Serum lipids and proteins in lactose malabsorption.

It has been suggested that dietary lactose may reduce the intestinal absorption of fat and protein in individuals with lactase deficiency. On the other hand, it is known that a high carbohydrate diet increases serum lipids. The purpose of this study was to examine whether there are differences in the fasting serum lipid and protein concentrations between people with lactose malabsorption and people with normal lactose absorption. Therefore in the connection of a family study serum lipids and proteins were measured in 409 subjects belonging to 11 families. Of these 288 were relatives of the 11 index persons and 121 were spouses or relatives of the spouses. The weight, height, and milk consumption of each person were recorded. When the age, sex, relative weight and milk consumption effects were taken into account there was a statistical difference between the lactose malabsorption and lactose absorption groups for the concentration of serum triglycerides, but not for the other variables. Besides, serum triglyceride values of over 200 mg/100 ml were significantly fewer in people with lactose malabsorption. It was hypothesized that increased intestinal motility may disturb the absorption of fats and cause the observed difference at least in the Finnish population.

Becoming a doctor--was it the wrong career choice?

The aim of the study was to investigate the social background of physicians, the reasons that influenced doctors to enter medicine, and the association between those reasons and satisfaction in career choice of young Finnish doctors. An extensive postal questionnaire was mailed to a random sample of 2632 young Finnish doctors in 1988 and to 2332 doctors in 1993. We found out that majority of the respondents reported that interest in people, a wide range of job opportunities, the fact that medicine is a highly-appreciated profession, and success at school had influenced their decision to enter medicine quite a lot or very much. In 1988, 8% and in 1993, 7% of the respondents reported that interest in people had not influenced their career choice at all or only slightly. More women than men were influenced quite a lot or very much by factors like interest in people, success at school and vocation, meaning the lifelong calling to physicians' profession. A total of 22% of respondents would not enter medicine again. Vocation, interest in people and wide range of job opportunities were significantly more rarely mentioned as an important career choice motive by these respondents. It seems that interest in human beings and vocation are important to would-be doctors, and also help them to get along in the physicians' profession. Medical schools should develop their curricula towards more humanistic medicine in order to maintain their students' interest in people.

Contraceptive methods: knowledge sources rated by women and men.

People today live amid a welter of information regarding contraception, and health care professionals have been the most prominent sources to which people turn. This study evaluates the relative importance of various information sources and ascertains the position of the physicians among them. Random samples (393 women and 395 men) were drawn from the Finnish population. Response rates were 56% for women and 45% for men. The respondents were asked to estimate the amount of knowledge they had obtained from various sources on a visual analog scale. The three most important sources for women were literature, physicians, and women's journals. For men, literature and the spouse/partner were the most prominent. The youngest age groups--women and men alike--had received more information from the school nurse and the teacher than older groups. Physicians have a central role as information sources. They should be aware of other information sources in the community and should adapt their own work accordingly.

PIP: This study aims to evaluate the relative importance of various information sources in Finland as measured by men and women¿s ratings of their knowledge of contraceptive methods. The place of physicians among the information sources was also specifically to be ascertained. Response rates were about 56% for women and 45% for men. The amount of knowledge that respondents obtained from various sources was estimated on a visual analog scale. The three most important sources for women were literature, physicians, and women¿s journals. The most prominent sources for men were literature and their spouses/partners. The younger age groups of both sexes gained more information from school nurses and teachers. This study shows that physicians have primary roles as information sources. They need to be familiar with other information sources and should fulfill their responsibility accordingly.

Contraceptive methods used and preferred by men and women.

In 1997, a random sample of Finnish men (n = 395) and women (n = 393) aged 18-50 years received a postal questionnaire concerning family planning, in which they were asked which contraceptive methods they had ever used and which three methods they considered to be best. Men's contraceptive preferences were compared to those of women. The response rate for men was 45% and for women 56%. The majority of both men and women had used, together with their partners, condom, oral contraceptives (OCs) and intrauterine devices (IUDs). The use of diaphragm, Norplant, Depo Provera and postcoital IUDs was not common. Among the men, 2-11% did not know whether their partner/partners had used the contraceptives in question. Concerning the three best contraceptive methods, men placed the condom first and women OCs. No male or female respondents rated postcoital emergency pills a superior method. Both men and women appreciated the most reliable means.

Use and knowledge of hormonal emergency contraception.

Hormonal emergency contraception (EC) is an acceptable means of postcoital prevention of pregnancy, but potential users should have information and education about it before they need it. The aim of this study was to establish how many women and how many men's partners have used hormonal EC and how well the respondents know the correct time to take EC pills. Random samples (393 women and 395 men) were drawn from the Finnish population register. Response rates were 56% for women and 45% for men. Of all responding women and men, 12% had themselves or together with their partners used EC. The proportion of EC users was highest in the younger age group among both women and men. It was greater among single and cohabiting women than among married women. Only a minority of respondents knew that EC pills could be taken up to 72 h after unprotected intercourse. Women who had used EC were most knowledgeable, as were also the younger age groups among both women and men. Awareness of the availability of EC and of its correct use should be further promoted to avoid unwanted pregnancies.

Oral contraceptives: views among primary health-care physicians and the general population.

OBJECTIVES: To ascertain the views of physicians and the general population concerning oral contraceptive (OC) use and the risk of thrombosis after the pill scare and, moreover, to investigate whether respondents' smoking habits had any impact on these perceptions. METHOD: A questionnaire on family planning was mailed to randomly selected Finnish health-center physicians (n = 351) and to a random sample of Finnish women (n = 393) and men (n = 395). All were asked to evaluate statements concerning OCs using a visual analog scale from 0 (strongly disagree) to 100 (strongly agree). RESULTS: The response rate for physicians was 69%, for women 56% and for men 45%. Respondents in all subgroups agreed to some extent that OCs increase the risk of thrombosis. Among the population, more women than men were of the opinion that it is dangerous to smoke while using OCs and non-smokers were more aware of the risk of OC use and simultaneous smoking than were smokers. Physicians' personal smoking habits had no evident impact on opinions concerning OC use, risk of thrombosis and smoking. CONCLUSIONS: Although differences existed between the perceptions of physicians and those of the general population concerning OCs, their opinions are realistic and in harmony.

Low trehalase activity is associated with abdominal symptoms caused by edible mushrooms.

BACKGROUND: The purpose of the study was to evaluate whether maldigestion of trehalose causes abdominal symptoms and which available diagnostic method best distinguishes intolerant from tolerant subjects. METHODS: A 25-g oral trehalose load test was performed in 64 subjects. The 19 experiencing clear symptoms constituted the trehalose-intolerant subjects. Changes from base-line levels of blood glucose, breath hydrogen, and methane and symptoms were recorded after the test. Trehalase activity was determined in serum and on a duodenal biopsy specimen obtained by endoscopy. RESULTS: Intolerant subjects were best differentiated from tolerant subjects by changes in breath gases (hydrogen and methane) and duodenal trehalase to sucrase ratio. The change in breath gases correlated inversely with duodenal trehalase activity, duodenal trehalase to sucrase ratio, and plasma trehalase activity. The correlation between serum and duodenal trehalase activities was on the order of 0.6. Two subjects were found to have trehalase deficiency. CONCLUSIONS: It is obvious that trehalose maldigestion can cause symptoms similar to those of lactose maldigestion and intolerance. Three factors control the genesis of symptoms: 1) the activity of small-bowel trehalase: if it is low, trehalose is maldigested and more trehalose is passed into the colon; 2) the maldigested trehalose, which causes osmotic water flow into the colon, resulting in loose stools and diarrhea; and 3) most importantly, the microflora of the colon, from which symptoms will arise if there are bacteria capable of producing gases from maldigested trehalose. If colonic bacteria cannot produce gases, then distention of the abdomen and intestinal gas expulsion as eructations and flatus will not occur.

Strip test is reliable in common prevalences of hypolactasia.

The object of this study was to compare the indirect diagnostic methods on the basis of urinary galactose determination in the diagnosis of lactose malabsorption with the actual lactase activities. One hundred and seven patients were studied. The specificity and sensitivity of the strip test were 97%. With 30% actual prevalence the positive predictive value was 94%, and the negative predictive value was 99%. In common prevalences of hypolactasia the strip test was reliable.

How Estonian and Finnish primary care doctors rate their need for common drugs.

OBJECTIVE: To compare ratings of the necessity of drugs in the daily practice of experienced primary care doctors in Estonia and Finland to find out the differences and similarities in the therapeutic traditions of the two different societies. METHODS: A questionnaire was sent to all Estonian district doctors born in the 1940s and to all Finnish specialized general practitioners born in the 1940s, who then evaluated the necessity of the listed drugs on a visual analogue scale. The ratings, from 0 to 100, were entered into a computer, using a graphic tablet and a pressure sensitive pointer. RESULTS: The six most highly-evaluated drugs among the Estonian respondents were digoxin, glyceryl trinitrate, aspirin, calcium-channel blockers, beta-adrenoceptor blockers and frusemide; and among the Finnish general practitioners (GPs) were penicillin, insulin, glyceryl trinitrate, beta-adrenoceptor blockers, frusemide and angiotensin-converting enzyme (ACE) inhibitors. The ratings of 15 out of 33 drugs/drug groups were very similar both in Estonia and Finland. The biggest differences between the opinions of the Estonian and Finnish doctors appeared in the ratings regarding the necessity of antacids, cimetidine, insulin, sulphonylureas, reserpine. ACE inhibitors, oral contraceptives, penicillin, metronidazole, trimethoprim, indomethacin, phenobarbital and theophylline. CONCLUSION: The revealed differences are suggested to be related to the different health care systems (different task profiles of doctors, different pharmaceutical services), different education of doctors, different availability of drugs in the past and different prices, all of which influence therapeutic traditions.

Galactitol is not a cause of senile cataract.

It has been postulated that the accumulation of sugar alcohol, galactitol, from milk induces cataract in the eye lens through an osmotic mechanism. In this study the concentrations of galactitol and other sugar alcohols (sorbitol, mannitol and inositol) were measured by sensitive gas chromatography in the lenses of 15 patients operated on for senile idiopathic cataracts and in 14 clear lenses removed at autopsy. Large amounts of inositol (mean +/- SD, 4.1 +/- 3.1 vs 4.7 +/- 3.0 mumol/g lens wet weight) and small amounts of mannitol and sorbitol were detected in both study groups. Galactitol levels remained clearly below the detection limit (2 nmol/g) in all lenses. It seems unlikely that senile cataract is a result of the accumulation of galactitol in the eye lens.

Course of antrum and body gastritis in pernicious anemia families.

The course of antrum and body gastritis was studied using an essentially linear multicompartmental model in pernicious anemia probands, their first-degree relatives, and controls consisting of a representative family sample of a large Finnish population. Our earlier dynamic approach showed that progression of body gastritis was virtually identical in a series followed up with biopsies and in cross-comparison analyses, indicating that cross-sectional data can be used for dynamic analyses at a population level. The collected data fitted a model which consisted of stepwise progression of body gastritis to severe atrophy, of corresponding progressive steps for antral gastritis, and of regression of the antral changes after the end-stage of the body process had been reached. In addition, acceleration of the progression of gastritis in older subjects had to be taken into account in the model construction. The main findings which characterized pernicious anemia probands and their close relatives were: (1) a rapid overall progression of body gastritis particularly after 50 years of age; (2) a very rapid progression of body atrophy in its final stages, which was unrelated to age; (3) the occurrence of juvenile severe body atrophy; and (4) the healing of antral gastritis which was most marked at the stage of superficial gastritis. These results may offer a dynamic explantation for the occurrence of severe body atrophy in association with a normal or slightly altered antral mucosa in pernicious anemia and the prepernicious anemia state.

More women enter medicine: young doctors' family origin and career choice.

This study is part of the Finnish Junior Physicians 88 Study, the purpose of which was to shed light on the life situation, career choice and future plans of young doctors and their views on medical education. The survey population included all the medical doctors registered during the years 1977-1986 in Finland (n = 5208). A postal questionnaire was sent to a sample of 2632 doctors born on odd-numbered days. After a reminder letter, 1745 questionnaires (66%) were returned. Forty-nine per cent of the respondents were women. Typically both men and women doctors had a father who was an upper-level white-collar worker and a mother who was a housewife. More men than women had a father who was a doctor or other health professional. More women than men mentioned that a lifelong calling (42% vs 30%), success at school (58% vs 47%) and an interest in helping people (78% vs 71%) had considerable influence on their decision to become a doctor. Men more often than women emphasized the medical profession being regarded as a highly paid (56% vs 47%) and a high status profession (64% vs 56%) and also that a family member was a doctor (15% vs 11%).

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 study.

The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the 'Junior Physician 88' study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977-1986 in Finland (n = 5208). After randomization, a postal questionnaire was sent to one half (n = 2631) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team-work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.

[The self-perception of their professional role of the primary care physicians of Estonia and Finland]. / Autopercepción del rol profesional de los médicos de atención primaria de Estonia y Finlandia.

OBJECTIVE: To find out how experienced primary care physicians working in different societies see themselves as doctors. DESIGN: A cross-sectional study. SETTING: Primary health care in Estonia and Finland. PARTICIPANTS: Estonian district doctors (n = 110) and Finnish specialists of general practice (n = 211). METHODS: In a postal questionnaire the respondents were asked to evaluate how well 18 different expressions described them as doctors on a 5-step scale from "1 = very poorly" to "5 = very well". RESULTS: Four of the five expressions that were thought most accurate and telling--"Listener", "Vocational doctor", "Helper", and "Family physician"--were the same in Estonia and Finland. CONCLUSIONS: Even though there are differences in health care systems, the self-images of primary care doctors in both countries were more or less consistent with the international definitions of the general practitioner's job and role.

Lactose malabsorption in Khants in western Siberia.

BACKGROUND: We wanted to estimate the prevalence of selective lactose malabsorption (SLM) in Khants, a small Finno-Ugric population living in Western Siberia who have traditionally consumed no milk in adulthood. METHODS: A total of 80 Khants, aged 8-57 years and living on the middle reaches of the River Ob, were studied. The diagnosis was based on a lactose tolerance test; general malabsorption was excluded by a glucose-galactose tolerance test whenever possible. In six subjects electronmicroscopic examination of the duodenal mucosa was performed. RESULTS: The prevalence of SLM in the Khants was 94%. CONCLUSION: This is the highest prevalence found in the previous Soviet Union.

Evaluation of undergraduate medical education in Finnish community-oriented and traditional medical faculties: a 10-year follow-up.

OBJECTIVES: This study focused on Finnish physicians' views of their undergraduate medical education. Differences between traditional and community-oriented medical faculties were examined and changes which had taken place during a 10-year follow-up period were also assessed. METHODS: The study was based on data retrieved from a postal survey made among Finnish physicians in 1998. The study population consisted of all doctors who graduated between 1987 and 1996 (n=4926); those born on odd-numbered days were selected for this study (n=2492). A postal questionnaire and two reminders were sent to those selected, and 1822 questionnaires were returned, giving a response rate of 73.1%. RESULTS: Physicians who graduated from the community-oriented faculties were more satisfied with their undergraduate medical education when compared with their colleagues graduating from traditional faculties. There were some differences between the universities with respect to education for hospital work. The teaching of primary health care, however, was clearly more effective in community-oriented faculties. The proportion of graduates who were satisfied with their primary care education was over 70% in community-oriented faculties, whereas in the traditional faculties it was only 35-45%. CONCLUSIONS: According to graduates, the community-oriented medical school curriculum better meets the needs of practising physicians than that in traditional faculties. In curriculum reforms, more emphasis should be placed on comprehensive medical education, which includes both primary and secondary health care.

Where should special attention be paid in undergraduate medical education? Two surveys among Finnish physicians.

The study focuses on Finnish doctors' views of their undergraduate medical education. In 1988, a study (Junior Physician 88 Study) involving all the doctors registered during the years 1977-1986 in Finland (n = 5208) was carried out. A questionnaire was sent to a random sample of 2632 doctors, and after two mailings 1745 questionnaires (66.3%) were returned. A total of 1334 gave at least one answer to the question: 'Where should special attention be paid in undergraduate medical education?' Five years later, in 1993, another study (Physician 93 Study) involving all medical doctors registered in Finland during the years 1982-1991 (n = 4671) was carried out. The same questionnaire was sent to a random sample of 2332 doctors, and after two reminders 1818 questionnaires (78.0%) were returned, and 1228 doctors also answered the open-ended question. Content analysis was used to analyse the answers qualitatively and quantitatively. About 90% of the answers could be classified into two main categories: practical skills and evaluation of subjects. The most common proposal for the improvement of undergraduate medical education was that the practical skills needed in general practice should be taught. More education in administration and health economics was also desired. Respondents said that preclinical and clinical studies should be more closely integrated. In answers to the open question, the course in public health was strongly criticized for being too theoretical. Learning of the core knowledge for medical practice was considered essential.