Validity of the estimated food diary: comparison of 2-day recorded and observed food and nutrient intakes.

We assessed the validity of the estimated food diary by comparing recorded and observed food and nutrient intakes for 121 subjects (71 men and 50 women) aged 15 to 65 years. We obtained observed intake by unobtrusively recording the amounts of foods, preweighed or measured when served, at the four meals on each of the two study days. At the same time, subjects kept an estimated food diary. In general, the mean food intake recorded in the food diaries deviated from the observed intake by 15% at most. The deviation exceeded 20% for only a few food items. With the exception of calcium (-11%), starch (+10%) and thiamin (+8%), there was no difference or only a few percent difference in the means for energy and the 16 nutrients calculated. The validity of the food diary was equally high for men and women in the 15 to 34, 35 to 44, and 45 to 65 age groups. Product-moment correlation coefficients ranged from 0.68 to 0.97 for food intake and from 0.75 to 0.92 for nutrient intake. We conclude that validity is very satisfactory on the group level and is probably acceptable on the individual level.

Agreement between dietary interviews.

The nutrient intake for 86 male myocardial infarction patients was calculated from data based on the interview methods studied both one and two years after infarction. The dietary history method resulted in systematically higher mean daily intakes than the other methods. The differences in mean intakes calculated from the recall methods were, in general, rather small. The agreement, measured by the intraclass correlation coefficient, varied from 0.42 to 0.69. The pattern of mean differences between methods was consistent one and two years after infarction.

Validity of the 24-hour dietary recall.

The validity of the 24-hour recall was studied with a comparison of recalled and observed food and nutrient intake for 140 subjects, 84 males (60%) and 56 females (40%), 15 to 57 years old. The observation was carried out during 1 day by recording the amounts of foods selected by the subjects at four meals. The following day, 24-hour recalls were obtained. The results showed that some food items eaten were omitted in the recall, the extremes being 4% of times eaten for fish and 50% for cooked vegetables. In addition, some food items not actually eaten were added in the recall, the additions ranging from 2% of times recalled for bread to 29% for sugar. The difference between mean recalled and observed nutrient intake was between -6% and 11%, except for sucrose (-20%) and vitamin C (-16%). The product-moment correlation coefficient between observed and recalled nutrient intake was in the range of 0.58 to 0.74. Women achieved somewhat more accurate results than men, and the recall results in the 35 to 44 age group were the most valid. It was concluded that validity is unsatisfactory on the individual level and satisfactory on the group level.

Comparison of nutrient intake data calculated on the basis of two different databases. Results and experiences from a Swedish-Finnish study.

BACKGROUND AND OBJECTIVE: In international surveys of food consumption and nutrient intake, it is essential that the dietary data are comparable when different databases and calculation programs are used. The aim of the present analysis was to examine the comparability of nutrient intake data calculated on the basis of the Swedish food composition database PC-kost and the Finnish food composition database Nutrica. SUBJECTS AND METHODS: A total of 20 male adults currently living in Sweden were selected from a group of Finnish twins of the Finnish Twin Cohort Study. Food consumption data were collected by means of diet history interviews. The estimated intakes of 30 nutrients calculated on the basis of PC-kost were compared to the corresponding estimates calculated on the basis of Nutrica. The calculation procedures were standardised. RESULTS: No statistically significant differences were observed in the mean intakes of energy, total fat, saturated fat, carbohydrates, dietary fibre, alcohol, cholesterol, vitamin A, retinol, beta-carotene, vitamin D, alpha-tocopherol, riboflavin, niacin, vitamin B(12), vitamin C or phosphorus. PC-kost yielded a 20% higher intake (NS) for vitamin D and 23% higher intake (P<0.001) for thiamine than Nutrica, which is mainly attributed to the differences in the enrichment of foodstuffs between Sweden and Finland. Conversely, PC-kost yielded 53% lower values (P<0.001) for selenium than Nutrica, owing to the increased selenium content in many Finnish foodstuffs as a result of the addition of selenium to fertilisers. Statistically significant differences were found for protein, monounsaturated fatty acids, vitamin B(6), iron and sodium (5-9% higher values from PC-kost) and for polyunsaturated fatty acids, folate, zinc, calcium, magnesium and potassium (4-10% lower values from PC-kost). The variation in the intake of these nutrients between the two methods may be explained by the differences in foodstuff-specific nutrient values (eg product formulations), or differences in the sources of data, recipes or calculation procedures. The correlation coefficient was > or =0.81 for most nutrients. At least 85% of the subjects in each PC-kost quintile were classified into the same or adjacent Nutrica quintile for all nutrients. CONCLUSIONS: Our results indicate that, for a dominant part of the examined nutrients, the estimated intakes calculated by means of standardised procedures using the PC-kost and Nutrica databases are comparable between Sweden and Finland. Differences observed for some nutrients reflect either actual differences in foods between the two countries or methodological differences in the assessment of nutrient intakes.

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part I: Patient characteristics and differences between groups.

Based on a prospective study on 342 sciatica patients examined with rhizography, the aim was to determine which factors others than the rhizography finding and the grade and duration of symptoms were related to the selection of patients to undergo operation. Compared with surgically treated patients, conservatively treated patients who did not undergo operation and who had pathologic rhizography findings had pessimistic attitudes to possible surgery, often expressed a desire to retire, and considered their work as physically stressful. The women in this group were older and had lower pain indices than women who underwent operation. Conservatively treated patients with negative rhizography had more severe occupational handicaps, minor expectations of possible surgery, physically more strenuous jobs requiring difficult physical positions, and lower indices for pain and ADL than did the operated patients. The social and ergonomic background problems are emphasized in sciatica patients conservatively treated after rhizography.

A prospective study of patients with sciatica. A comparison between conservatively treated patients and patients who have undergone operation, Part II: Results after one year follow-up.

The prospective study included 122 sciatica patients who had not undergone operation (NOPs) and 220 sciatica patients who had undergone operation (OPs); all had been examined by rhizography. The follow-up study was done on 110 (90%) of the NOPs and 212 (96%) of the OPs. The NOPs were divided into two groups: 30 patients with pathologic rhizography (PR) and 80 patients with negative rhizography (NR). Pain-, ADL-, and occupation-handicap indices showed that after the 1 year follow-up the OP group had the best result and the NR group the lowest result. The PR group had nearly as good a result as the OP group. Thus, sciatica patients are candidates for conservative therapy, even though they have pathologic findings in rhizography, if the symptoms are mild. To improve therapeutic outcome, more accurate diagnostic tools are needed to develop specific therapy especially for those sciatica patients with negative rhizography.

Psychological impairments, disabilities, and handicaps: a pilot study of psychological assessment of functioning in chronic pain patients.

This study addresses the psychological assessment of functioning in chronic pain patients. First, a model of functional assessment is proposed, which is based on the biopsychosocial view of chronic disease (Engel) and on the consequences of diseases (WHO). Second, a set of psychological criteria for impairments, disabilities, and handicaps, described by WHO as the consequences of diseases, are determined. Third, the psychological criteria selected are operationalized and the utility of the psychological assessment instruments tested in a clinical rehabilitation study. The results indicate that prediction of post-treatment functioning in the rehabilitation patient, by psychological procedures, may improve if the concept of functioning is determined as three sub-areas of impairments, disabilities, and handicaps.

Rehabilitation after surgery for lumbar disc herniation: results of a randomized clinical trial.

The aim of this prospective study was to examine the one-year postoperative results in patients operated on for lumbar disc herniation randomized in two groups: one with comprehensive rehabilitation and the other taken care of by normal care facilities. A total of 212 patients without any previous spinal operations comprised the final study group. The physiatrist, the surgeon, the social worker, and the psychologist performed the handicap evaluation according to the occupation handicap scales of the WHO. The handicap was evaluated for two phases: before the onset of acute sciatica leading to operation and one year after operation. No significant differences in handicap distribution between the intervention and normal care groups were seen. The postoperative handicap correlated highly significantly with preoperative handicap for both groups. More than half (57%) of all the patients returned to work within two months of the operation. The amount of sick leaves did not differ significantly between the intervention and normal care groups. A total of 15 persons (7%) retired during the postoperative year.

Effects of comprehensive rehabilitation on weight reduction in myocardial infarction patients.

The effect of a comprehensive rehabilitation programme, including diet therapy, was studied in overweight male myocardial infarction (MI) patients randomly assigned to a rehabilitation group (n = 69) and a control group (n = 64). The results show a mean weight decrease of 3.8 kg in the rehabilitation group and a mean weight increase of 1.1 kg in the control group (t = -5.78, p less than 0.001). The proportion of patients reducing their weight more than 5 kg was 33% in the rehabilitation group and 5% in the control group (chi 2 = 15.6, p less than 0.001). Patient characteristics which significantly affected the weight change by univariate analysis were age, level of overweight, smoking habits, employment situation and social problems. Multivariate analyses yielded a two-variable model with moderate explanatory power in the rehabilitation group. The model includes the variables Body Mass Index and cessation of smoking before MI.

Invalidity pension after lumbar disc operation.

A total of 753 patients (328 women, 425 men) below 65 years of age and without previous pension living in the South-West of Finland, were operated on for the first time for lumbar disc herniation during the period 1975-1979. The frequency of a new invalidity pension was observed during a follow up period of two years. Of the 753 patients there were 100 new invalidity pensioners (13%) during one year and 133 (18%) during two years after the first operation. According to a statistical model for the impact of age and nature of work on invalidity pension the greatest risk of pensioning for women was associated with age, pensioning being more than five times higher in the age group 45-54 years than below 35 years. Moderate and heavy work by women constituted a minor risk factor, increasing the risk by less than two times compared with light work. In men the risk correlated clearly to both age and nature of work. Moderate and heavy work increased the risk nearly three times compared with light work. The frequency of pensions among 45-64 year old men was even 6-8 times higher, than the risk for men below 35 years. A second operation increased the risk on average two to three times. Cauda equina syndrome was not a risk factor for receiving an invalidity pension. The primary diagnosis for an invalidity pension was something other than lumbar disc herniation in 20%. Patients with unsatisfactory results after lumbar disc operations account for about 10% of all the new invalidity pensions due to some form of back disease in Finland.

A health promotion programme for oil refinery employees: changes of health promotion needs observed at three years.

The main aim of this three-year follow-up study was to evaluate the long-term effects of a workplace health promotion intervention programme offered by the Neste Oyj corporation's occupational health service. Another aim was to study factors associated with changes in health promotion needs. These were assessed using information obtained by means of questionnaires and laboratory measurements. The target areas assessed were physical activity, musculoskeletal problems, dietary habits, obesity, blood pressure, serum lipids, smoking, quality of sleep and mental well-being. Participants from one oil refinery were offered special health promotion counselling, while those from the other oil refinery studied received only their personal results, written information and instructions. Evaluation of the changes in needs was mainly based on comparison of the results of two examinations performed with an interval of three years. Effects of special health promotion counselling were observed in the target area of physical activity. Elimination of certain health promotion needs was seen in both groups in all of the target areas. The most extensive changes were seen in the target areas of musculoskeletal symptoms, dietary habits, blood pressure and mental well-being. Basic education, occupational status and age-group, as well as the value of tending health were frequent variables explaining the reduction in the need for health promotion activities. Worker participation in health promotion counselling activities provided by occupational health services can be high, as in this study in which the participation rate was 90% and the drop-out rate during the three years only 10%.

Long-term reduction in sudden deaths after a multifactorial intervention programme in patients with myocardial infarction: 10-year results of a controlled investigation.

Three-hundred and seventy-five unselected patients below 65 years of age and with acute myocardial infarction participated in a controlled investigation aimed at studying the effects of a multifactorial intervention programme on morbidity, mortality and risk factor control. After ten years' follow-up the significantly lower sudden death and coronary mortality observed three years after myocardial infarction still persisted in the intervention group (188 patients) compared with the control group (187 patients). The incidence of sudden death in the intervention group was 12.8% compared with 23.0% in the controls (P = 0.01). The incidence of coronary mortality was 35.1% and 47.1%, respectively (P = 0.02). No significant difference was found in the number of patients with clinical non-fatal reinfarctions (25.6% and 19.3%, respectively). During the first year, when the mortality difference was most marked, the use of beta blockers was not significantly different between the groups. The results suggest that with a multifactorial intervention programme which starts early after the infarction and lasts for years a significant long-term reduction in sudden deaths and coronary mortality can be attained.

Subjective quality of sleep and use of hypnotics in an elderly urban population.

To investigate the characteristics and subjective quality of sleep, the use of hypnotics and their correlates in an urban elderly population, a structured interview was administered to a stratified random sample of 600 elderly subjects in five age groups. Interrupted sleep and napping were common; nonetheless, 88% of the subjects considered their sleep at least satisfactory. According to specific criteria, 17% were good, 72% moderate and 11% poor sleepers. Habitual insomnia was reported by 12% of the subjects. Quality of sleep did not differ between age groups or genders. Hypnotics were habitually used by 8% of the men and 25% of the women. Consumption increased with age in both sexes, and 77% of the hypnotics were benzodiazepines. In multivariate regression analyses, insomnia and habitual use of hypnotics were associated with poor health, but only the latter with age and gender. As a conclusion, most of the subjects considered their sleep satisfactory, and aging itself did not seem to have an effect on the quality of sleep. The use of hypnotics was common, more prevalent in women and increased with age. Aging and poor health were independently associated with the use of hypnotics, but not with poor quality of sleep or insomnia.

Exercise habits and physical performance during comprehensive rehabilitation after coronary artery bypass surgery.

The effects of training as part of a comprehensive rehabilitation programme on exercise capacity and habits was studied in 171 male coronary artery bypass surgery patients randomized into a rehabilitation (R) (n = 93) and a reference, hospital-based treatment (H), group (n = 78). The rehabilitation programme started with a 2-day informative course before surgery and continued with a 3-week exercise-based course 2 months after surgery followed by a 2-day refresher 8 months post-operatively. The percentages of subjects having regular exercise were 22% and 10% pre-operatively, 42% and 38% 6 months and 46% and 38% 12 months after surgery in the R and H groups, respectively. The changes in the proportions observed in R and H groups were not significantly different. Total work during a bicycle exercise test increased from 38.9 +/- 24.3 kJ pre-operatively to 64.0 +/- 31.4 kJ 6 months (P less than 0.001) and to 70.0 +/- 35.7 kJ 12 months (P less than 0.001) post-operatively in group R and from 40.8 +/- 25.6 kJ to 57.3 +/- 26.6 kJ (P less than 0.001) and to 60.4 +/- 30.8 kJ (P less than 0.001) in group H, respectively. The increase from the pre-operative value was greater in group R than in group H both 6 (P = 0.03) and 12 months (P = 0.02) after surgery. Respective changes occurred in maximal work load, but the increase was significantly greater in group R than in group H only 12 months post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Life-style related health promotion needs in oil refinery employees.

This report describes the screening procedure used in the assessment of health promotion needs in a group of oil refinery employees (n = 885). The aim of the study was to assess the life-style related health promotion needs before initiating an intervention programme study. The frequency of different health promotion needs and their distribution according to age, gender and employee group were examined, as well as the factors explaining different health promotion needs. The assessment was based on laboratory tests and questionnaires covering the target areas of physical activity and fitness, dietary habits, overweight, blood pressure, serum lipids, smoking, alcohol consumption, sleep, mental health, and musculoskeletal symptoms. Life-style related health promotion needs were frequent. Self-assessed health was strongly associated with health promotion needs in most of the ten target areas and also with the total number per person of areas with health promotion needs. Health promotion needs were also associated with such demographic variables as age, gender, basic education, and vocational training. If health promotion activities are provided to employees in a company, assessment of individual needs is necessary to find the employees with the greatest need of health promotion actions. This study presents one method of screening, although certain simplification is needed to make it fit into the daily routines. The contents of health promotion activities could also vary according to the differences related to age and gender observed in health promotion needs of the target population.

The proportion of patients with cognitive impairment after coronary artery bypass surgery: an 8-month follow-up study.

The aim of this study was to investigate cognitive function after coronary artery bypass surgery and the association of this with surgical variables. All male patients scheduled for elective surgery, aged 40-64 years, mean age 54 +/- 6 (n = 104), and participating in a randomized rehabilitation study, were included. A comprehensive psychodiagnostic examination was conducted preoperatively, 2, and 8 months postoperatively. The assessment of change was conducted using tertiles, defined according to population norms. More patients revealed improvement than impairment, and practically no significant associations with surgical variables were found.

Lumbar spinal canal size of sciatica patients.

Seven measures at the three lowest lumbar interspaces were recorded from conventional radiographs of the lumbar spines of 160 consecutive patients with low back pain and sciatica admitted for myelography and possible surgery. Eighty-eight patients were operated upon for disc herniation, and of the conservatively-treated 72 patients, 18 had a pathologic and 54 a normal myelogram. The results were evaluated after one year using the occupational handicap scales of WHO. Correlations of radiographic measures to stature were moderate and to age small. After adjusting for stature and age, only the male interpedicular distances and the antero-posterior diameter of intervertebral foramen at L3 were greater than those of females. The males with a pathologic myelogram had smaller posterior disc height at L3 and a smaller interarticular distance at L3 and L4 than those with normal myelogram, likewise the midsagittal diameter at L3 and L4 in females. In all patients other measures besides posterior disc height were smaller than those for low back pain patients (p less than 0.001) or for cadavers (p less than 0.001). The only correlation between measures and clinical manifestations was between pedicular length at L3 and limited straight leg raising. Where the disc material had been extruded into the spinal canal, the interpedicular distance was significantly wider. Only anterior disc height at L3 revealed differences between good and poor outcome one year after surgery, as did the interarticular distance at S1 in patients with normal myelogram after conservative treatment.

Determinants of symptoms suggestive of gastroesophageal reflux disease in the elderly.

The study material consisted of 487 subjects from a stratified random sample of the non-institutionalized population of Turku aged 65 years or more (n = 24,937). The study was based on a population study on health status and sleeping habits of the elderly. Information on health status and medications was obtained by means of interviews and from the national health insurance records of the subjects. A postal questionnaire inquired about symptoms suggestive of gastroesophageal reflux disease (GERD). In univariate analyses, perceived poor health, insomnia, disability, depression, previous peptic ulcer, cholelithiasis, and bronchial asthma were associated with daily symptoms suggestive of GERD. Moreover, the symptoms were associated with the use of beta-blocking agents, benzodiazepines, and neuroleptic agents. In multivariate analyses, previous peptic ulcer, perceived poor health, insomnia, and use of benzodiazepines were independently associated with symptoms suggestive of GERD. In conclusion, the determinants of symptoms suggestive of GERD in the elderly differ from those reported in young and middle-aged subjects.