Effectiveness of screening for colorectal cancer with a faecal occult-blood test, in Finland.

BACKGROUND: Screening for colorectal cancer (CRC) with guaiac-based faecal occult-blood test (FOBT) has been reported to reduce CRC mortality in randomised trials in the 1990s, but not in routine screening, so far. In Finland, a large randomised study on biennial FOB screening for CRC was gradually nested as part of the routine health services from 2004. We evaluate the effectiveness of screening as a public health policy in the largest population so far reported. METHODS: We randomly allocated (1:1) men and women aged 60-69 years to those invited for screening and those not invited (controls), between 2004 and 2012. This resulted in 180 210 subjects in the screening arm and 180 282 in the control arm. In 2012, the programme covered 43% of the target age population in Finland. RESULTS: The median follow-up time was 4.5 years (maximum 8.3 years), with a total of 1.6 million person-years. The CRC incidence rate ratio between the screening and control arm was 1.11 (95% CI 1.01 to 1.23). The mortality rate ratio from CRC between the screening and control arm was 1.04 (0.84 to 1.28), respectively. The CRC mortality risk ratio was 0.88 (0.66 to 1.16) and 1.33 (0.94 to 1.87) in males and females, respectively. CONCLUSIONS: We did not find any effect in a randomised health services study of FOBT screening on CRC mortality. The substantial effect difference between males and females is inconsistent with the evidence from randomised clinical trials and with the recommendations of several international organisations. Even if our findings are still inconclusive, they highlight the importance of randomised evaluation when new health policies are implemented. TRIAL REGISTRATION: 002_2010_august.

Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial.

UNLABELLED: The ability of combined step aerobic- and circuit-training to prevent bone loss after breast cancer treatments was related to skeletal site and patients' menopausal status. Among premenopausal breast cancer survivors, a 12-month exercise intervention completely prevented bone loss at the femoral neck, whereas no exercise effect was seen at lumbar spine or at neither site in postmenopausal women. INTRODUCTION: The primary objective of this randomised clinical trial was to determine the preventive effect of supervised weight-bearing jumping exercises and circuit training on bone loss among breast cancer patients. METHODS: Of 573 breast cancer survivors aged 35-68 years randomly allocated into exercise or control group after adjuvant treatments, 498 (87%) were included in the final analysis. The 12-month exercise intervention comprised weekly supervised step aerobic- and circuit-exercises and similar home training. Bone mineral density (BMD) at lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical performance was assessed by 2-km walking and figure-8 running tests, and the amount of physical activity was estimated in metabolic equivalent-hours/week. RESULTS: In premenopausal women, bone loss at the femoral neck was prevented by exercise, the mean BMD changes being -0.2% among the trainees vs. -1.4% among the controls (p = 0.01). Lumbar bone loss could not be prevented (-1.9% vs. -2.2%). In postmenopausal women, no significant exercise-effect on BMD was found either at the lumbar spine (-1.6% vs. -2.1%) or femoral neck (-1.1% vs. -1.1%). CONCLUSIONS: This 12-month aerobic jumping and circuit training intervention completely prevented femoral neck bone loss in premenopausal breast cancer patients, whereas no effect on BMD was seen in postmenopausal women.

Early detection of colorectal cancer with faecal occult blood test screening.

BACKGROUND: Faecal occult blood test (FOBT) screening has been shown to decrease the incidence and mortality from colorectal cancer. This study compared the stage profile of patients with colorectal cancer diagnosed at the first FOBT screening round with that of an unscreened control group. METHODS: Subjects aged 60-64 years were allocated randomly to biennial FOBT screening (52 998 subjects) or a control group (53 002) in a Finnish prospective public health policy in 2004-2006. FOBT was performed with a guaiac test. At the end of 2007 the screened and control populations were linked to the Finnish Cancer Registry database, and the colonoscopic findings in the screen positives were analysed. RESULTS: Early-stage colorectal cancer was observed in 52 per cent of the FOBT-positive subjects, in 42.2 per cent of the total screened population and in 38 per cent of the control population (P = 0.191 for FOBT positives, P = 0.592 for total screened population). The prevalence of adenomas and colorectal cancer was 31.5 and 8.2 per cent respectively among the 806 subjects with a positive FOBT. Some 27.3 per cent of all colorectal tumours in the screened population were interval cancers. The tumour was located in the right colon in 28.9 per cent of the screened subjects and 22 per cent of controls (P = 0.255). CONCLUSION: Biennial FOBT screening improves detection of colorectal cancer at the first screening round, but the high percentage of interval cancers is a cause for concern.

Physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland.

This study describes physicians' attitudes towards the use of complementary therapies (CTs) by cancer patients in Finland. Responses to 33 Likert-type statements were received from 234 physicians; the response rate was 50.6%. The questionnaire items were analysed separately and using five sum variables. Data analysis was based on descriptive statistics, chi-square and t-tests and analysis of variance. Attitudes among physicians and oncologists in particular were quite critical. Over four-fifths of the physicians (86%) were doubtful whether CTs should be used at all, given the scarcity of solid research evidence on their benefits. Three quarters (75%) referred to unknown risk factors, half (51%) were of the opinion that CTs should not be used in cancer care at all. On the other hand 58% believed that CTs could help to relieve stress and anxiety among cancer patients, and 79% wanted to see scientific testing to establish the effects of CTs. The most positive attitude towards CTs was shown by general practitioners and non-specialized physicians. Positive attitudes were associated with personal CT use, with recommending CTs to patients and with a high level of interest to participate in CT training. The physicians did not believe the specific CTs singled out for investigation would help patients to recover from cancer. They thought that the use of CTs by cancer patients was motivated by future hope, a determination to do everything possible to cure the cancer and the perception of CTs as a last resort. The result that professional attitudes towards CTs are quite critical in Finland presents a very special challenge to the relationship between physicians and patients: it is crucial that physicians know enough about CTs so that they can discuss the issue with patients and provide relevant advice and guidance on their use.

Initial results from the European Network of Health Promoting Schools program on development of health education in Finland.

The European Network of Health Promoting School (ENHPS) program aims to foster healthy lifestyles for school populations by developing supportive teaching and learning environments conducive to promotion of health. Most European countries have joined the network since its organization in 1993. This paper describes how the European, national, and local aims of the ENHPS program have been realized in Finnish schools during the first year of the second triennium (1997-1999). Substantial development related to health promotion has occurred in the Finnish ENHPS schools. A safe school environment was emphasized, and networking with other schools was encouraged at the international and national levels. Attitudes toward the ENHPS program generally were positive. However, Finnish schools have emphasized developing "structures" for health promotion. In the future, efforts should concentrate on students' active participation in the activities of health promotion in everyday teaching and learning situations.

To what extent do parents strive to protect their children from environmental tobacco smoke in the Nordic countries? A population-based study.

OBJECTIVE: To assess to what extent Nordic parents strive to protect their children from environmental tobacco smoke (ETS) at home. DESIGN: A cross-sectional study using an anonymous questionnaire. SUBJECTS AND SETTING: A stratified, random sample of 5500 households containing a child born during 1992, including 1500 households in Denmark and 1000 households in each of the countries of Finland, Iceland, Norway, and Sweden. MAIN OUTCOME MEASURES: Smoking status of parents, prevalence and magnitude of weekly ETS exposure, rules regarding smoking in the home. RESULTS: 82% of current smokers reported having tried to change their smoking behaviour for the sake of their children. Of all parents who answered the questionnaire, 75% reported having introduced some rules to limit ETS in their home. In households where at least one parent smoked, 57% reported that children were exposed to ETS at home. Child exposure to ETS was most prevalent in single-parent households and in households in which parents had lower levels of education. However, these parents were not less likely than other smoking parents to report having tried to change their smoking behaviour for the sake of their children. CONCLUSION: Environmental tobacco smoke at home is still a problem for many children in the Nordic countries. However, most smoking parents reported having made efforts to change their smoking behaviour for the sake of their children; and in approximately half of all households containing at least one daily smoker, parents reported protecting their children from ETS exposure in the home. Although actual exposure may be higher owing to possible under-reporting of ETS, our results indicate a general awareness in the Nordic countries of the potential negative effects of ETS on children.

Children's residential exposure to environmental tobacco smoke varies greatly between the Nordic countries.

OBJECTIVE: To assess similarities and differences in the Nordic countries regarding ETS (environmental tobacco smoke) exposure in young children. DESIGN: A population-based cross-sectional study comprising a randomly selected sample of 5,500 households which included a child born in 1992. Data were collected using a mailed anonymous questionnaire. RESULTS: While the prevalence of household smoking was similar in all countries, there was a great difference between the countries with regard to child ETS exposure. Finnish parents were more likely than all other Nordic parents to protect their children from ETS and the situation was worst in Denmark and Iceland, where almost half of all households, and nine out of ten households containing daily smokers, exposed their children. Approximately eight out of ten current and former smokers in all countries stated that they had made efforts to change their smoking habits because of their children.

Importance of using proper techniques to teach cardiopulmonary resuscitation to laymen.

Immediate attempts to resuscitate patients with cardiac arrest by lay bystanders distinctly increase the chances of survival in such patients. In the present study we investigated possibilities of intensifying the cardiopulmonary resuscitation (CPR) training of laymen. A group of 46 young conscripts (test group) was given 2 hours of CPR instruction in what was considered the most efficient way. The procedures included showing a film on the theory and practice of CPR, a discussion of the film, and then 3 to 5 min instructed individual practice with a recording manikin. Another 56 conscripts participated in a 1-h illustrated lecture on CPR, which was followed by group training with a non-recording manikin; they served as a reference group. The performance of the subjects in CPR was measured with a recording manikin before and 2 months after the training. Before training, none of the subjects passed the surprise resuscitation test. After training, the skills of 62% of the subjects in the test group were acceptable according to original criteria for lay public, and 28% passed the test according to the strict criteria for medical personnel. The less intensive training given to the reference group did not improve the acceptability of resuscitation. It is concluded that CPR training for laymen may lead to failure to attain an adequate level of skill. Proper training techniques and equipment are important, but even their use does not guarantee that an adequate level of CPR performance will be attained by all laymen if their skills are not later refreshed.