste samples, but decreased in pulp mill biosludge sample during humification. The humic acids were degraded by CuO oxidation and the phenolic degradation products were analysed by reversed-phase high-performance liquid chromatography. The yield of these aromatic degradation products was in the range 0.9-2.0% for each sample. The main phenolic degradation products were 4-hydroxybenzoic acid, vanillic acid, 4-hydroxybenzaldehyde, vanillin, syringaldehyde, and acetovanillone. Two lignin dimers, dehydrodivanillin and dehydrodiacetovanillone, were also identified.

Generation of reference values for cardiac enzymes from hospital admission laboratory data.

An approach is described for using patient databases of a hospital information system as a source of reference values for cardiac enzymes. Of a total of 2029 emergency admission patients with serial cardiac enzyme data, 538 patients were considered "healthy" (having no damage in myocardium) because their discharge diagnoses suggested neither myocardial damage nor any other condition that could lead to elevated enzyme activities, and because their serially collected cardiac enzyme activities remained stable. Enzyme activities of creatine kinase (EC 2.7.3.2), creatine kinase isoenzyme MB, lactate dehydrogenase (EC 1.1.1.28), and lactate dehydrogenase isoenzyme 1 of these patients at admission to hospital were considered as suitable health related reference values. The upper (97.5%) reference limits of activities, measured at 37 degrees C according to Scandinavian recommendations, were as follows (age dependent limits given at 25 and at 75 years of age, U/l): creatine kinase men 268, 192; creatine kinase women 200 (no age effect); creatine kinase-MB 16, 24; lactate dehydrogenase 497, 603; lactate dehydrogenase isoenzyme 1 103, 140. For comparison, reference values were also produced conventionally from a group of 246 healthy subjects. Observed effects of age on enzyme activities were quite similar to those in the selected patient group. Calculated reference limits for isoenzymes creatine kinase-MB and lactate dehydrogenase isoenzyme 1 were also similar but reference limits for less cardiospecific total enzyme activities, creatine kinase and lactate dehydrogenase, were more variable between these two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Knee disorders in carpet and floor layers and painters. Part II: Knee symptoms and patellofemoral indices.

One hundred and sixty-eight carpet and floor layers and 146 painters were examined with the aid of a questionnaire, clinical tests of the patellofemoral joint, a knee exertion test and measurements of patellofemoral indices. Carpet and floor layers reported previous knee conditions more frequently than painters. Patellofemoral tenderness was not related to occupation, patellofemoral indices or perceived knee conditions. On the contrary, pain in the knee exertion test of 50 squats was related to perceived knee injuries and pain on compression of the patella. Exertion test seems to be more accurate than traditional clinical tests in the screening of knee lesions.

Seven-year follow-up of white-finger symptoms and radiographic wrist findings in lumberjacks and referents.

OBJECTIVES: In 1978, a cross-sectional study of 279 lumberjacks exposed to hand-arm vibration and 178 unexposed referents was conducted. The aim of the present study was to provide a seven-year follow-up on (i) the changes in the white-finger symptoms among the lumberjacks and the referents, (ii) the effect of white-finger symptoms on the professional prognosis of the lumberjacks, and (iii) the relationship between hand-arm vibration and changes in wrist bones. METHODS: The methods consisted of a questionnaire, a routine clinical examination, and radiographs of the wrists and hands. The examinations were conducted as a field study using a mobile unit. RESULTS: The prevalence of white-finger symptoms was 18% among the lumberjacks and 3% among the referents in the original study. Seven years later 213 lumberjacks and 140 referents participated in the follow-up. The prevalence of white-finger symptoms was 24.9 among the lumberjacks and 5.7 among the referents, and the seven-year cumulative incidence was 14.7% among the lumberjacks and 2.3% among the referents. After allowance for age, there was no difference in the incidence of white-finger symptoms between the lumberjacks with fewer than 15 years of exposure and the referents, but the risk increased with increasing duration of exposure (risk ratio 8.9, 95% confidence interval 2.5-28.9 for those exposed at least 25 years). There was no difference between the two groups in the prevalence of radiographically detectable translucencies or osteoarthrotic changes in the wrists and hands. CONCLUSION: According to the results, white-finger symptoms are still a problem among lumberjacks who started chain-saw work before 1970.

Knee laxity in carpet and floor layers and painters.

The knees of 154 carpet and floor layers and 131 painters were examined clinically and the anteroposterior displacement of the knees was measured with a computer-based arthrometer. The drawer test, the pivot shift and the thigh muscle stretching tests showed greater mobility among carpet and floor layers than among painters. The arthrometric examination showed equal anteroposterior tibiofemoral displacements in the two groups. Two percent of the subjects had a right knee/left knee difference indicating a cruciate ligament insufficiency. Tightness in the rectus femoris stretching test, and among carpet and floor layers also radiographic tibiofemoral osteophytosis predicted small arthrometric changes.

Effects of work-oriented fitness courses in lumberjacks with low back pain.

This prospective controlled study examined changes in fitness, health, and work ability after a work-oriented physical fitness course arranged for lumberjacks experiencing low back pain but being still at work. The 1-week courses were designed to activate exercising during leisure time and consisted of fitness tests, various types of exercise, and lectures. Eighty-seven lumberjacks participated in the courses and 61 subjects served as controls. Questionnaire data obtained before and 1 year after the course were available for 78 (90%) of the course participants and 41 (67%) of the controls. In the intervention group, perceived fitness, health, and work ability improved and ergonomic strain at work decreased. Both groups reported an increased frequency of leisure-time physical activity. There were between- group differences in the development of fitness, health, distress symptoms, and subjective work ability, whereas the changes in physical activity, back and musculoskeletal symptoms, or ergonomic strain did not differ between the groups. In a 6-month follow up, muscle function improved in the intervention group, but no change was observed in aerobic capacity. There was a tendency of the number of back pain-related sickness leaves, but not of their duration, to develop more favorably in the intervention group, when data from the year before and the year after the course were compared.