Hans Helenius

The Effect of Changes in the Consumption of Macrolide Antibiotics on Erythromycin Resistance in Group A Streptococci in Finland

BACKGROUND In the early 1990s there was an increase in erythromycin resistance among group A streptococci in Finland. In response, policies regarding outpatient antibiotic therapy were changed, and nationwide recommendations were issued that called for reductions in the use of macrolide antibiotics for respiratory and skin infections in outpatients. We studied the effect of this policy on the pattern of erythromycin resistance throughout Finland. METHODS From 1991 through 1996, a total of 39,247 group A streptococcal isolates from throat swabs (82 percent of the isolates) and pus samples (18 percent) and 290 isolates from blood cultures were studied in regional microbiology laboratories. The susceptibility of the isolates to erythromycin was tested by the disk-diffusion or the screening-plate method. RESULTS Consumption of macrolide antibiotics decreased from 2.40 defined daily doses per 1000 inhabitants per day in 1991 to 1.38 in 1992 (P=0.007) and remained near the lower level during the study period. The change in consumption was followed by a steady decrease in the frequency of erythromycin resistance among group A streptococcal isolates from throat swabs and pus samples, from 16.5 percent in 1992 to 8.6 percent in 1996 (odds ratio for 1996 as compared with 1992, 0.5; 95 percent confidence interval, 0.4 to 0.5). CONCLUSIONS In Finland, after nationwide reductions in the use of macrolide antibiotics for outpatient therapy, there was a significant decline in the frequency of erythromycin resistance among group A streptococci isolated from throat swabs and pus samples.

Interrelations Between Brachial Endothelial Function and Carotid Intima-Media Thickness in Young Adults The Cardiovascular Risk in Young Finns Study

Background—Endothelial vasodilator dysfunction and carotid intima-media thickening (IMT) are 2 indicators of subclinical cardiovascular disease. We examined their correlation and interaction with risk factors in a large, community-based cohort of young adults. Methods and Results—As part of the longitudinal Cardiovascular Risk in Young Finns Study, we measured endothelium-dependent brachial artery flow–mediated dilatation (FMD) and carotid artery IMT by ultrasound in 2109 healthy adults aged 24 to 39 years. FMD was inversely associated with IMT (P≤0.001) in a multivariate model adjusted for age, sex, brachial vessel size, and several risk variables. The subjects with age- and sex-specific FMD values in the extreme deciles were classified into groups of impaired (n=204, FMD=1.1±1.4%, mean±SD) and enhanced (n=204, FMD=16.3±2.9%) FMD response. The number of risk factors was correlated with increased IMT in subjects with an impaired FMD response (P<0.05) but not in subjects with an enhanced FMD response (P>0.2). Conclusions—Brachial FMD is inversely associated with carotid IMT. The number of risk factors in young adults is correlated with increased IMT in subjects with evidence of endothelial dysfunction, but not in subjects with preserved endothelial function. These observations suggest that endothelial dysfunction is an early event in atherosclerosis and that the status of systemic endothelial function may modify the association between risk factors and atherosclerosis.

Farm environment in childhood prevents the development of allergies

A protective effect of infections in early life might explain the firmly reported finding of an inverse association between atopic disorders and large sibships.

Non-response and related factors in a nation-wide health survey

Objective: To analyse selective factors associated with an unexpectedly low response rate. Subjects and methods: The baseline questionnaire survey of a large prospective follow-up study on the psychosocial health of the Finnish working-aged randomly chosen population resulted in 21,101 responses (40.0%) in 1998. The non-respondent analysis used demographic and health-related population characteristics from the official statistics and behavioural, physical and mental health-related outcome differences between early and late respondents to predict possible non-response bias. Reasons for non-response, indicated by missing responses of late respondents, and factors affecting the giving of consent were also analysed. Results: The probability of not responding was greater for men, older age groups, those with less education, divorced and widowed respondents, and respondents on disability pension. The physical health-related differences between the respondents and the general population were small and could be explained by differences in definitions. The late respondents smoked and used more psychopharmaceutical drugs than the early ones, suggesting similar features in non-respondents. The sensitive issues had a small effect on the response rate. The consent to use a medical register-based follow-up was obtained from 94.5% of the early and 90.9% of the late respondents (odds ratio: 1.70; 95% confidence interval: 1.49–1.93). Consent was more likely among respondents reporting current smoking, heavy alcohol use, panic disorder or use of tranquillisers. Conclusions: The main reasons for non-response may be the predisposing sociodemographic and behavioural factors, the length and sensitive nature of the questionnaire to some extent, and a suspicion of written consent and a connection being made between the individual and the registers mentioned on the consent form.

Psychosocial risk factors associated with cyberbullying among adolescents: a population-based study.

CONTEXT To our knowledge, no population study examining psychosocial and psychiatric risk factors associated with cyberbullying among adolescents exists. OBJECTIVE To study cross-sectional associations between cyberbullying and psychiatric and psychosomatic problems among adolescents. DESIGN Population-based cross-sectional study. SETTING Finland. PARTICIPANTS The sample consists of 2215 Finnish adolescents aged 13 to 16 years with complete information about cyberbullying and cybervictimization. MAIN OUTCOME MEASURES Self-reports of cyberbullying and cybervictimization during the past 6 months. RESULTS In the total sample, 4.8% were cybervictims only, 7.4% were cyberbullies only, and 5.4% were cyberbully-victims. Cybervictim-only status was associated with living in a family with other than 2 biological parents, perceived difficulties, emotional and peer problems, headache, recurrent abdominal pain, sleeping difficulties, and not feeling safe at school. Cyberbully-only status was associated with perceived difficulties, hyperactivity, conduct problems, low prosocial behavior, frequent smoking and drunkenness, headache, and not feeling safe at school. Cyberbully-victim status was associated with all of these risk factors. Among cybervictims, being cyberbullied by a same-sex or opposite-sex adult, by an unknown person, and by a group of people were associated with fear for safety, indicating possible trauma. CONCLUSIONS Both cyberbullying and cybervictimization are associated with psychiatric and psychosomatic problems. The most troubled are those who are both cyberbullies and cybervictims. This indicates the need for new strategies for cyberbullying prevention and intervention.

What is the early adulthood outcome of boys who bully or are bullied in childhood? The Finnish "From a Boy to a Man" study.

OBJECTIVE. Our goal was to study predictive associations between bullying and victimization at age 8 years and psychiatric disorders in early adulthood. METHODS. The sample comprised 2540 boys born in 1981. Information about bullying and victimization was gathered in 1989 when the boys were 8 years old from parents, teachers, and children. Information about psychiatric disorders was based on military call-up examination and army registry when the subjects were 18 to 23 years old. RESULTS. In univariate logistic regression analysis, frequent bullying-only status predicted antisocial personality, substance abuse, and depressive and anxiety disorders; frequent victimization-only status predicted anxiety disorder, whereas frequent bully-victim status predicted antisocial personality and anxiety disorder. When controlled against the effects of parental education level and parent and teacher reports of emotional and behavioral symptoms by using Rutter scales, frequent victimization-only status predicted anxiety disorders, and frequent bullying-only predicted antisocial personality disorder, whereas frequent bully-victimization predicted both anxiety and antisocial personality disorder. Information about frequent bullying and victimization as primary screening for children at risk identified ∼28% of those with a psychiatric disorder 10 to 15 years later. CONCLUSIONS. Both bullying and victimization during early school years are public health signs that identify boys who are at risk of suffering psychiatric disorders in early adulthood. The school health and educational system has a central role to play in detecting these boys at risk.

Age-related dopamine D2/D3 receptor loss in extrastriatal regions of the human brain.

Loss of dopamine D2-like receptors in the striatum has been associated with both normal human aging and impairment of cognitive and motor functions in the elderly. To investigate whether there are age-associated changes in dopamine D2 and D3 receptor subtypes (D2/3Rs) outside the striatum, a D2/3R selective high-affinity radioligand [11C]FLB 457 was used in positron emission tomography (PET) examinations for 24 normal healthy male subjects (age range 19-74 years). Significant age-related declines of D2/3Rs were detected in all the brain regions studied: the anterior cingulate cortex (decline of 13% per increase of a decade in age, P < 0.001). the frontal cortex (11%, P < 0.001), the lateral temporal cortex (10%, P < 0.001), the hippocampus (10%, P < 0.01), the medial temporal cortex (9%, P < 0.001), the amygdala (7%, P < 0.01), the medial thalamus (6%, P < 0.001) and the lateral thalamus (5%, P < 0.01). The rate of D2/3R decline was significantly faster in the frontal cortex as compared to the medial temporal cortex (P < 0.05, Bonferroni corrected) and as compared to the medial thalamus (P < 0.05, Bonferroni corrected). These results indicate that the previously demonstrated age-related decline in striatal dopamine D2 receptors extends to several extrastriatal regions in normal human males. Further, the rate of D2/3R decline may be faster in the frontal cortex as compared to the temporal and thalamic regions.

Alpha-synuclein-immunoreactive cortical Lewy bodies are associated with cognitive impairment in Parkinson's disease

Abstract Amygdala, hippocampus and six cortical gyri were examined for the Lewy body (LB) degeneration and Alzheimer’s disease (AD) type changes in 45 patients with Parkinson’s disease (PD). For detection of LBs, the brain areas were stained with an antibody against alpha-synuclein. The extent of neuropathological lesions was investigated in relation to cognitive dysfunction and apolipoprotein E (apoE) ɛ4 allele dosage. At least one cortical LB was found in 95% of cases (43/45). Furthermore, 40% of cases (18/45) had histological findings of definite AD (CERAD class C). Those PD cases with the apoE ɛ4 allele had a significantly greater number of cortical LBs than those without the apoE ɛ4 allele, but this was statistically significant only in precentral, angular and temporal gyri. The LB density correlated better with the number of plaques than with the density of tangles. The number of LBs in several cortical areas correlated significantly with the cognitive impairment. In stepwise linear regression analysis, the number of LBs in the cingulate gyrus and the amount of tangles in the temporal cortex remained statistically significant. When the CERAD class C was excluded, the correlation between cognitive decline and the number of LBs in cortical areas became even more pronounced. A stepwise linear regression analysis in these cases found the number of LBs in the frontal gyrus to be the statistically most significant predictor of cognitive impairment. This study shows, for the first time, that in PD, alpha-synuclein-positive cortical LBs are associated with cognitive impairment independent of AD-type pathology.

Parent-adolescent agreement on emotional and behavioral problems

Background: The aim of the study is to report parent/youth self-report agreement on emotional and behavioral symptoms among 15- to 16-year-old adolescents. Methods: A completed Child Behavior Checklist and Youth Self-Report were obtained from 580 subjects. Results: Adolescents reported significantly more problem behaviors than their parents. Adolescent girls reported a significantly higher level of distress than boys in most symptom domains. The discrepancies between parent reports and youth self-reports were greater, especially for internalizing symptoms, for girls than for boys. Conclusions: Many adolescents in need of psychiatric assessment do not receive appropriate help because their problems remain unnoticed by adults. Internalizing problems among girls seem especially likely to remain unrecognized by adults.

Sense of coherence as a predictor of subjective state of health: Results of 4 years of follow-up of adults

UNLABELLED A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS A strong SOC predicted good health in women and men. CONCLUSIONS SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.