Determination and Evaluation of Sense of Coherence in Women in Semi-urban Nepal: A part of the Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) Trial.

Background Sense of coherence (SOC) is a core concept of salutogenesis which relates to individuals' overall life orientation. Stronger SOC associates with better coping strategies, better health, and better quality of life. Although the SOC-questionnaire is validated in many cultures and languages, it has not, to date, been applied in Nepal. Objective To determine and evaluate women's SOC before and after a health education intervention. Method This study was conducted as a part of the Heart-health Associated Research, Dissemination, and Intervention in the Community in the semi-urban JhaukhelDuwakot Health Demographic Surveillance Site in Nepal. Jhaukhel and Duwakot were selected as the control and intervention areas, respectively. Participants were women with children aged 1-7 years. Eight hundred and fifty-seven women before and 1,268 women after the health education intervention participated in the study. The statistical analysis was carried out with chi-square tests and one-way uni-variate ANOVA. Result Women's total SOC mean values at baseline were 51.1-57.4 and at follow up 54.4-54.9 in the intervention and control area, respectively. At baseline, SOC was significantly weaker in the intervention area compared to the control area (p < 0.001). At followup three months later, SOC was significantly stronger in the intervention area than in the control area (p < 0.001). Conclusion Nepalese women had weaker SOC than women in high-income countries, but comparable to neighboring country India with similar cultural features. Empowerment of women through community participation and health education strengthened SOC. The SOC-13-questionnaire in its Nepali version is recommended to be further evaluated.

Healthy learning mind - Effectiveness of a mindfulness program on mental health compared to a relaxation program and teaching as usual in schools: A cluster-randomised controlled trial.

BACKGROUND: Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial. METHODS: Finnish school children and adolescents (N = 3519), aged 12-15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26). RESULTS: Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (ß=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (ß=-0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (ß=-1.37, SE 0.69, p = 0.049) and at T26 (ß=-1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation. LIMITATIONS: The inactive control group was smaller than the intervention and active control groups, reducing statistical power. CONCLUSIONS: A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.

Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data.

BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). CONCLUSIONS: Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

Determinants of a regular intake of a nutritionally balanced school lunch among 10-17-year-old schoolchildren with special reference to sense of coherence.

BACKGROUND: Free nutritionally balanced school lunches are offered to all schoolchildren in basic education in Finland in each school day. Having school lunch on a regular basis has been found to reflect overall eating patterns. However, skipping part of or even the entire lunch is common. The present study investigated the determinants of the regular consumption of a nutritionally balanced school lunch among schoolchildren, with special reference to the role of sense of coherence (SOC). METHODS: In total, 887 children (457 girls and 424 boys), aged 10-17 years from three municipalities in Eastern Finland, filled in a web-based questionnaire in class during a school day and reported eating patterns, body height and weight and perception of body image. SOC was measured by using the 13-item scale. The statistical analysis was carried out with logistic regression modelling and the chi-squared test. RESULTS: In addition to female gender, frequent shared family meals, perception of body image as appropriate and younger age, SOC was a significant determinant of regularly eating a nutritionally balanced school lunch in the final multivariate modelling. Strong SOC was also associated with more regular meal frequency and health-promoting snack choices. CONCLUSIONS: To promote healthy eating patterns among school-aged children, special attention should be paid to children with weak SOC because they may need specific support and encouragement. They might lack sufficient belief in their own capability and/or do not have adequate support from their family to influence their eating and other lifestyle patterns.

Job strain and the risk of severe asthma exacerbations: a meta-analysis of individual-participant data from 100 000 European men and women.

BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. RESULTS: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). CONCLUSIONS: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.

Barcelona consensus on supermicrosurgery.

The popularity of supermicrosurgery has increased dramatically over the past few years, but the lack of agreement regarding the name of the technique and its applications has caused misunderstandings among microsurgeons when trying to communicate and compare surgical procedures. We report the consensus reached on the name used to refer to supermicrosurgery techniques following the First European Conference on Supramicrosurgery held in Barcelona (Spain) on March 4-5, 2010. Present applications, advantages, and disadvantages of supermicrosurgery are discussed. It was agreed that supermicrosurgery was the most accurate name to reflect the essence of this extremely delicate technique. According to Koshima, supermicrosurgery is a technique of microneurovascular anastomosis for vessels of 0.3 to 0.8 mm and single nerve fascicles. The range of applications for this technique has increased rapidly and now includes lymphedema treatment, nerve reconstruction, replantation and reconstruction of amputated fingertips, microsurgical flap salvage, and new possibilities for free tissue transfer. Supermicrosurgery is a remarkably useful reconstructive tool that involves a great deal of skill and has a steep learning curve for the microsurgeon to master. Although it is currently performed by only a minority of microsurgeons, we consider it will be incorporated into conventional microsurgery in the near future.

The frequency and outcome of breast cancer risk-reducing surgery in Finnish BRCA1 and BRCA2 mutation carriers.

BACKGROUND AND AIMS: Risk-reducing mastectomy of BRCA1 and BRCA2 gene mutation carriers is known to significantly reduce lifetime risk of breast cancer. Our aim was to study the frequency and outcome of risk-reducing mastectomies performed in Helsinki University Central Hospital during 1997-2010. MATERIAL AND METHODS: In testing for mutations in BRCA1 and BRCA2, 136 female carriers had been identified and followed up in Helsinki University Central Hospital. RESULTS: A total of 69 breasts in 52 women were operated on for risk-reduction, including 28 (54%) bilateral mastectomies at mean age of 43 years. Autologous tissue was used for reconstruction in 40 (50%) and implants in 31 (39%) of the breasts, respectively. In all, 8 patients (15%) chose to have no reconstruction. Minor or major complications were recorded in 21 (40%) patients. Five reconstructions failed and were corrected with re-reconstruction. CONCLUSIONS: In this series of Finnish BRCA1 and BRCA2 mutation carriers, a high percentage 52 (41%) chose risk-reducing breast surgery. Autologous tissue was favored in breast reconstructions. Immediate breast reconstructions were associated with a relatively high risk of complications in free flaps and in implant reconstructions, but not in latissimus dorsi reconstructions. It is mandatory that patients are informed about the risks associated with risk-reducing operations.

Pelvic, perineal and genital reconstructions.

Perineogenital and pelvic surgery is challenging due to the complex anatomy and physiology, multi-organ involvement and microbial environment of this region. In reconstructive surgery local and pedicled flaps are usually applicable. Microvascular flaps are rarely needed. Positioning of the scars, tension in the wound edges and pressure conditions must be taken into account, because failed correction may create more functional and aesthetic problems as the defect itself. This brief review focuses on the reconstructive methods of perineum, genitals and pelvic floor, site by site, with special emphasis on functional details.

Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies.

BACKGROUND: Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. OBJECTIVES: To examine the association between job strain and body mass index (BMI) in a large adult population. METHODS: We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). RESULTS: A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. CONCLUSIONS: In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.

Sickness absence among Finnish special and general education teachers.

BACKGROUND: Although teaching is considered a high-stress profession, research on stress-related outcomes among teachers, such as absence from work due to illness (i.e. sickness absence), remains scarce. It is possible that teachers are not a homogeneous group but include subgroups with particularly high risk of sickness absence, such as special education teachers. AIMS: To examine differences in sickness absence rates between special and general education teachers in a large cohort of 2291 Finnish lower secondary school teachers. METHODS: Register data on teachers' job titles, sociodemographic characteristics and sickness absence were obtained from 10 municipal employers' registers. Indices of sickness absence included rates of short-term (1-3 days) and long-term (>3 days) absence spells during 2003-05. RESULTS: With multi-level models adjusted for individual- and school-level covariates, we found that although the absolute level of sickness absence was higher among women than among men, male special education teachers were at a 1.36-fold (95% CI: 1.15-1.61) increased risk of short-term and a 1.33-fold (95% CI: 1.01-1.76) increased risk of long-term sickness absence compared with male teachers in general education. Among women, there were no differences in sickness absence between special and general education teachers. CONCLUSIONS: Compared to male teachers in general education, male teachers in special education appear to have an excess risk of absence from work due to illness. Future studies should examine the causes for this excess risk and determine the need for preventive interventions.

Sense of coherence and health behaviour in adolescence.

AIM: To explore associations of Sense of coherence (SOC) with health behaviour and social competence among 15-year-old adolescents. METHODS: Study population is a prospective cohort of a randomized cluster sample of families and their first-born children from south-western Finland in 1986-1987. In this study, cross-sectional data of the 15-year-olds were used. The present data were based on mailed, pretested questionnaires. The outcome variable, SOC, was based on the 13-item scale of Antonovsky's Orientation to Life Questionnaire (OLQ). The principal explanatory variables were health behaviour, including experienced oral health, and social competence. The statistical analysis was performed using linear regression modelling. RESULTS: Strong SOC of adolescents associated significantly with lighter use of alcohol, being a non-smoker, better care of oral health and better social competence compared with the others. CONCLUSION: Sense of coherence is a useful tool for identifying adolescents in need of extra support and motivation for their health behaviour.

The role of parents' sense of coherence in irregular meal pattern and food intake pattern of children aged 10-11 in Finland.

BACKGROUND: Among adults, a stronger sense of coherence (SOC) seems to promote a better coping with strain and is associated with healthier behaviours, including eating patterns. The parents' SOC may also have a wider effect on the health behaviour of their children. The aim of this study is to determine whether there are associations between parents' SOC and the eating patterns of their children and if this can be explained by mediating factors. METHODS: Cross-sectional. In 2006, 1268 (response rate 79%) 10- and 11-year-old children in southern Finland, in a classroom situation, filled in a questionnaire assessing meal pattern and food frequency intake. Parents, 816 (response rate 64%), filled in a questionnaire assessing SOC (13 items) and eating patterns. Matching data were found from 772 child-parent pairs. chi(2) tests, factor analysis, univariate analysis of variance and logistic regression analyses were used as statistical methods. RESULTS: A weaker parental SOC was associated with children's irregular meal pattern (p = 0.004), more frequent intake of energy-rich foods (p = 0.002) and less frequent intake of nutrient-rich foods (p = 0.051). Mediating factors, such as availability and accessibility of fruit and vegetables at home, parent's nutrition knowledge, parents' own fruit and vegetable intake and an irregular meal pattern, explained the association between parents' SOC and children's intake of nutrient-dense foods, but not the association with energy-rich foods. CONCLUSIONS: Parents' weaker SOC was associated with children's unhealthier eating patterns. More research is needed on the associations between parents' SOC and other health-related behaviours in their children.

Patient complaints in Finland 2000-2004: a retrospective register study.

Today, monitoring of patient complaints in healthcare services is being used as a tool for quality assurance systems and in the future development of services. This nationwide register study describes the number of all complaints processed, number of complaints between different state provinces, healthcare services and healthcare professionals, and outcomes of complaints in Finland during the period 2000-2004. All complaints processed at the State Provincial Offices and the National Authority for Medicolegal Affairs were analysed by statistical methods. Complaints about mental healthcare were explored in greater detail. The analysis showed that the number of patient complaints increased considerably during the study period. There were changes in the number of complaints between study years in different provinces. Out of different healthcare services, an especially marked increase was seen in private healthcare. Nearly all complaints were lodged against physicians, and over half of the complaints were made because of medical error. In mental health care, patients more often complained about unsatisfactory certificates and statements and the use of compulsory hospital care. An analysis of the outcomes revealed that in mental health care complaints more seldom led to consequences. The results need to be utilised when planning interventions for advanced supervision, prevention of adverse events and patient safety in healthcare, and especially in mental health care. From the patients' perspective, it is important to create a culture where most problem situations are handled where the treatment was provided, thus avoiding a complex complaints process.

Merkel cell carcinoma in a young pregnant woman.

SUMMARY: We present a 27-year-old pregnant woman with Merkel cell carcinoma on the forehead. In early pregnancy, the lesion was excised as an epidermal cyst. It was only after recurrence that a diagnosis of Merkel cell carcinoma was made. Sentinel-node biopsy, excision with 2 cm margins and reconstruction with free microvascular radial forearm flap was carried out, and the patient received postoperative radiotherapy. No evidence of recurrence or disease progression was found 24 months after surgery.

Characteristics of neck pain associated with adolescent headache.

The objective of the study was to find out what kind of neck pain (NP) is associated with headache (HA) and with various headache variables: frequency, type, intensity, disturbance, and relief with analgesics. A population-based sample of 12-year-olds with and without HA (n = 304) was followed for 4 years. At the age of 16 years, NP was evaluated on the basis of self-reported symptoms and a thorough physical examination of the neck region. Both self-reported and measured NP were associated with HA variables. Co-occurrent NP was found in adolescents with migraine as often as in those with tension-type HA. Especially, muscle pain and intensive, frequent NP were associated with disturbing HA unresponsive to analgesics. The study indicates that concomitant NP should be considered in adolescent HA sufferers, and a thorough cervical and muscle evaluation is recommended when planning the treatment of HA.

Negative life events and stability of sense of coherence: a five-year follow-up study of Finnish women and men.

A strong sense of coherence (SOC) is found to be associated with good mental health. This study investigated (1) whether negative life events affect level of SOC, (2) whether initial level of SOC modifies the effect of negative life events on SOC, and (3) whether stability of SOC differs between genders. The data were derived from the 15-year Health and Social Support study (N= 17,271). Ordinary linear regression analysis was used. Negative life events decreased the level of SOC among both genders irrespective of the timing of the event. The more recent the life event, the lower the SOC. A strong SOC in 1998 did not protect SOC from declining during follow-up. Specific gender differences were not discovered. SOC was related to negative changes in people's environment. Initially strong SOC was not more stable than initially mediocre or weak SOC. Men and women reacted quite similarly to negative life events.

The MDM2 promoter polymorphism SNP309T-->G and the risk of uterine leiomyosarcoma, colorectal cancer, and squamous cell carcinoma of the head and neck.

BACKGROUND: MDM2 acts as a principal regulator of the tumour suppressor p53 by targeting its destruction through the ubiquitin pathway. A polymorphism in the MDM2 promoter (SNP309) was recently identified. SNP309 was shown to result, via Sp1, in higher levels of MDM2 RNA and protein, and subsequent attenuation of the p53 pathway. Furthermore, SNP309 was proposed to be associated with accelerated soft tissue sarcoma formation in both hereditary (Li-Fraumeni) and sporadic cases in humans. METHODS: We evaluated the possible contribution of SNP309 to three tumour types known to be linked with the MDM2/p53 pathway, using genomic sequencing or restriction fragment length polymorphism as screening methods. Three separate Finnish tumour materials (population based sets of 68 patients with early onset uterine leiomyosarcomas and 1042 patients with colorectal cancer, and a series of 162 patients with squamous cell carcinoma of the head and neck) and a set of 185 healthy Finnish controls were analysed for SNP309. RESULTS: Frequencies of SNP309 were similar in all four cohorts. In the colorectal cancer series, SNP309 was somewhat more frequent in women and in patients with microsatellite stable tumours. Female SNP309 carriers were diagnosed with colorectal cancer approximately 2.7 years earlier than those carrying the wild type gene. However, no statistically significant association of SNP309 with patients' age at disease onset or to any other clinicopathological parameter was found in these three tumour materials. CONCLUSION: SNP309 had no significant contribution to tumour formation in our materials. Possible associations of SNP309 with microsatellite stable colorectal cancer and with earlier disease onset in female carriers need to be examined in subsequent studies.

Comparison of phenotypic and genotypic detection of penicillin G resistance of Staphylococcus aureus isolated from bovine intramammary infection.

Resistance of Staphylococcus aureus to penicillin G is common among isolates from bovine mastitis. We determined phenotypic resistance to penicillin G for 151 S. aureus isolates derived from dairy cows with intramammary infection by two methods. The methods were determination of minimum inhibitory concentration (MIC) by a standard agar dilution technique and direct testing of beta-lactamase production using a chromogenic cephalosporin, nitrocefin. The results from these tests were compared with the presence of the beta-lactamase (blaZ) gene in the isolates, which was detected by polymerase chain reaction (PCR). Testing beta-lactamase production with nitrocefin was more predictive for the presence of the blaZ gene than the agar dilution method and the results of the former agreed highly with the presence of the blaZ gene in the isolates. In contrast, the resistance breakpoint generally used in the agar dilution method may be too high for prediction of penicillin resistance in S. aureus isolates with borderline MICs. Using this method, 40% of the isolates possessing the blaZ gene were classified as susceptible; however, majority of these isolates produced beta-lactamase when tested with nitrocefin.

Effect of intramammary Escherichia coli endotoxin in early- vs. late-lactating dairy cows.

We investigated the differences in the effect of intramammarily infused endotoxin for cows in early (EL) and late (LL) lactation. In this crossover study, nine cows were challenged twice with 100 microg of intramammarily infused Escherichia coli 0111:B4 LPS, each cow serving its own control. Systemic and local signs were recorded throughout the experiment to assess the severity of each cow's response. Daily milk yield and indicators of inflammation in blood and milk were also recorded. The response was significantly more severe in the EL period. Before the challenge, milk yield and serum free fatty acid concentration were higher and serum urea concentration lower in EL compared with LL cows. No significant differences were present in other parameters. After the challenge, milk SCC and leukocyte function, measured as chemiluminescence, increased, more markedly in EL. Blood neutrophil content varied from neutropenia to neutrophilia. Simultaneously with neutropenia, the function of neutrophils increased in LL but decreased in EL. Serum cortisol peaked 4 h after challenge in both groups. In conclusion, endotoxin challenge resulted in more severe response in EL. During that time cows also had impaired neutrophil function postchallenge.

A new index to measure the accuracy of refractive operations.

PURPOSE: To create a new index to help evaluate the accuracy of the outcome of refractive surgery. METHODS: By combining information given by the cross-cylinder form of surgically induced refractive change (SIRC) and basic methods of vector analysis, we constructed a new index which serves as a tool to evaluate postoperatively the changes achieved by refractive surgery. This new index gives easily understandable numerical values and takes into account changes in both spherical refraction and astigmatism. We demonstrated the use of this index in two study populations consisting of 20 consecutive eyes operated on using two different lasers, Meditec MEL60 and MEL70, respectively. RESULTS: Although postoperative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were better in the MEL70 group, the difference of photoefractive keratectomy (PRK) for combined astigmatism and myopia was not statistically significant. Comparison of the changes in refraction achieved by the two lasers indicated that the MEL60 was more accurate; this was also seen when comparing the total index of error between the two groups. CONCLUSIONS: We suggest the use of this total index of error (TIE) in clinical praxis because it provides an easy and accurate method of evaluating the accuracy of refractive operations. These inaccuracies might otherwise go unnoticed if the basic values only (e.g. UCVA, BCVA and haze) were used in postoperative evaluation.