Dairy- and supplement-based calcium intake in adulthood and vertebral dimensions in midlife-the Northern Finland Birth Cohort 1966 Study.

Among a representative sample of 1064 Northern Finns, we studied the association of dairy- and supplement-based calcium intake in adulthood with vertebral size in midlife. Inadequate calcium intake (< 800 mg/day) from age 31 to 46 predicted small vertebral size and thus decreased spinal resilience among women but not men. INTRODUCTION: Small vertebral size predisposes individuals to fractures, which are common among aging populations. Although previous studies have associated calcium (Ca) intake with enhanced bone geometry in the appendicular skeleton, few reports have addressed the axial skeleton or the vertebrae in particular. We aimed to investigate the association of dairy- and supplement-based Ca intake in adulthood with vertebral cross-sectional area (CSA) in midlife. METHODS: A sample of 1064 individuals from the Northern Finland Birth Cohort 1966 had undergone lumbar magnetic resonance imaging at the age of 46, and provided self-reported data on diet and Ca intake (dairy consumption and use of Ca supplements) at the ages of 31 and 46. We assessed the association between Ca intake (both continuous and categorized according to local recommended daily intake) and vertebral CSA, using generalized estimating equation and linear regression models with adjustments for body mass index, diet, vitamin D intake, education, leisure-time physical activity, and smoking. RESULTS: Women with inadequate Ca intake (< 800 mg/day) over the follow-up had 3.8% smaller midlife vertebral CSA than women with adequate Ca intake (p = 0.009). Ca intake among men showed no association with vertebral CSA. CONCLUSIONS: Inadequate Ca intake (< 800 mg/day) from the age of 31 to 46 predicts small vertebral size and thus decreased spinal resilience among middle-aged women. Future studies should confirm these findings and investigate the factors underlying the association of low Ca intake in women but not in men with smaller vertebral size.

Psychosocial and lifestyle correlates of musculoskeletal pain patterns in adolescence: a 2-year follow-up study.

BACKGROUND: The prevalence of musculoskeletal (MS) pain has been increasing among adolescents in the last decades. This may be related to either adverse changes in lifestyle and/or the psychosocial environment. Our study analysed the psychosocial and lifestyle correlates of musculoskeletal pain progression in adolescence. METHODS: The study was based on the 1986 Northern Finland Birth Cohort and included 1773 adolescents at the ages of 16 to 18. Latent class analysis was applied to find the homogeneous profiles of MS pains in four body areas (neck, shoulder, low back and limb). We analysed the associations between time spent in sedentary activities and sleeping, physical activity level, body mass index, alcohol consumption, smoking, and emotional and behavioural factors at 16 years, and belonging to pain clusters at 16 and 18 years. RESULTS: We found an association between a higher probability of MS pains between 16 and 18 years and increasing emotional and behavioural problems in both genders. Among boys, a high likelihood of MS pains during follow-up was also associated with a long time spent sitting and insufficient sleeping time. Among girls, alcohol consumption associated with high pain probability. MS pains already co-occur to a large extent in their early course. CONCLUSIONS: The strong overlap of emotional and behavioural problems and MS pains in adolescence requires awareness in both research and clinical work.

Determinants of adolescent health care use for low back pain.

BACKGROUND: Recent studies have indicated that low back pain (LBP) is common already in adolescence, but only few studies have evaluated the factors that determine LBP-related health care use at this age. METHODS: The study population included 1987 adolescents aged 18 from the Oulu Back Study, a subcohort of the 1986 Northern Finland Birth Cohort. We used logistic regression to evaluate whether enabling resources, need factors, personal health habits or psychological problems are associated with seeking health care for LBP, among adolescents reporting LBP during the last year. RESULTS: Of the 1987 respondents, 50% of the females and 42% of the males reported having had LBP during the previous year. Of the 921 respondents with LBP, 89 (16%) females, and 59 (16%) males had consulted a health care professional. In both genders, pain intensity was strongly associated with seeking care [visual analogue scale (VAS) 8-10 vs. VAS 0-3; males: OR 16.6, 95% CI 3.8-72.5, females: OR 18.8 95% CI 6.3-56.1]. In addition, LBP-related daily activity limitations (impairment index 4-6 vs. 0 OR 15.7 95% CI 1.7-142.5) were associated with care seeking among males. Student status was also associated with care seeking among males (OR 2.34 95% CI 1.02-5.36). CONCLUSIONS: Approximately one out of six adolescents with LBP seeks medical care. Intensity of pain and daily activity limitations appear to be the main determinants of seeking care for LBP in adolescence.

Association of 25-hydroxyvitamin D with the incidence of knee and hip osteoarthritis: a 22-year follow-up study.

OBJECTIVE: In the light of conflicting results from previous studies on the role of vitamin D, we studied serum 25-hydroxyvitamin D [25(OH)D] with regard to its prediction of incident knee and hip osteoarthritis (OA). METHODS: The study population (n = 805) consisted of participants of a national health examination survey who had undergone baseline and follow-up clinical examinations at intervals of 20-23 years. Knee and hip OA were diagnosed on the basis of a standardized clinical examination by physicians with the same diagnostic criteria at baseline and follow-up. Information on covariates, including age, sex, season of blood draw, education, body mass index (BMI), physical workload, leisure time physical activity, smoking history, and previous injuries, was collected at baseline. Serum 25(OH)D concentrations were determined from baseline serum samples kept frozen at -20°C. RESULTS: We found no significant association between serum 25(OH)D level and the risk of incident knee or hip OA. However, a statistically significant interaction between season of blood draw and serum 25(OH)D emerged when predicting the development of definite knee OA (p = 0.004). After adjusting for all the covariates, the relative odds (95% confidence interval) of developing definite knee OA per increment of 1 SD (20.7 ng/mL) in winter season 25(OH)D was 1.57 (1.10-2.27), whereas for summer season sera the corresponding rate was 0.53 (0.28-1.00). CONCLUSION: The results do not support the hypothesis that a low level of serum 25(OH)D contributes to the development of OA. Instead, our study suggests that season is a potent effect modifier of 25(OH)D, which merits attention in future research.

Positive treatment response improves the health-related quality of life of patients with early rheumatoid arthritis.

OBJECTIVE: To examine treatment induced changes in health-related quality of life (HR-QoL) in patients with early rheumatoid arthritis (RA). METHODS: Changes in HR-QoL were assessed by the Nottingham Health Profile (NHP) instrument in 62 consecutive working age patients with recent onset RA with duration of symptoms of less than two years and naive with regard to disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids. Treatment-response was assessed by the criteria of the European League against Rheumatism (EULAR; 28-joint score; DAS28) at 6 months. RESULTS: NHP mean scores for pain (p=0.029) and emotional reaction (p=0.035) at baseline were related to EULAR response at 6 months, i.e. non-responders had the poorest baseline HR-QoL scores. When the patients were grouped according to EULAR response at 6 months there was a statistically significant mean linear change to better HR-QoL in NHP energy (p=0.0023), pain (p<0.001) and mobility (p=0.0085) from baseline to 6 months from the lowest to highest treatment-response level. CONCLUSION: Our results show that good treatment-response as measured by the EULAR response criteria translates into improved HR-QoL dimensions for energy, pain and mobility.

An outbreak of respiratory diseases among workers at a water-damaged building--a case report.

We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin G (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. Skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin E (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism.

[Neuropsychiatric problems among children are signigicantly underdiagnosed. Intervention programs result in better and less expensive care]. / Betydande underdiagnostik av neuropsykiatriska problem hos barn. Riktade åtgärdsprogram ger bättre och billigare vård.

Neuropsychiatric problems (Asperger syndrome, ADHD, reading and writing disorders) affect 6-10 per cent of all children in Sweden. Many of these disorders are never diagnosed. As a consequence, secondary behaviour problems and impaired family relations often follow. A study of 60 families with at least one child affected by one of the above mentioned disorders shows that quality of life can be increased and problems reduced if parents and children are informed of the child's disabilities and the child receives a special education programme. Families who do not receive this special treatment more often apply for medical care from other (more expensive) sources. Quite often do they find this treatment unsatisfactory.

Muscle strength characteristics and central bone mineral density in women with recent onset rheumatoid arthritis compared with healthy controls.

Muscle strength and bone mineral density (BMD) at the lumbar spine (BMDspine) and femoral neck (BMDfem) were determined in 20 healthy women and in 20 women with recent onset rheumatoid arthritis (RA). The mean duration of articular symptoms of the patients was eleven months and none of them had used glucocorticoids or disease modifying antirheumatic drugs. BMDs were measured by dual x-ray absorptiometry (DXA). Knee extension, trunk extension, and flexion as well as grip strength were measured with David 200 and Digitest dynamometers. BMDspine (1.17 g/cm2 and 1.20 g/cm2) and BMDfem (0.98 g/cm2 and 0.96 g/cm2) between the women with early RA and healthy women did not differ. However, knee extension strength was 46%, grip strength 31%, trunk extension strength 14% and overall muscle strength index 29% lower in RA women (p < 0.020-0.001) than in healthy subjects. Femoral neck BMD correlated statistically significantly with knee extension strength and muscle strength index in both groups and with trunk extension and flexion strength as well as rapid force development in RA women. The data indicates that the loss of muscle strength is clearly visible during the first months of disease but the significant bone loss at central bone regions develops later.

Diurnal rhythm of melatonin in bovine milk: pharmacokinetics of exogenous melatonin in lactating cows and goats.

We investigated whether the melatonin levels in bovine milk exhibit a similar daily rhythm as serum levels. In 4 Ayrshire cows at the beginning of the lactation period in May the nocturnal rise in milk melatonin was moderate (from 7 +/- 2 pg/ml at noon to 15 +/- 1 pg/ml at night; mean +/- SEM) and did not correlate well with the melatonin level in serum (from 7 +/- 2 pg/ml to 27 +/- 7 pg/ml, respectively). On the other hand, 6 cows in a later phase of lactation, studied in February, showed a clear long-lasting nocturnal melatonin increase both in serum (from 9 +/- 1 pg/ml at noon to 26 +/- 3 pg/ml at night) and in milk (from 12 +/- 5 pg/ml to 26 +/- 7 pg/ml, respectively). Melatonin kinetics during lactation was studied in more detail in 4 Ayrshire cows and 4 dairy goats by giving an intravenous bolus injection of melatonin. A 3-compartment model with melatonin elimination from the central compartment was used to describe the data. The values (mean +/- SD) for the cows and the goats were: elimination half-life 27 +/- 4 min and 27 +/- 1 min, mean residence time 24 +/- 4 min and 18 +/- 4 min, steady state distribution volume 1.0 +/- 0.3 l/kg and 0.6 +/- 0.1 1/kg (p < 0.05), and plasma clearance 0.044 +/- 0.004 l/kg/min and 0.035 +/- 0.011 l/kg/min, respectively. Following injection, the melatonin concentration in milk increased rapidly and exceeded the corresponding serum value 15-30 min later, remaining thereafter above the serum level. Our results suggest that milk melatonin levels reflect blood concentrations of melatonin with a short delay.

A new beclomethasone dipropionate multidose powder inhaler in the treatment of bronchial asthma.

The clinical efficacy, tolerability and acceptability of a new multidose powder inhaler (MDPI) containing beclomethasone dipropionate (BDP) were compared with those of a BDP aerosol administered with a large volume spacer (MDI-spacer) among adult asthmatics currently receiving from 500 to 1,000 microgram/day of an inhaled corticosteroid. During the study, the dosage of BDP from both devices was 400 microgram twice daily. Ninety-one patients were randomized to the MDPI group and 42 to the MDI-spacer group. The trial was performed as an open, randomized, parallel group multicenter study. The duration of the treatment period was 12 weeks, and the study was preceded by a 2-week run-in period. During the run-in period, the mean morning peak expiratory flow (PEF) was 487 and 466 1/min in the MDPI and MDI-spacer groups, respectively. After the 12-week treatment, the morning PEF was 491 1/min in the MDPI group and 463 1/min in the MDI-spacer group. The evening values were 500 and 479 1/min during the run-in period and 496 and 476 1/min after the 12-week treatment, respectively. Asthma symptom scores and the use of rescue medication were low in both groups, indicating good efficacy of the preparations tested. The median dose of histamine required to decrease forced expiratory volume in 1 s by 15% increased during the study from 800 to 1,098 microgram in the MDPI group and from 795 to 960 microgram in the MDI-spacer group. The most frequent adverse events in both groups were hoarseness and sore throat. There were no statistically significant differences between the treatment groups in serum cortisol values or in the number of patients with thrush. Seventy-two percent of the patients regarded the MDPI easier to use while 95% considered it more portable. Over 80% of the patients felt that the MDPI was also easier to clean and as easy or easier to learn to use than the MDI-spacer. To conclude, the novel powder inhaler is well tolerated and at least equally effective as the conventional MDI-spacer combination in the treatment of asthma with BDP. However, in everyday use, patients clearly favored the powder inhaler.

Comparison of a Multidose Powder Inhaler Containing Beclomethasone Dipropionate (BDP) with a BDP Metered Dose Inhaler with Spacer in the Treatment of Asthmatic Patients.

OBJECTIVE: The clinical efficacy, tolerability and acceptability of a new multidose powder inhaler (MDPI) [Easyhaler((R)), Orion Pharma, Finland] containing a high dose (500 microg/dose) of beclomethasone dipropionate (BDP) were compared with those of BDP metered dose inhaler administered with a large volume spacer (MDI-spacer). PATIENTS AND STUDY DESIGN: Recruited patients were adult asthmatics currently receiving 800 to 1000 microg/day of inhaled corticosteroid. The dose of BDP during the study was 1000 mg/day. The study was an open, randomised, parallel-group multicentre study and included a 2-week run-in period followed by a 12-week treatment period. RESULTS: 74 patients were randomised to both groups. During the run-in period the mean morning peak expiratory flow (PEF) was 489 and 478 L/min in the MDPI and MDI-spacer groups, respectively. During the last 2 weeks of the study the morning PEF was 485 L/min in the MDPI group and 477 L/min in the MDI-spacer group. Asthma symptom scores and use of rescue medication were low in both groups. The median dose of histamine required to decrease forced expiratory volume in 1 second (FEV(1)) by 15% was 1.05mg in the MDPI group and 0.64mg in the MDI-spacer group. The most frequent adverse events were hoarseness and sore throat. Mean serum cortisol levels were not affected in either treatment group. Patients' personal opinion regarding acceptability of the devices clearly favoured the MDPI. CONCLUSION: In conclusion, the novel powder inhaler was well tolerated and at least equally effective compared with the conventional MDI-spacer combination in the treatment of asthma with BDP. However, in everyday use the patients clearly favoured the powder inhaler.

Depressed fibromyalgia patients are equipped with an emphatic competence dependent self-esteem.

Employing a recently developed questionnaire we studied the self-esteem structure of 61 female fibromyalgia (FM) patients by comparing them with i) 40 healthy psychology students and ii) 37 patients suffering from rheumatoid arthritis. Depressed FM patients (n=36) had a high need to gain self-esteem through competence and others' approval combined with a low basic sense of self-esteem. In this regard they differed significantly from the healthy controls who had a more equal amount of the two types of self-esteem. These patients had also a more demanding and "hard-driving" self-esteem structure than either control group and exhibited a lower self-assertiveness and less emotional candour than the healthy controls. The non-depressed FM patients did not display this self-esteem pattern. In conclusion, FM patients are probably not a homogeneous group. Furthermore, we suggest that an emphatic competence-dependent self-esteem is one vulnerability factor which, in proper genetic and environmental conditions, increases susceptibility to fibromyalgia and depression.

Modified Hauser operation for patellar instability. Immediate mobilization of 35 knees, a 5-8 year follow-up study.

We performed a follow-up examination of 35 knees with chronic patellar instability treated by a modified Hauser operation: medialization and distalization of the tibial tubercle without dorsal transfer, and fixation of the tubercle rigidly with 2 cortical screws. Cast immobilization was not used and the patients were allowed to mobilize the knee immediately. The follow-up period was 6 (5-8) years. 27 of 35 knees were excellent or good at follow-up, while 8 patients were more or less dissatisfied with the result. 5 knees had arthrosis at follow-up. No severe complications occurred, nor did the rate of minor complications differ from earlier reports.

Effect of exercise on enzymatic activity in tracheal fluid and on intrapleural pressure difference in horses.

Seventeen trotters, eight healthy and nine with a mild respiratory disease, underwent a submaximal treadmill exercise. Heart rate, breathing frequency, intrapleural pressure difference (IP difference) as well as haematocrit and concentration of lactic acid in blood were monitored before exercise, during exercise and during recovery. The activities of beta-glucuronidase and plasmin, total proteolytic activity and trypsin inhibitory capacity were measured from the tracheal fluid before and after exercise. IP difference significantly increased during exercise and returned to normal values within 15 min in healthy horses. Differences in intrapleural pressure between healthy and diseased horses were not significant during exercise. Increase of the respiratory rate was monitored during recovery probably due to respiratory compensation of the lactic acidosis. Activities of beta-glucuronidase increased and activities of plasmin and trypsin inhibitory capacity decreased due to exercise. Most prominent changes were seen in the decrease of plasmin activity. The total proteolytic activity in the tracheal fluid before exercise correlated with the VLa4 values, indicating that a mild respiratory disease, which causes proteolysis in the respiratory tract, decreases performance capacity of the horse.

Immobilization in neutral versus equinus position after Achilles tendon repair. A review of 32 patients.

In this retrospective study, we compared Achilles tendon ruptures treated with augmented repair and equinus cast and ruptures treated with end-to-end suture and immobilization of the ankle in neutral position. No differences in the outcome or complication rate were found. We recommend that Achilles tendon rupture should be treated by the simplest method, i.e., end-to-end suture and immobilization of the ankle in neutral position.

Hard metal lung disease: a clinical, histological, ultrastructural and X-ray microanalytical study.

Four employees occupied in hard metal grinding work at the same machine shop developed interstitial lung disease after 2-7 years of working. Open lung biopsies from two of them showed giant cell interstitial pneumonia with bronchiolitis. The multinucleate giant cells were shown by electron microscopy to include both pneumocytes and macrophages. The giant pneumocytes were severely damaged, the endoplasmic reticulum being swollen and the few lamellar bodies being small, and some mitoses were visible in the pneumocytes. No mitoses were found in the giant macrophages. Pulmonary dust particles were studied in situ by scanning transmission electron microscopy and energy-dispersive spectrometry. Cobalt was no longer found in most of the pulmonary hard metal particles, but it was regularly detected in grinding dust particles in air samples studied by scanning electron microscopy and energy-dispersive spectrometry.

Withdrawal of inhaled corticosteroid under cover of nedocromil sodium.

Patients satisfactorily controlled on both an inhaled corticosteroid and a regularly inhaled bronchodilator were randomly allocated to 12 weeks of treatment with either nedocromil sodium (4 mg q.i.d.) or matching placebo. After 3 weeks of treatment, inhaled steroids were abruptly withdrawn. Severity of asthma deteriorated in both groups but more rapidly in the placebo group (p less than 0.05). Lung function tests showed little between-group difference. Nedocromil sodium had greater efficacy than placebo in the control of asthma in patients requiring an inhaled corticosteroid but abrupt corticosteroid withdrawal is not recommended. However, there are some clinical suggestions of the benefits of the combined use of nedocromil sodium and an inhaled corticosteroid.

Remodelling after femoral shaft fracture in children.

Fifty-two children in the 1-14 year age range who had a femoral fracture and were treated by traction and casting, were re-examined 2-17 years later. The results of radiological measurements of femoral length and alignment are analysed by computer. The femoral over-growth following fracture 10.7+/-6.6 mm, did not depend on site or dislocation of fracture. Lateral dislocation completely corrected, varus deformity on an average only up to 40% and valgus deformity up to 60% of the initial defect. Minor deviations corrected less. Repairing continued for over 5 years. Ante- and recurvatum could correct nearly 70%, if the original deformity was over 10 degrees, otherwise less. In neither plane was the correction of axial deviation influenced by site or type of fracture. There were individual cases of complete correction of axial dislocation and cases of complete failure to correct.

Indications and results of operative treatment of femoral shaft fractures in children.

In the literature a number of risks due to operative treatment of femoral shaft fracture in children have been reported and justification for such treatment has been thrown into doubt. In our patient series 35 out of 191 children (18%) with femoral shaft fracture were treated by operation, 18 by intramedullary nailing, 16 by other means of osteosynthesis and one crushed extremity by primary amputation. No infections occurred. Nineteen patients of these were re-examined 4.5 to 13.9 years later. Eleven of them had no subjective complaints. Weakness of the fractured limb was suffered by 2 in normal life and by an additional 6 patients in hard exercise. Muscle atrophy of the thigh, more than 2 cm in circumference, was found in 9 patients. Mean longitudinal overgrowth of the fractured femur treated by operation was 9.8 mm corresponding to 10.7 mm in 52 patients treated by traction and casting. Overgrowth of 7.2 mm in intramedullary nailed patients was significantly less (P less than 0.001) than 13.5 mm in those treated by other means of osteosynthesis. A rigid fixation of the fracture partly prevented later spontaneous correction of angulation. Based on the results gained by previous author and from this study a list of indications for osteosynthesis of femoral shaft fracture in children is considered.