Morbidity and mortality after adolescent eating disorders requiring inpatient care.

PURPOSE: This retrospective study utilized comprehensive Finnish national register data to examine the course and mortality of eating disorders among Finnish adolescent inpatients. METHODS: The study population (N = 17,112) comprised of all subjects admitted for the first time to psychiatric hospital care at age 13-17 in 1980-2010. In 10-year follow-up, morbidity and mortality were compared between those admitted for eating disorders (ED group) and other psychiatric patients (non-ED group). RESULTS: Of the study population, 1081 were ED patients (1031 female and 50 male). Mean age was 15 (SD = 1) in both ED and non-ED groups, and the mean follow-up time was 7.7 (SD = 2.2) and 8.4 years (SD = 2.1), respectively. Over 50% of the patients had readmissions during follow-up, the ED group having a higher risk for readmissions. Crude mortality rate (CMR) was 1.5 in the ED group and 2.9 in the non-ED group. Suicide was the most common cause of death: 43.8% in the ED group vs. 52.9% in the non-ED group (p = .28). In multivariate analyses, ED at index admission predicted rehospitalizations but, compared to other disorders, was not associated with increased mortality. CONCLUSION: In the ED group, psychiatric readmissions were more common, but in contrast to earlier reports, mortality was not higher than in other psychiatric disorders. The subjects were treated in specialized adolescent psychiatric services. The prognosis of adolescent onset EDs may improve when treatment is developmentally sensitive.

Physical activity measured by accelerometry among adolescents participating in sports clubs and non-participating peers.

The purpose of this descriptive cross-sectional study is to describe the amount and intensity of physical activity (PA) measured by accelerometry among adolescents participating in organized sports (SCP) and age-matched non-participating peers (NP). SCPs (332) and NPs (139) wore an accelerometer on the hip for seven days. PA was reported using the 1-min exponential moving average. The current moderate-to-vigorous physical activity (MVPA) recommendation of at least an average of 60 min of MVPA daily was reached by 85% of SCPs and 45% of NPs (p < .001). During training days, the MVPA times among SCPs ranged from 153 ± 39 min in males and 109 ± 35 min in females participating in basketball to 113 ± 33 min in males participating in floorball and 83 ± 32 min in females participating in gymnastics. Sports participation contributes rather strongly to the accumulation of the recommended amount of MVPA. During training days, SCPs, except for females participating in gymnastics, accumulated more MVPA than NPs. During non-training days, only males participating in cross-country skiing and females participating in track and field accumulated more MVPA than NPs.HIGHLIGHTSPA of Finnish adolescents participating in nine different organized sports and age-matched non-participating peers was measured by accelerometry for one week and the results are reported using the 1-min exponential moving average.Adolescents participating in many organized sports accumulated more PA than non-participants; this was observed in meeting the PA recommendations, total amount of PA at different intensities, and step count.The current PA recommendation of at least an average of 60 min of MVPA per day was reached by 85% of SCPs and 45% of non-participating peers. Vigorous physical activity at least three times per week was incorporated by 96% of SCPs and 81% of NPs.During training days, males participating in soccer, basketball, and cross-country skiing spent more time in MVPA than females participating in the same sports. During non-training days, the time spent in MVPA was similar between males and females participating in sports clubs.

Acute and overuse injuries among sports club members and non-members: the Finnish Health Promoting Sports Club (FHPSC) study.

BACKGROUND: Physical activity in adolescence is promoted for its multi-dimensional health benefits. However, too intensive sports participation is associated with an increased injury risk. Our aim was to compare the occurrence of acute and overuse injuries in Finnish sports club members and non-members and to report training and competing habits associated with a higher injury risk in sports club members. METHODS: In this cross-sectional survey targeted at 14-16-year-old adolescents, a structured questionnaire was completed by 1077 sports club members and 812 non-members. The main outcome measures were self-reported acute and overuse injuries, their location and type. RESULTS: At least one acute injury in the past year was reported by 44.0% of sports club members and 19.8% of non-members (P < 0.001). The sex-adjusted odds ratio (OR) for acute injury in sports club members compared to non-members was 3.13 (95% confidence interval (95% CI) 2.54-3.87). Thirty-five percent of sports club members and 17.4% of non-members (P < 0.001) reported at least one overuse injury during the past year. The overuse injury OR for sports club members was 2.61 (95% CI 2.09-3.26). Sports club members who trained 7-14 h per week during training (OR 1.61, 95% CI 1.21-2.12, P = 0.001) or competition season (OR 1.55, 95% CI 1.18-2.06, P = 0.002) were more likely to report an injury compared to members who trained 3-6 h per week. Those sports club members who participated in forty competitions or more compared to 7-19 competitions per year were more likely to report an acute injury (OR 1.55, 95% CI 1.05-2.08, P = 0.028) or for an overuse injury (OR 1.53, 95% CI 1.02-2.30, P = 0.038). CONCLUSIONS: Both acute and overuse injuries are common among youth sports club members, and the number increases along with increasing amounts of training and competitions. More effective injury prevention is needed both for adolescents engaging in sports club activities and for other adolescents.

Low back and neck and shoulder pain in members and non-members of adolescents' sports clubs: the Finnish Health Promoting Sports Club (FHPSC) study.

BACKGROUND: The objective of this study was to investigate the prevalence of self-reported low back pain (LBP) and neck and shoulder pain (NSP), and the related factors in members and non-members of adolescents' sports clubs. METHODS: This cross-sectional study was based on surveys of 14-16-year-olds as a part of the Finnish Health Promoting Sports Club (FHPSC) Study. The surveys on self-reported health behaviours, injuries, and musculoskeletal health were conducted among sports club members (n = 962) and non-members (n = 675). Binary logistic regression analysis was applied to study the associations between dependent variables of LBP and NSP, and the independent factors. RESULTS: The prevalence of LBP during the preceding 3 months was 35.0 % in girls and 24.5 % in boys (p < 0.05 for sex difference). The prevalence of NSP was 55.9 % in girls and 27.3 % in boys (p < 0.001 for sex difference). Being a sports club member increased the odds for LBP in boys (odds ratio [OR] 2.35, 95 % CI 1.48-3.72). On the other hand, sports club participation was associated with lower odds of frequent NSP in girls (OR 0.52, 95 % CI 0.33-0.82). No associations were found between other leisure-time physical activity and LBP or NSP. Higher screen time (computer games, TV/DVD, phone, Internet) during leisure-time increased the odds of NSP in boys and LBP in boys and girls. CONCLUSIONS: In this study, self-reported LBP and NSP were already relatively common among adolescents. Girls have a higher risk for reporting LBP and NSP. Measures that are more effective in the prevention of LBP in male sports club members are needed. Excessive screen time is weakly associated with LBP and NSP, which should be taken into account in health promotion among adolescents.

Age, sex, and body mass index as determinants of back and hip extensor fatigue in the isometric Sørensen back endurance test.

OBJECTIVE: To study the ability of a widely used isometric back endurance test to measure lumbar back erector muscle fatigue and to assess the influence of age, sex, and body mass index (BMI) on back and hip extensor muscle fatigability (EMG spectral indices). DESIGN: Cross-sectional study of men and women without back problems. SETTING: Occupational health center and rehabilitation clinic in Finland. SUBJECTS: Experiment 1 consisted of 233 consecutive occupational health center customers (133 women, 100 men) without back problems. Experiment 2 consisted of 20 healthy women. INTERVENTION: Subjects performed the isometric Sørensen back endurance test up to 240sec in experiment 1 and to the limit of endurance in experiment 2. OUTCOME MEASURES: Raw surface EMG was recorded bilaterally over the belly of lumbar erector spinae muscles at L1-L2 and L4-L5 levels in experiment 1, and bilaterally over the medial paraspinal muscles at L1-L2, L3-L4, and L5-S1 levels and over the major hip extensor muscles (gluteus maximus and biceps femoris) in experiment 2. In both experiments, time to endurance was recorded (in experiment 1 up to 240sec). The EMG spectral median frequency (MF) decrease over time was used for the assessment of back and hip extensor fatigability. RESULTS: In experiment 1, the rate of change in paraspinal MF was greater in men than in women, indicating greater paraspinal fatigability in men. Multiple regression analysis indicated that the rate of MF decrease (fatigue) during the test was dependent on age and BMI in both sexes and that the effects of age and BMI were more pronounced in women than in men. Correlation analysis revealed that the rate of paraspinal muscle MF decrease was associated with endurance time and BMI in women and with endurance time and age in men. In experiment 2, the paraspinal muscles, as well as the hip extensor muscles, biceps femoris, and gluteus maximus, showed clear decreases in MF during the isometric endurance test in women. MF decrease was highly related to endurance time and BMI in women. CONCLUSIONS: Lumbar paraspinal muscle fatigability during the Sørensen test is influenced by subject characteristics. Further, the hip extensor muscles also significantly fatigue, indicating load sharing between back and hip extensor muscles during the test. According to these results, the validity of this widely used back endurance test in specifically measuring lumbar paraspinal muscle endurance is questionable, as is the direct comparison of test results between women and men.

The assessment of functional ability in patients with Parkinson's disease: the PLM-test and three clinical tests.

This study assesses functional ability of Parkinson's disease (PD) patients by means of an objective movement analysis (the PLM-test) and three clinical tests. The correlation between the tests was also studied. The main object of this study was to detect and measure relevant disabilities in Parkinson's disease to obtain a clinical test battery.

Content and predictors of consultation experiences among Finnish primary care patients.

The study focuses on how patients' explanations of their illnesses, their own diagnoses and their expectations are related to their experience of general practice consultations. Before seeing the General Practitioner (GP) on call, 127 Finnish acute health centre patients were interviewed about their interpretation of their symptoms, their explanations for the causes of their illnesses and their expectations of the forthcoming consultations. After seeing the GP they were asked to describe what happened in the consultations and to evaluate their experiences. In the qualitative analysis, the following consultation experiences were found: (1) being treated with holistic approach; (2) enjoyment of support and consolation; (3) receipt of important information; (4) subjection to routine and ritualistic conduct; (5) experience of insecurity and helplessness; and (6) experience of indifference and neglect. Loglinear models for predicting the success of medical consultations showed that 'negative medical consultation' is more likely to happen if: (a) the patient's illness explanation integrates both biomedical and psychosocial models; and (b) there is no match between the patient's own and the doctor's diagnosis.

Long-term patterns of general practice consulting behaviour: a qualitative 9-year analysis of general practice histories of a working-aged rural Finnish population.

The 9-year practice histories of 100 working-aged residents of the rural municipality of Kaavi in Finland were analysed. Based upon an analysis of these histories, an interview of the 81% who participated and the personal patient knowledge of the author from his work as a general practitioner for 7 years in the community, 78% of the persons studied could be classified into six categories in a qualitative typology of consulting patterns. The descriptive names of the categories, together with their proportionate sizes and the mean annual consultation rates within the categories were: (1) 'Healthy and competent' (16%; 1.03); (2) 'Contented returners' (12%; 3.28); (3) 'Information seekers' (8%; 4.08); (4) 'Support seekers' (15%; 4.62); (5) 'Drifters' (21%; 2.21) and (6) 'Those hard to convince' (6%; 3.59). The rest (22%; 1.15) could not be classified. The implications of the typology are discussed from two standpoints: (1) In view of the current Finnish debate on the need for fee deterrents for the use of public general practitioner's services. (2) The potentials and limitations of different broad strategies suggested for general practice.

Tiapride and chlordiazepoxide in acute alcohol withdrawal. A controlled clinical trial.

The efficacy of chlordiazepoxide and tiapride in the management of acute alcohol withdrawal syndrome was compared in a randomized, parallel-group, double-blind trial. The mean daily dose for both preparations on the first two days was four capsules, i.e., 200 mg for chlordiazepoxide and 400 mg for tiapride. Thereafter the patients were treated according to the relief of symptoms obtained. The treatment periods lasted 3-5 days. Both drugs effectively alleviated alcohol withdrawal symptoms, especially anxiety, fear, hallucinations, insomnia, sweating, tremor, abdominal pain and vertigo. Seventy percent of the patients in the chlordiazepoxide and 42% in the tiapride group considered the drug effective. The difference was statistically significant in favour of chlordiazepoxide (p less than 0.05). Tiapride is an alternative drug in the treatment of this condition, if benzodiazepines are to be avoided.