Pekka Laippala

Longitudinal study of maternal depressive symptoms and child well-being

OBJECTIVE To investigate whether prenatal, postnatal, and/or current maternal depressive symptoms are associated with low level of psychosocial functioning or high level of emotional/behavioral problems in school-age children. METHOD As part of a prospective longitudinal study, maternal depressive symptoms were screened with the Edinburgh Postnatal Depression Scale prenatally, postnatally, and when the children were 8 to 9 years old. The original sample of 349 mothers was collected in 1989-1990 in Tampere, Finland. Of the 270 mother-child pairs at the latest stage of the study in 1997-1998, 188 mother-child pairs participated and 147 were included. The associations between maternal depressive symptoms at different points in time and the level of childrens psychosocial functioning and problems reported on the Child Behavior Checklist and Teachers Report Form were examined. RESULTS Childrens low social competence and low adaptive functioning were associated with concurrent maternal depressive symptoms. Maternal postnatal depressive symptoms predicted low social competence. The presence of prenatal depressive symptoms in the mother was a strong predictor of childs high externalizing and total problem levels (odds ratio 3.1, 95% confidence interval 1.1-8.9 and odds ratio 8.5, 95% confidence interval 2.7-26.5). Prenatal as well as recurrent maternal depressive symptoms were associated with the least favorable child outcome. CONCLUSIONS Maternal depressive symptomatology at any time, especially prenatally, is a risk factor for the childs well-being. This should be noted already in prenatal care. The timing and the recurrence of maternal depressive symptoms affect the outcome for the child.

New biomarker evidence of oxidative DNA damage in patients with non-insulin-dependent diabetes mellitus

Urinary 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) has been reported to serve as a sensitive biomarker of oxidative DNA damage and also of oxidative stress. We have investigated oxidative DNA damage in patients with non‐insulin‐dependent diabetes mellitus (NIDDM) by urinary 8‐OHdG assessments. We determined the total urinary excretion of 8‐OHdG from 24 h urine samples of 81 NIDDM patients 9 years after the initial diagnosis and of 100 non‐diabetic control subjects matched for age and gender. The total 24 h urinary excretion of 8‐OHdG was markedly higher in NIDDM patients than in control subjects (68.2±39.4 μg vs. 49.6±37.7 μg, P=0.001). High glycosylated hemoglobin was associated with a high level of urinary 8‐OHdG. The increased excretion of urinary 8‐OHdG is seen as indicating an increased systemic level of oxidative DNA damage in NIDDM patients.

Prospective Analysis of Accuracy of Positron Emission Tomography, Computed Tomography, and Endoscopic Ultrasonography in Staging of Adenocarcinoma of the Esophagus and the Esophagogastric Junction

AbstractBackground: Exact preoperative staging of esophageal cancer is essential for accurate prognosis and selection of appropriate treatment modalities. Methods: Forty-two patients with adenocarcinoma of the esophagus or the esophagogastric junction suitable for radical esophageal resection were staged with positron emission tomography (PET), spiral computed tomography (CT), and endoscopic ultrasonography (EUS). Results: Diagnostic sensitivity for the primary tumor was 83% for PET and 67% for CT; for local peritumoral lymph node metastasis, it was 37% for PET and 89% for EUS; and for distant metastasis, it was 47% for PET and 33% for CT. Diagnostic specificity for local lymph node metastasis was 100% with PET and 54% with EUS, and for distant metastasis, it was 89% for PET and 96% for CT. Accuracy for locoregional lymph node metastasis was 63% for PET, 66% for CT, and 75% for EUS, and for distant metastasis, it was 74% with PET and 74% with CT. Of the 10 patients who were considered inoperable during surgery, PET identified 7 and CT 4. The false-negative diagnoses of stage IV disease in PET were peritoneal carcinomatosis in two patients, abdominal para-aortic cancer growth in one, metastatic lymph nodes by the celiac artery in four, and metastases in the pancreas in one. PET showed false-positive lymph nodes at the jugulum in three patients. Conclusions: The diagnostic value of PET in the staging of adenocarcinoma of the esophagus and the esophagogastric junction is limited because of low accuracy in staging of paratumoral and distant lymph nodes. PET does, however, seem to detect organ metastases better than CT.

Effectiveness of dynamic muscle training, relaxation training, or ordinary activity for chronic neck pain: randomised controlled trial

Abstract Objective To determine the effectiveness of dynamic muscle training and relaxation training for chronic neck pain. Design Randomised controlled trial. Setting Five occupational healthcare centres, Tampere, Finland. Participants 393 female office workers (mean age 45 years) with chronic non-specific neck pain randomly assigned to 12 weeks of dynamic muscle training (n = 135) or relaxation training (n = 128), plus one week of reinforcement training six months after baseline; or ordinary activity (control group; n = 130). Main outcome measure Change in intensity of neck pain at three, six, and 12 months. Results No significant difference was found in neck pain between the groups at follow up. However, the range of motion for cervical rotation and lateral flexion increased more in the training groups than in the control group. Conclusions Dynamic muscle training and relaxation training do not lead to better improvements in neck pain compared with ordinary activity.

Age-Dependent Association of Apolipoprotein E Genotype With Coronary and Aortic Atherosclerosis in Middle-Aged Men An Autopsy Study

BACKGROUND Apolipoprotein E (apoE) polymorphism is one of the genetic determinants of serum cholesterol values. The apoE epsilon4 allele has been associated with advanced coronary heart disease (CHD) diagnosed by angiography, but the role of the apoE genotype in atherosclerosis has not been confirmed at vessel-wall level, nor is any age-dependent effect of the apoE genotype on the development of CHD known. METHODS AND RESULTS The right and left anterior descending coronary arteries (RCA and LAD) and the aorta from 700 male autopsy cases (Helsinki Sudden Death Study) in 1981-1982 and 1991-1992 (average age 53 years, range 33 to 70 years) were stained for fat, and all areas covered with fatty streaks, fibrotic plaques, and complicated lesions were measured. In the RCA and LAD, the apoE genotype was significantly associated with the area of total atherosclerotic lesions in men <53 years old but not with that in older men (P=0.0085 and P=0.041, respectively, for age-by-genotype interaction). Men <53 years old with the epsilon4/3 genotype showed 61% larger total atherosclerotic lesion area in the RCA (P=0.0027) and 26% larger area in the LAD (P=0.12) than did men with the epsilon3/3. The apoE epsilon4/3 was also associated with atherosclerotic lesions in the abdominal (P=0.014) and thoracic (P=0.12) aorta, but this effect, unlike that of the coronary arteries, was not age-related. CONCLUSIONS In men, the apoE epsilon4 allele is a significant genetic risk factor for coronary atherosclerosis in early middle age. This suggests that at older age, other known risk factors of CHD play a more important role in the atherosclerotic process than apoE polymorphisms.

Mutations at the mitochondrial DNA polymerase (POLG) locus associated with male infertility

Human mitochondrial DNA polymerase, encoded by POLG, contains a polyglutamine tract encoded by a CAG microsatellite repeat. Analysis of POLG genotypes in different populations identified an association between absence of the common, ten-repeat allele and male infertility typified by a range of sperm quality defects but excluding azoospermia.

CSF and MRI findings in patients with acute herpes zoster

Objective: To explore MRI and CSF findings in patients with herpes zoster (HZ) and to correlate the findings with clinical manifestations of the disease. Methods: Fifty immunocompetent patients (mean age, 59 years; range, 17 to 84 years) with HZ of fewer than 18 days duration participated. None had clinical signs of meningeal irritation, encephalitis, or myelitis. In 42 patients (84%), the symptoms constituted pain and rash only. Six patients (12%) had motor paresis, and three patients (6%) had ocular complications. One to three CSF samples were obtained from 46 patients (the first sampling taken 1 to 18 days from onset of rash), and 16 patients (all with either trigeminal or cervical HZ) underwent MRI of the brain. The clinical follow-up continued at least 3 months. Results: CSF was abnormal in 28/46 patients (61%): pleocytosis (range, 5 to 1,440 µL) was detected in 21, elevated protein concentration in 12, varicella zoster virus (VZV) DNA in 10, and immunoglobulin G antibody to VZV in 10. These changes were more common in patients with acute complications, although they did not predict development of postherpetic neuralgia (PHN). In 9/16 patients (56%), MRI lesions attributable to HZ were seen in the brainstem and cervical cord. At 3 months, 5/9 patients (56%) with abnormal MRI had PHN, whereas none of the 7 patients with no HZ-related lesions on MRI had any remaining pain. Conclusions: Subclinical extension of viral inflammation into the CNS occurs commonly in HZ. This finding may have implications for treatment of HZ and prevention of various associated complications.

Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. A prospective population-based study.

Background: In order to identify the risk factors essential for preventing major injurious falls, the associations between injurious falls and certain factors were assessed among disabled and independent elderly, respectively, who had fallen during a 2-year period. Methods: A prospective population-based study was conducted in five rural northern Finnish municipalities. The series consisted of all inhabitants aged 70 years or over, initially 979 persons. During a 2-year follow-up period, all injurious falls were recorded on the basis of telephone contacts, diary reporting and a review of the medical records of the participants. Results: Thirty percent of the subjects having fallen sustained a major injury. The multivariate model applied to the disabled elderly showed the following variables to be related to a high risk for major injurious falls: divorced, widowed or unmarried marital status (odds ratio = 2.2), a low body mass index (odds ratio = 3.1), incomplete step continuity (odds ratio = 2.2), poor distant visual acuity (odds ratio = 2.3) and the use of long-acting benzodiazepines (odds ratio = 2.4). Among the independent elderly, the risk of a fall resulting in major injury was high among the subjects who had peripheral neuropathy (odds ratio = 2.5) or were suffering from insomnia (odds ratio = 4.1). Conclusions: The risk factors for major injuries in fall occurrences differ between the disabled and independent elderly. Preventive measures should be targeted according to the disabilities of the population.

Is cellulose sponge degradable or stable as implantation material? An in vivo subcutaneous study in the rat.

The long-term behaviour of cellulose sponge implants, 10 x 10 x 5 mm in size, and tissue reactions in and around them were examined in the subcutaneous tissue of the rat from 1 to 60 weeks after implantation. The cellulose sponge used was filled up with connective tissue 4 to 8 weeks after implantation. Histologically, moderate foreign body tissue reaction inside the implant, the appearance of cracks and fissures, spotty colouration, and softening of the pore walls were observed up to 16 weeks after implantation. Later, the foreign body reaction inside the sponge became milder, the spotty colouration disappeared and micropores enlarged in the viscose cellulose matrix. Histomorphometrically, the cross-sectional area of the implants and the size of the pore wall fragments decreased, and the number of pore wall fragments increased significantly. The cellulose sponge used can be regarded as a slowly degradable implantation material. However, the time needed for the total disappearance of the cellulose sponge from subcutaneous tissue is longer than the 60 weeks.

Predictors for recurrent falls among the home-dwelling elderly

OBJECTIVE Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly, although there are remarkable age and sex differences according to whether or not the falls recur. In this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year. DESIGN A community-based prospective study covering two years. SETTING All home-dwelling persons (N = 1016) aged 70 years or older living in five municipalities in northern Finland. OUTCOME MEASURES The risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses. RESULTS Previous falls, peripheral neuropathy, use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling. The risk of recurrent falling increased with an increasing number of previous falls. CONCLUSIONS Early preventive measures should be taken among the elderly persons who are prone to falling. In order to reduce the risk of recurrent falls among the elderly, the attending physician should take a critical view of the use of psychotropic medications, and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait.