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Aims: Findings concerning the impact of socio‐economic status on the risk of gestational diabetes mellitus (GDM) are inconclusive and little is known about the simultaneous impact of income and educational attainment on the risk of GDM. This study aims to assess the impact of maternal prepregnancy income in combination with traditional GDM risk factors on the incidence of GDM in primiparous women. Methods: This is an observational cohort study including 5962 Finnish women aged ≥ 20 years from the city of Vantaa, Finland, who delivered for the first time between 2009 and 2015, excluding women with pre‐existing diabetes mellitus. The Finnish Medical Birth Register, Finnish Tax Administration, Statistics Finland, Social Insurance Institution of Finland and patient healthcare records provided data for the study. We divided the study population according to five maternal income levels and four educational attainment levels. Results: Incidence of GDM decreased with increasing income level in primiparous women (P < 0.001 for linearity, adjusted for smoking, age, BMI and cohabiting status). In an adjusted two‐way model, the relationship was significant for both income (P = 0.007) and education (P = 0.039), but there was no interaction between income and education (P = 0.52). Conclusions: There was an inverse relationship between both maternal prepregnancy taxable income and educational attainment, and the risk of GDM in primiparous Finnish women. What's new?: Little is known about the simultaneous impact of maternal prepregnancy income and educational attainment on the risk of gestational diabetes mellitus (GDM).Both maternal prepregnancy annual taxable income and educational attainment show an inverse relationship with the risk of GDM.Women with low prepregnancy taxable income may need more support and guidance before and during pregnancy to reduce the risk of GDM. [ABSTRACT FROM AUTHOR]

Abstract: Background: Healthy diets before and during pregnancy have been suggested to reduce the risk of gestational diabetes (GDM). Several lifestyle intervention studies for pregnant women have reported dietary improvements after counselling. However, evidence concerning the effect of counselling initiated before pregnancy on diets is limited. Methods: This randomised controlled study explored whether pre‐pregnancy lifestyle counselling influenced food intakes, as well as whether changes in food intakes were associated with GDM. The participants comprised 75 women with prior GDM and/or a body mass index ≥ 30 kg m–2. Women were randomised into a control or an intervention group, and their food intakes were followed from pre‐pregnancy to early pregnancy using a food frequency questionnaire. The control and intervention groups were combined to assess the association between changes in food intakes and GDM. The diagnosis of GDM was based on a 75‐g oral glucose tolerance test conducted in the first and second trimester of pregnancy. Results: Pre‐pregnancy lifestyle counselling showed no major overall effect on food intakes. The intake of low‐fat cheese increased significantly in women who did not develop GDM compared to women who did after adjusting for potential confounders (P = 0.028). This association was not observed for regular‐fat cheese. Conclusions: The findings obtained in the present study suggest that an increased intake of low‐fat but not regular‐fat cheese between pre‐pregnancy and early pregnancy is associated with a lower risk of GDM in high‐risk women. [ABSTRACT FROM AUTHOR]

To assess the relationship between physical activity (PA) in work, transport, domestic, and leisure‐time domains (with sitting time included) and health‐related quality of life (HRQoL) among young adult men. The long version of IPAQ and SF‐36 Health Survey were used to assess PA and HRQoL, respectively, in 1425 voluntary 20‐ to 40‐year‐old Finnish male participants. Participants were divided into tertiles (MET‐h/week): Lowest tertile (<38 MET‐h/week), Middle tertile (38‐100 MET‐h/week), and Highest tertile (>100 MET‐h/week). The IPAQ domain leisure‐time PA predicted positively the Physical Component Summary (PCS) (β = 0.11, 95% CI: 0.06 to 0.16) and Mental Component Summary (MCS) (β = 0.11, 95% CI: 0.05 to 0.16) dimensions. Occupational PA predicted negative relationships in the PCS (β = −0.13, 95% CI: −0.19 to −0.07), and sitting time predicted negative relationships in the MCS dimension (β = −0.13, 95% CI: −0.18 to −0.07). In addition, a linear relationship was found between total PA level (including sitting time) and all of the IPAQ domains (<0.001). The Middle tertile had the highest leisure‐time PA (38% of total PA), whereas the highest sitting time (28%) and lowest occupational PA (8%) were found in the Lowest tertile. The Highest tertile had the highest occupational PA (61%), while the leisure‐time PA was the lowest (16%). Different PA domains appear to have positive and negative relationships to mental and physical aspects of HRQoL. Relatively high leisure‐time PA indicated a better HRQoL regardless of the amount of total PA, while occupational PA and higher daily sitting time related negatively to HRQoL. [ABSTRACT FROM AUTHOR]

Aim To study both the association between adult height and glucose regulation based on findings from a 75-g oral glucose tolerance test, and the combined effect of height and adiposity on glucose values. Methods We conducted a population-based, cross-sectional study among apparently healthy people with high cardiovascular risk living in south-western Finland. The study included 2659 participants aged 45-70 years, who had at least one cardiovascular risk factor but no previously diagnosed diabetes or manifested cardiovascular disease. An oral glucose tolerance test was performed in all participants. Height and weight were measured and BMI was calculated. The participants were divided into five height groups based on normal distribution. For further analysis of the association between height and glucose concentrations the participants were divided into four BMI groups (<25.0 kg/m2; 25-29.9 kg/m2; 30-34.9 kg/m2; ≥35 kg/m2). Data were analysed using age-adjusted linear regression models. Results Height was inversely associated with 2-h plasma glucose, but not with fasting plasma glucose concentration. No gender difference was observed. The 2-h plasma glucose values increased with an increase in BMI, so that height was inversely associated with 2-h plasma glucose in the three lowest BMI groups, but not in the highest BMI group ( P=0.33). Conclusions Taller people had lower 2-h plasma glucose concentrations than shorter people, up to a BMI of 35 kg/m2. Adjustment for height and BMI is needed for accurate interpretation of oral glucose tolerance tests. [ABSTRACT FROM AUTHOR]

Background Many studies have evaluated the prevalence of intellectual disability (ID) by focusing on different ages during childhood and adolescence. Although the prevalence of ID is higher in older age groups, how cumulative prevalence increases, and what level it reaches before adulthood, remains unclear. Method We used Care Register for Health Care to retrieve information on individuals born in 1996-2007 with any of the inclusion diagnoses of ID (F7 group and/or aetiological diagnoses) for the period 1996 to 2013. The cumulative prevalence was calculated as percentages for every age based on Finnish population data. Results The registration of new diagnoses of ID continued steadily throughout the developmental years. The cumulative prevalence reached 1.19% by age 17.5 among those born in 1996. Later-born age groups appeared to receive their first ID diagnoses earlier in childhood. Those born in 1999 reached a cumulative prevalence of 1.21% already by age 14.5. Of all those with ID, 67% had an F7 diagnosis only, 42% had an aetiological diagnosis only and 9% had both diagnoses. Conclusions Cumulative prevalence of ID by year, until the age of 18, will provide a better estimate and understanding of the prevalence of ID than a point prevalence at any one point during the developmental years. [ABSTRACT FROM AUTHOR]

It has been proposed that the Akt kinase pathway provides a regulatory mechanism to limit the inflammatory response. We examined the activation of Akt upon lipopolysaccharide ( LPS) challenge in monocytes of patients with rheumatoid arthritis ( RA) and correlated it with disease activity. Twelve subjects with recent-onset, DMARD-naïve RA, thirteen patients with chronic, DMARD therapy-non-responding RA and 27 healthy volunteers provided whole blood samples for phosphospecific flow cytometric measurement of unstimulated and LPS-stimulated Akt phosphorylation at serine 473 in monocytes, determined in relative fluorescence units ( RFU). Activation capability, that is responsiveness of monocytes, was determined as the difference between stimulated and unstimulated samples and compared between groups using Mann-Whitney test. CRP and ESR, swollen and tender joint counts, patients' global assessment of disease activity, DAS28 score and plasma IL-6 determined by ELISA were correlated with Akt activation using Spearman method. Median (interquartile range) Akt activation capability was significantly lower in DMARD-naïve (379 RFU [285, 432], P = 0.016) and even lower in DMARD-non-responding RA (258 RFU [213, 338], P < 0.001), compared to healthy controls (505 RFU[408, 639]) and showed a negative correlation with swollen joint count ( r = −0.48, CI −0.78 to −0.05, P = 0.014), CRP ( r = −0.42, CI −0.80 to −0.02, P = 0.039) and plasma IL-6 levels ( r = −0.44, CI −0.65 to −0.17, P = 0.001). In conclusion, Akt activation capability of monocytes is low in early untreated RA and even lower in chronic, DMARD-non-responding RA, suggesting a role for Akt pathway in the pathogenesis of RA. [ABSTRACT FROM AUTHOR]

Background Incidence and complications of peptic ulcer disease ( PUD) have declined, but mortality from peptic ulcer bleeding has remained unchanged. The few recent studies on mortality associated with both uncomplicated and complicated patients with peptic ulcer disease provide contradictory results. Aims To evaluate short- and long-term mortality, and the main causes of death in peptic ulcer disease. Methods In this retrospective epidemiologic cohort study, register data on 8146 adult patients hospitalised with peptic ulcer disease during 2000-2008 were collected in the capital region of Finland. All were followed in the National Cause of Death Register until the end of 2009. The data were linked with the nationwide Drug Purchase Register of the Finnish Social Insurance Institution. Results Mean follow-up time was 4.9 years. Overall mortality was substantially increased, standardised mortality ratio 2.53 (95% CI: 2.44-2.63); 3.7% died within 30 days, and 11.8% within 1 year. At 6 months, the survival of patients with perforated or bleeding ulcer was lower compared to those with uncomplicated ulcer; hazard ratios were 2.06 (1.68-2.04) and 1.32 (1.11-1.58), respectively. For perforated duodenal ulcers, both the short- and long-term survival was significantly impaired in women. The main causes of mortality at 1 year were malignancies and cardiovascular diseases. Previous use of statins was associated with significant reduction in all-cause mortality. Conclusions One-year mortality in patients hospitalised with peptic ulcer disease remained high with no change. This peptic ulcer disease cohort had a clearly decreased survival rate up to 10 years, especially among women with a perforated duodenal ulcer, most likely explained by poorer survival due to underlying comorbidity. [ABSTRACT FROM AUTHOR]

Background The characteristics of peptic ulcer disease ( PUD) are changing. Aim To evaluate time trends in the incidence of PUD and its complications in hospitalised patients at the beginning of the 21st century, drug therapies in out-patient care as a risk factor for recurrent PUD, and medication used by PUD patients compared with the background population. Methods In this retrospective epidemiologic cohort study, data from the years 2000-2008 came from The Hospital District of Helsinki and Uusimaa, and the Finnish Care Register. All hospitalised adult patients with PUD in the capital region of Finland were included. The data were linked with nationwide Prescription Register of the Finnish Social Insurance Institution allowing detailed individual medicine purchase data. Results A total of 9951 peptic ulcers were detected among 8146 individual patients during the study period. The mean annual incidence of all peptic ulcers decreased from 121/100 000 (95% CI: 117-125) in 2000-2002, to 79 (95% CI: 76-82) in 2006-2008 [Incidence rate ratio = 0.62 (95% CI: 0.58-0.64), P < 0.001 after age and sex adjustment]. Decrease in incidence was seen in all age groups and in both sexes. The overall rate of severe complications of PUD was reduced. One-year cumulative incidence of recurrent ulcers was 13%. Use of several drugs was associated with increased risk for recurrence. The purchases of various drugs were more common among PUD patients compared with background population. Conclusions Both the incidence and complication rates have markedly decreased during the study period. Recurrent peptic ulcer disease was associated with polypharmacy. [ABSTRACT FROM AUTHOR]

Background The yeast Malassezia belongs to our normal cutaneous flora, but is capable of sensitizing individuals with atopic dermatitis ( AD). Our objective was to investigate the prevalence of sensitization to Malassezia with a 10-yr follow-up among children suffering from AD combined with food allergy ( FA) in relation to the extent of AD in infancy. Methods One hundred and eighty seven infants diagnosed with AD and milk/wheat allergy before 1 yr of age were included in the study. The area of AD was estimated from patient records of the first visit and measured with SCORAD at the 10-yr follow-up. Specific Ig E against Malassezia was determined with Immuno CAP™ at 11 yr of age. Results In infancy, 24 children (13%) were allergic to milk, 71 (38%) to wheat, and 92 (49%) to both milk and wheat, and 94 (50%) children had mild, 57 (30%) moderate and 36 (19%) severe AD. At the 10-yr follow-up visit, 19 (10%) of the children had ongoing milk and/or wheat allergy; 147 children (79%) had mild AD and 30 (16%) had SCORAD index of 0. Specific Ig E against Malassezia mix was positive (≥0.35 kU/l) in 27% and specific Ig E against M. sympodialis in 20% of the 187 children. The area of AD in infancy was associated with a greater risk of having allergen-specific Ig E to Malassezia at the 10-yr follow-up. The risk ratio for FA was 3.11 (95% CI: 2.05-4.72; p < 0.001) if specific Ig E to Malassezia was positive. Conclusions Infants with severe AD and FA seem to have a greater risk of becoming sensitized to Malassezia during a 10-yr follow-up. [ABSTRACT FROM AUTHOR]

Objective: The study aimed at investigating the quality of life (QoL) and physical performance and activity, and their interrelations, in Finnish female breast cancer patients shortly after adjuvant treatments. Methods: A total of 537 disease-free breast cancer survivors aged 35-68 years were surveyed at the beginning of a one year randomized exercise intervention. The patients were interviewed using EORTC QLQ-C30, FACIT-F, RBDI, and WHQ (for vasomotor symptoms) questionnaires. Physical performance was tested by a 2 km walking test. Physical activity was measured by a questionnaire and a prospective two-week diary. Multivariate analysis was used to study the factors associated with QoL. Results: About 26% of the patients were rated as depressed, 20.4% as fatigued, and 82% suffered from menopausal symptoms. The global QoL was lower than in general population (69.4 vs 74.7, p<0.001). About 62% of the walking test results were below the population average. Fatigue ( p<0.001), depression ( p<0.001), body mass index ( p = 0.016) and comorbidity ( p = 0.032) impaired, and physical activity ( p = 0.003) improved QoL. Physical activity level correlated positively to physical performance ( r = −0.274, p<0.0001). Conclusions: The QoL of the patients shortly after adjuvant treatments was impaired and the physical performance poor as compared to general population. In particular, depression and fatigue were related to impaired QoL. Physical performance and activity level were the only factors that correlated positively to QoL. Thus, physical exercise could be useful in rehabilitation of cancer survivors, especially for depressed and fatigued patients. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

BACKGROUND: The presence of neck-shoulder pain as a predictor of depression is not widely studied. AIM: To analyse the association of neck-shoulder pain at baseline with depressive symptomatology after a 7-year follow-up. METHODS: A total of 604 subjects who had not had depressive symptomatology at baseline participated in 7-year follow-up survey. The number of subjects with depressive symptomatology (Beck Depression Score10) after 7-year follow-up were measured in three groups - subjects without neck-shoulder pain, with infrequent neck-shoulder pain and with daily neck-shoulder pain at baseline. RESULTS: A total of 77 (13%) participants had developed depressive symptomatology by the follow-up. Prevalence of depressive symptomatology in follow-up in subjects without neck-shoulder pain, with infrequent neck-shoulder pain and with daily neck-shoulder pain at baseline pain was 9.5%, 11.2% and 28.4%. In multivariate logistic regression analysis odds for having depressive symptomatology in daily neck-shoulder pain subjects was almost three fold higher (OR, 2.64, 95% CI, 1.27-5.48) compared to those without neck-shoulder pain. CONCLUSIONS: Frequent neck-shoulder pain is a preceding symptom for the depressive symptomatology in adults. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the evolution of functional and clinical outcomes over 11 years in patients with early rheumatoid arthritis (RA) initially treated with a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or with a single DMARD. METHODS: A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone or treatment with a single DMARD (initially, sulfasalazine) with or without prednisolone. After 2 years, the drug treatment strategy became unrestricted, but still targeted remission. At 11 years, function was assessed with the Health Assessment Questionnaire (HAQ), and clinical outcomes were assessed with the modified Minimal Disease Activity (MDA) measure and the American College of Rheumatology (ACR) criteria for remission. RESULTS: At 11 years, 138 patients were assessed (68 in the combination-DMARD group and 70 in the single-DMARD group). The mean +/- SD HAQ scores were 0.34 +/- 0.54 in the combination-DMARD group and 0.38 +/- 0.58 in the single-DMARD group (P = 0.88). Modified MDA was achieved by 63% (95% confidence interval [95% CI] 51, 77) and by 43% (95% CI 32, 55) (P = 0.016) of the combination-DMARD group and the single-DMARD group, respectively, and ACR remission by 37% (95% CI 26, 49) and by 19% (95% CI 11, 29) (P = 0.017), respectively. CONCLUSION: Initial therapy with a combination of DMARDs in early RA results in higher rates of patients achieving modified MDA and strict ACR remission even over the long term than initial single-DMARD therapy. Targeting remission with tight clinical controls results in good functional and clinical outcomes in most RA patients. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess differences in the effects of competitive gymnastics and running on bone mineral content (BMC) of the lumbar spine and femoral neck when compared with their non-competing age-matched controls. Caucasian healthy peri-pubertal girls (52 competing gymnasts, 46 competing runners, 44 non-athletic controls) were included. Weight, height, and type and amount of exercise (MET h/week) as well as BMC of the lumbar spine and femoral neck were measured repeatedly. Statistical comparisons between groups were made using ANOVA. Repeated measures were analyzed using generalized linear mixed models. The median MET value of gymnasts was significantly higher when compared with runners and controls at baseline, P=0.001. The weekly median MET hours decreased during the follow-up. The mean (adjusted for height, weight, and years from menarche in the 7-year follow-up) BMC of the lumbar spine and femoral neck was significantly higher among gymnasts when compared with the other two groups. Group-by-time interaction was significant only at the femoral neck ( P=0.048). The type of physical activity was a significant factor in BMC of the adolescent women. Gymnasts had greater BMC at lumbar spine and femoral neck during the total 7-year follow-up period when compared with runners and controls. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To clarify the association between anticholinergic drugs and apolipoprotein E epsilon4 allele carrier status (APOE4) and cognitive dysfunction. DESIGN: Cross-sectional analyses of current drug use and cognitive functioning according to the baseline assessments of the Drugs and Evidence-Based Medicine in the Elderly Study. SETTING: Helsinki, Finland. PARTICIPANTS: Four hundred community-dwelling people aged 75 to 90 without clinical dementia but with a history of stable atherosclerotic disease. MEASUREMENTS: Cognitive function according to the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Participants' use of anticholinergic drugs was estimated using definitions from previous scientific literature. APOE alleles determined from peripheral blood leukocyte deoxyribonucleic acid using standard polymerase chain reaction-based methods. RESULTS: There was an association between anticholinergic drugs and lower MMSE scores (P for trend <.001). The higher the number of anticholinergic drugs, the lower the MMSE score. Subjects with the APOE4 allele and using drugs with anticholinergic properties had the lowest median MMSE score (26), whereas those without the APOE4 allele and not using drugs with anticholinergic properties had the highest median MMSE score (28). When adjusted for age, sex, and education, the difference between the groups remained significant. The finding was similar for CDR scores. CONCLUSION: Use of drugs with anticholinergic properties was associated with lower cognitive function irrespective of APOE4 carrier status. Having lower cognitive function as a group, APOE4 carriers may be more vulnerable to this undesirable effect, but a follow-up study is needed to demonstrate this. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the effects of psychosocial group nursing intervention on older people's feelings of loneliness, social activity and psychological well-being. Background. Older people's loneliness is associated with low quality of life, and impaired health, increased use of health and social services and increased mortality. Previous intervention studies have achieved quite modest results. Method. A randomized controlled trial was conducted between 2003 and 2006 using a group intervention aimed at empowering older people, and promoting peer support and social integration. A total of 235 people (>74 years) suffering from loneliness met 12 times with professional leaders in groups. The UCLA Loneliness Scale and Lubben's Social Network Scale were used at entry, after 3 and 6 months. Psychological well-being was charted using a six-dimensional questionnaire at baseline and 12 months later. Findings. A statistically significantly larger proportion of intervention group participants had found new friends during the follow-up year (45% vs. 32%, P = 0·048), and 40% of intervention group participants continued their group meetings for 1 year. However, no differences were found in loneliness or social networks between the groups. Psychological well-being score improved statistically significantly in the intervention groups [+0·11, 95% confidence interval (CI): +0·04 to +0·13], compared with the controls (+0·01, 95% CI: -0·05 to +0·07, P = 0·045). Feeling needed was statistically significantly more common in the intervention groups (66%) than in controls (49%, P = 0·019). Conclusion. New sensitive measurements of loneliness and social isolation are needed to measure fluctuations in feelings of loneliness and in social isolation. [ABSTRACT FROM AUTHOR]

Aims We explored gender differences in the association of high-sensitivity C-reactive protein (hs-CRP), interleukin-1 receptor antagonist (IL-1Ra) and adiponectin with the metabolic syndrome (MetS) defined by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) criteria. Methods A population-based study of 923 middle-aged subjects in Pieksämäki, East Finland. Results The prevalence of the MetS according to the IDF and NCEP definitions was 38% and 34% in men ( N = 405) and 34% and 27% in women ( N = 497), respectively. hs-CRP and IL-1Ra levels were higher in subjects with the MetS compared with those without the MetS in both sexes ( P < 0.001). The levels of hs-CRP ( P < 0.001) and IL-1Ra ( P = 0.0016 for NCEP criteria, P = 0.0028 for IDF criteria) were significantly higher in women with MetS than in men with MetS. In contrast, in subjects without MetS, no gender differences in the levels of hs-CRP or IL-1Ra were found. Conclusion Women with MetS, defined by the IDF or NCEP criteria, had higher levels of hs-CRP and IL-1Ra than did men with MetS. Thus, low-grade inflammation may contribute to the high risk of cardiovascular disease in women with MetS. [ABSTRACT FROM AUTHOR]

Background: Assessment of allergenic potential of medical devices made of natural rubber latex (NRL) requires the measurement of concentrations of specific allergenic proteins or polypeptides eluting from rubber. Methods: Four NRL allergens (Hev b 1, 3, 5, and 6.02) were quantified in all medical glove brands marketed in Finland in 1999, 2001, and 2003 ( n = 208) by a capture enzyme immunoassay. The results were compared with those obtained from previous nationwide market surveys, using a skin prick test-validated human IgE-based ELISA-inhibition method. Results: A high overall correlation ( r = 0.87, 95% CI 0.83–0.90) emerged between the sum values of the four allergens(μg/g glove) and IgE-ELISA inhibition (allergen units, AU/ml, 1 : 5 diluted glove extract). The sum of four allergens when set at 0.15 μg/g discriminated ‘low allergenic’ (<10 AU/ml) from ‘moderate- to high-allergenic’ (≥10 AU/ml) gloves at a sensitivity of 0.93 (95% CI 0.85–0.98) and specificity of 0.90 (95% CI 0.83–0.94). When the sum was below the detection limit (0.03 μg/g) all gloves belonged to the previously defined low-allergen category. Conclusions: By comparing the sum concentration of four selected NRL allergens with results obtained in human IgE-ELISA inhibition, it was possible set a cut-off level (0.15 μg/g) below which virtually all gloves contain low or insignificant amounts of allergens, and can be considered as low allergenic. At different cut-off-points, one could calculate the likelihood of a given glove to belong to the previously defined low, moderate or high allergen categories. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze longitudinal data over 5 years for changes in Health Assessment Questionnaire (HAQ) scores in patients with rheumatoid arthritis (RA) and age- and sex-matched controls from the general population. METHODS: In 2000 and 2005, identical self-report questionnaires were mailed to a cohort of patients with RA and control cohort from the community. The questionnaire included the HAQ, which was used to assess functional status. Changes in HAQ scores over 5 years were analyzed. RESULTS: In 2000, 73% of 1,495 patients with RA and 77% of 2,000 general population controls responded to the questionnaire. In 2005, 84% of 2,022 patients with RA and 77% of 1,817 controls responded. A total of 863 patients with RA and 1,176 community controls responded in both 2000 and 2005 and were included in the analyses. Mean baseline HAQ scores were significantly higher in patients with RA than in controls (0.71 versus 0.17; P < 0.001). Over 5 years, the HAQ scores increased by 0.01 units per year in both the RA cohort and the community population; in both cohorts, the net change was primarily attributable to individuals over age 70 years. Changes in HAQ scores were similar in patients and controls who had low HAQ scores at baseline. Female patients with baseline HAQ scores of >or=0.5 had less potential for improvement than did controls. Among subjects in both groups who had HAQ scores >2, death was a common outcome over the next 5 years. CONCLUSION: Currently, progression of functional disability among patients with RA and among persons in the general population is largely explained by the aging process. Our results showing stable function scores over 5 years in most patients with RA who are younger than age 70 years provide further evidence of improved status of RA patients today compared with the major declines observed in previous decades. [ABSTRACT FROM AUTHOR]

Background: When skin prick testing (SPT) young children with atopic dermatitis (AD) for suspected food allergy, we frequently found positive reactions with turnip rape ( Brassica rapa) and oilseed rape ( Brassica napus). We performed food challenge to examine whether these children react clinically to turnip rape. Methods: A total of 1887 children were screened with SPTs for sensitization to turnip rape and oilseed rape. Twenty-eight children with clearly positive SPT (≥5 mm) were first subjected to labial challenge with turnip rape seeds followed, if negative, by open oral challenge for up to 7 days. Twenty-five children with AD but negative SPT to turnip rape and oilseed rape served as controls. Results: Two-hundred and six (10.9%) children had positive SPT to turnip rape and/or oilseed rape. Twenty-five (89%) of 28 children showed a positive challenge reaction to turnip rape. Seventeen reacted with labial whealing, and eight in oral challenge with facial urticaria, flare-up of AD or abdominal symptoms. All 25 control children remained negative in the labial challenge. Conclusions: Turnip rape and oilseed rape seem to be new important food allergens in young children with AD. The modes of exposure to these allergens and the possible routes of sensitization remain to be established. [ABSTRACT FROM AUTHOR]

The aim was to evaluate whether 40-year-old men and women are able to estimate their level of fitness compared with actual measured physical fitness. Twenty-nine men and 35 women first completed a questionnaire at home and then their physical fitness was measured at laboratory. The index of self-estimated physical fitness was calculated by summing up the scores of self-estimated endurance, strength, speed and flexibility. The index of self-estimated endurance was calculated by summing up the scores of self-estimated endurance and those of the self-estimated distance they could run, cycle, ski and walk. The index of measured physical fitness was calculated by summing up the z-scores of a submaximal bicycle ergometer test, ergojump tests (counter-movement jump and jumping in 15 s), a 30-s sit-up test, hand-grip tests and a sit-and-reach test. The correlation (Spearman) between the indices of self-estimated and measured physical fitness was 0.54 for both sexes, and that between self-estimated endurance and measured endurance was 0.53 for both sexes. Maximal oxygen uptake estimated based on submaximal ergometer test was higher among those with longer self-estimated distance of running, cycling, skiing and walking ( P for linear trend <0.001). Our study shows that 40-year-old adults can estimate at group level their fitness according to different categories moderately well. They can also estimate at group level their endurance moderately well by estimating the distance they can run, cycle, ski or walk. However, in some individuals self-estimation of fitness is not in agreement with the results of fitness tests. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore the impact of an early treatment response on maintenance of work capacity in patients with early, active rheumatoid arthritis (RA). METHODS: In the Finnish Rheumatoid Arthritis Combination Therapy trial, 195 patients with recent-onset RA were randomized to receive either a combination of disease-modifying antirheumatic drugs (DMARDs) with prednisolone or a single DMARD with or without prednisolone for 2 years. Treatment responses were evaluated according to the American College of Rheumatology (ACR) criteria. After a 5-year followup, the cumulative number of days of sick leave and RA-related permanent work disability was calculated for each of the 162 patients who were available for the active work force at baseline. RESULTS: Of the 159 patients assessed at 6 months, 29 were in clinical remission, 66 achieved an ACR50 response but not remission, 29 achieved an ACR20 response but not an ACR50 response, and 35 failed to achieve an ACR20 response. In these 4 groups, the median numbers of work disability days per patient-year from 6 months through 60 months of followup were 0 (interquartile range [IQR] 0-3), 4 (IQR 0-131), 16 (IQR 0-170), and 352 (16-365), respectively (P < 0.001). Pairwise multiple comparisons showed a statistically significant difference between all groups except the ACR50 and ACR20 groups. At 12 months, 30 patients were in remission. None of the 44 patients in remission at 6 or 12 months became permanently work disabled over the 5-year followup, as compared with 15 patients in the ACR50 group (23%), 6 in the ACR20 group (21%), and 19 without an ACR20 response at 6 months (56%). CONCLUSION: Prompt induction of remission translates into maintenance of work capacity. At 6 months, an ACR50 response is no better than an ACR20 response with regard to future productivity, while failure to achieve an ACR20 response carries a high risk for work disability. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Both coeliac disease (CD) and Sjogren's syndrome (SS) have an autoimmune background and increased risk of oral mucosal and dental abnormalities. Individuals suffering concomitantly from CD and SS could even be at a higher risk. STUDY DESIGN: Oral mucosal and dental abnormalities were examined in 20 patients with CD + SS (mean age 61 years) and compared with age- and sex-matched controls with either CD or SS. RESULTS: Oral mucosal changes were most common in SS (80%), followed by CD + SS (65%) and CD (40%). Coeliac-type dental enamel defects were found in 89% in CD + SS and in 88% in CD compared with only 25% in SS (P < 0.001). The median number of teeth was six in the CD + SS, 24 in the CD and 22 in the SS group. The DMF index was higher (P < 0.005) in the CD + SS than in the CD group. CD + SS was characterized by higher salivary flow rate (P < 0.001) and lower inflammatory focus score in the salivary glands (P < 0.01) than SS. CONCLUSIONS: The co-occurrence of CD and SS should be recognized because of its effects on dental and oral mucosal health. A lower salivary gland inflammatory focus score and higher salivary flow rate in CD + SS than in SS suggests that a gluten-free diet treatment may alleviate autoimmune inflammation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the long-term frequency of disease remissions and the progression of joint damage in patients with early rheumatoid arthritis (RA) who were initially randomized to 2 years of treatment with either a combination of 3 disease-modifying antirheumatic drugs (DMARDs) or a single DMARD. METHODS: In this multicenter prospective followup study, a cohort of 195 patients with early, clinically active RA was randomly assigned to treatment with a combination of methotrexate, sulfasalazine, hydroxychloroquine, and prednisolone or with a single DMARD (initially, sulfasalazine) with or without prednisolone. After 2 years, the DMARD and prednisolone treatments became unrestricted, but were still targeted toward remission. The long-term effectiveness was assessed by recording the frequency of remissions and the extent of joint damage seen on radiographs of the hands and feet obtained annually up to 5 years. Radiographs were assessed by the Larsen score. RESULTS: A total of 160 patients (78 in the combination group and 82 in the single group) completed the 5-year extension study. At 2 years, 40% of the patients in the combination-DMARD group and 18% in the single-DMARD group had achieved remission (P < 0.009). At 5 years, the corresponding percentages were 28% and 22% (P not significant). The median Larsen radiologic damage scores at baseline, 2 years, and 5 years in the combination-DMARD and single-DMARD groups were 0 and 2 (P = 0.50), 4 and 12 (P = 0.005), and 11 and 24 (P = 0.001), respectively. CONCLUSION: Aggressive initial treatment of early RA with the combination of 3 DMARDs for the first 2 years limits the peripheral joint damage for at least 5 years. Our results confirm the earlier concept that triple therapy with combinations of DMARDs contributes to an improved long-term radiologic outcome in patients with early and clinically active RA. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare the efficacy of therapy with a combination of disease-modifying antirheumatic drugs (DMARDs) versus therapy with a single DMARD in the prevention of work disability in patients with early rheumatoid arthritis (RA). METHODS: In the Finnish Rheumatoid Arthritis Combination Therapy trial, 195 patients with recent-onset RA were randomly assigned to receive either combination therapy with DMARDs (sulfasalazine, methotrexate, hydroxychloroquine) plus prednisolone or single therapy with a DMARD with or without prednisolone. After 2 years, the drug treatment strategy was no longer restricted. At baseline, 162 patients (80 in the combination-treatment group and 82 in the single-treatment group) were still working or at least available for work. After 5 years of followup, data on all sick leave and retirement were obtained from social insurance registers or case records. The main outcome for each patient was the cumulative duration of all sick leaves and RA-related disability pensions, divided by the observation period during which the patient was not retired because of another disease or because of age. RESULTS: The cumulative duration of work disability per patient-observation year was significantly lower in those randomized to combination therapy than in those randomized to single therapy: median 12.4 days (interquartile range [IQR] 0-54) versus 32.2 days (IQR 6-293) (P = 0.008, sex- and age-adjusted P = 0.009). This was mainly due to the difference in sick leaves (i.e., work disability periods

Background: People frequently experience whealing and delayed papules from mosquito bites. Whealing is mediated by antisaliva immunoglobulin (Ig)E antibodies and histamine. Cetirizine, ebastine and loratadine have earlier shown effects on mosquito-bite reactions but no comparative studies exist. Methods: A double-blind, placebo-controlled, cross-over study was performed with cetirizine 10 mg, ebastine 10 mg and loratadine 10 mg in 29 mosquito-bitesensitive adults exposed to Aedes aegypti mosquito-bites. The size of the bite lesion and the intensity of pruritus (visual analog scale) were measured at 15 min and 2, 6 and 24 h. Results: Cetirizine and ebastine, but not loratadine, decreased significantly the size of whealing (P<0.01) and accompanying pruritus (P<0.001) compared to placebo. Cetirizine was most effective on pruritus but caused more often sedation than ebastine or loratadine. The delayed bite symptoms remained too faint for any statistical comparison. Conclusion: This comparative study in mosquito-bite-sensitive adults shows that cetirizine and ebastine decrease significantly whealing and accompanying pruritus, and that cetirizine seems to be the most effective against pruritus. [ABSTRACT FROM AUTHOR]

Background: Children frequently experience harmful whealing and delayed papules from mosquito bites. Whealing is mediated by antisaliva IgE antibodies and histamine, but the effect of antihistamines on mosquito-bite symptoms has not been evaluated in children. Methods: The effect of loratadine (0.3 mg/kg) was examined in 28 mosquito-bite-sensitive children (aged 2–11 years). The double-blind, placebo-controlled, crossover study was performed with exposure to Aedes aegypti laboratory mosquitoes. The size of the bite lesion and the intensity of pruritus (visual analog scale) were measured at 15 min and at 2, 6, and 24 h. Results: Loratadine decreased the size of the wheals by 45% (P<0.001, 25 children) and accompanying pruritus by 78% (P=0.011, 12 children) at 15 min compared to placebo. The size of the 24-h delayed bite lesion also decreased significantly (P=0.004), but there was no change at 2 or 6 h. Loratadine was well tolerated and no marked side-effects were recorded. Conclusions: This study in children shows that prophylactically given loratadine decreases significantly the whealing and pruritus caused by mosquito bites and also reduces the size of the 24-h bite lesions. Therefore, the therapeutic profile of loratadine extends from immediate to delayed allergic symptoms in mosquito-bite-sensitive children. [ABSTRACT FROM AUTHOR]

The aims of this study were to prospectively follow up population-based cohorts of children with widespread pain, children with neck pain and pain-free children, in order to evaluate 1-y changes in pain symptoms and to evaluate predictors for persistent widespread pain and for the change of neck pain to widespread pain. A structured pain questionnaire, the Children's Depression Inventory, and a sleep questionnaire were completed by the pre-adolescent cohorts, and clinical evaluation with tender point palpation and pain threshold measurements was carried out in both years. The Child Behavior Checklist, the Teacher's Report Form and a sociodemographic questionnaire were completed at baseline. More children in the 2 pain cohorts reported pain at follow-up than did controls (p < 0.0001). Children with persistent widespread pain had lower pain thresholds compared with those whose pain classification changed. In the neck pain group, 19 (20.4%) reported widespread pain at follow-up. Although depressive symptoms and sleep problems were associated with the change of neck pain to widespread pain, neither they nor other measured factors showed independent explanatory power in multiple logistic regression analysis. In conclusion, fluctuation of pain symptoms occurred mainly among pain cohorts. Depressive and sleep problems may have an effect on the spreading of regional neck pain to widespread pain. Pain threshold measurement and evaluation of depressive and sleep problems may be useful tools for secondary prevention of musculoskeletal pain in pre-adolescents. [ABSTRACT FROM AUTHOR]

Background: The objective of the present study was to evaluate the relevance of skin tests and the concentration of cow's milk‐specific IgE antibodies in correlation with oral cow's milk challenge in infants with suspected cow's milk allergy. Methods: The study material comprised 143 infants under the age of 2 years who had undergone a diagnostic elimination challenge because of suspected cow's milk allergy in 1996. Cow's milk‐specific IgE was measured, and skin prick and patch tests were performed. Results: Of the 143 oral cow's milk challenges performed, 72 (50%) were positive. Of the positive reactions, 22 involved immediate‐type reactions. In 50 patients, delayed‐onset reactions of eczematous or gastrointestinal type appeared. Of the infants with challenge‐proven cow's milk allergy, 26% showed elevated IgE concentrations to cow's milk, 14% had a positive skin prick test, and 44% had a positive patch test for cow's milk. Interestingly, in most patch test‐positive patients, the prick test for cow's milk was negative. Conclusions: Our study demonstrated that many patients with a negative prick test result had a positive patch test to cow's milk. The patch test was a more sensitive method than the prick test or RAST to detect cow's milk allergy in this study population. Our results indicate that patch testing will significantly increase the probability of early detection of cow's milk allergy. Confirmation of the diagnosis is essential in patients with negative test results but a clinical suspicion of food allergy, and in patch test‐positive patients. For this purpose, the most reliable method is the elimination‐challenge procedure. [ABSTRACT FROM AUTHOR]

Tolerance induction to prevent development of nickel allergy has been suggested with permanent dental braces. We wanted to find out which effect orthodontic treatments had had on the development of nickel allergy in university students. We examined and patch tested 153 students, of whom 113 had a history of pierced skin, and 70 a history of orthodontic treatment roughly 10 years earlier. All except one student with pierced skin were females. Development of nickel allergy was significantly associated with skin piercing (54% compared with 12%). At the time of the study, there was a slight but non-significant difference in the prevalence of nickel allergy between students who had been subjects for orthodontic treatment (49%) compared with non-treated ones (58%) if they had pierced skin. There were no significant differences in the development of nickel allergy among students who had had permanent dental braces before (50%) or after skin piercing (48%). However, from 40 students without skin piercing four of 11 (three males) with a history of permanent braces had developed nickel allergy, as compared with none of 22 ( P = 0.008) without orthodontic treatment suggesting possibility of sensitization through dental devices. Orthodontic treatment may not lead to tolerance induction on all occasions, and sensitization through permanent devices seems to be possible. [ABSTRACT FROM AUTHOR]

A response from the authors of the article "Increased short-and long-term mortality in 8146 hospitalised peptic ulcer patients" in the 2016 issue is presented.

AIM: Maintenance of positive effects of physical activity on growing bone is unknown. Physical activity was associated with increased BMC and BMD in a 7-year follow-up with 142 adolescent girls. Marked reduction in physical activity had an unfavorable effect on bone measurements, which is an important finding when the prevention of osteoporosis is considered. INTRODUCTION: Environmental factors influence quality and durability of bone. Physical activity, with high-impact weight bearing activity during puberty in particular, has been shown to have a beneficial effect on growing bone. Only few studies have been published on the maintenance of these effects. METHODS: At baseline, 142 girls aged 9–15 years participated in the present 7-year follow-up study. Growth and development, physical activity and intakes of calcium and vitamin D were recorded at intervals. BMC and BMD measurements were repeated using DXA. Based on the recording of physical activity during the follow-up measurements, the effect of the reduction in physical activity was examined with the bone measurements, and the measurements in the tertiles based on the amount of physical activity during the whole follow-up period were compared. RESULTS: Physical activity was positively associated with the development of BMC and BMD during the follow-up. The mean BMC of the lumbar spine increased 1.69 g (3%) ( P=0.021) more among those girls who maintained the physical activity level as compared with those who reduced it during last 4 years. In the femoral neck, the corresponding difference was 0.14 g (4.6%) ( P=0.015) between the same two groups of girls. The mean increases in BMC at lumbar spine and femoral neck were more substantial among those girls having the highest physical activity levels during the 7-year follow-up (46.7% and 22.6%) as compared with those having the lowest physical activity levels (43.3% and 17.4%, respectively). CONCLUSIONS: The findings of the present study show that regular physical activity is valuable in preserving the peak bone mass acquired at puberty in particular. Many of the girls who markedly reduced their activity levels lost bone in their femoral neck before their 25th birthday. [ABSTRACT FROM AUTHOR]

Background and Aims: A new definition of dominant stricture (NDS) has recently been defined for patients with primary sclerosing cholangitis (PSC). Prevalence and clinical features of this, compared to traditional dominant stricture (TDS), have not been reported., Methods: In this single-centre longitudinal prospective cohort study, all PSC patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between October 2021 and 2022 were recruited. Symptoms of cholestasis, laboratory values (P-alkaline phosphatase, P-Bilirubin), Helsinki PSC-score, brush cytology findings and need for endoscopic therapy (i.e. dilation, stenting) were prospectively collected., Results: Overall, 228 patients with PSC underwent 248 ERCPs. NDS was detected in 43 (17%; 36 patients) and TDS without NDS (TDS group) was detected in 62 (25%; 58 patients) ERCPs, respectively; in the remaining 143 ERCPs, neither TDS nor NDS was seen (no dominant stricture [NoDS] group). PSC duration (median 8 years) and patient's age did not differ between the three groups; males presented more often with NDS. Patients with NDS were more often symptomatic, had higher cholestatic liver enzymes, advanced bile duct disease and markers of biliary inflammation (p < .001). Patients with NDS needed dilation (81%) and stenting (21%) more often than the TDS group (60% and 5%, respectively). Dysplasia in brush cytology was more common in TDS (5%) and NDS (9%) than in NoDS (3%) groups (p = .04), but did not differ between TDS and NDS groups., Conclusions: Dominant stricture according to the new definition developed in 17% of PSC patients in our cohort and identifies patients with more advanced disease, biliary inflammation and need of endo-therapy., (© 2024 The Author(s). Liver International published by John Wiley & Sons Ltd.)

Background and Purpose: Use of thromboprophylaxis effectively prevents pulmonary embolism (PE) and deaths after total hip and knee arthroplasty (THA and TKA). The optimum length of thromboprophylaxis is not known and has traditionally been based on the type of operation. Nowadays, a more individualized approach is preferred. This study analyzed if risk stratification-based planning of thromboprophylaxis has an association with the all-cause mortality after fast-track THA and TKA., Patients and Methods: We compared fast-track THAs and TKAs operated between 2015-2016 and 2020-2021. Between 2015 and 2016, all patients received a routine length of thromboprophylaxis. From 2020 onwards, thromboprophylaxis was planned by risk stratification, and patients at low risk for venous thromboembolism received thromboprophylaxis only during hospitalization. All causes of death within 90 days of surgery were identified and the incidence of mortality was calculated. Mortality rates between the two periods were then compared., Results: Between 2015 and 2016, 3192 arthroplasties were performed. A total of eight deaths occurred within 90 days of surgery, yielding an incidence of all-cause mortality of 0.3% (95% CI 0.1-0.5). Between 2020 and 2021, a total of 3713 arthroplasties were performed to patients who received risk stratification-based thromboprophylaxis. Thirteen of these patients died within 90 days of surgery, yielding an all-cause mortality incidence of 0.4% (95% CI 0.2-0.6). Cardiovascular diseases were the main cause of death during both study periods. None of the deaths were caused by PEs., Interpretation: Risk stratification-based thromboprophylaxis was not associated with increased all-cause mortality within 90 days of fast-track THA and TKA., (© 2024 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Background: Individuals with depression and depressive symptoms have a higher mortality rate than non-depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non-melancholic, may provide some explanation to this phenomenon., Methods: One thousand nine hundred and ninety five participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depression Inventory. Standardized mortality ratios were calculated., Results: Participants were followed up for a total of 28,044 person-years. The melancholic depressive group had an increased adjusted risk of mortality [HR 1.49 (95% CI: 1.02-2.20)] when compared to the non-depressive group. Comparing mortality to the whole population of Finland using standardized mortality ratios (SMR) both the non-melancholic [1.11 (95% CI: 0.85-1.44)] and melancholic depressive [1.26 (95% CI: 0.87-1.81)] groups had higher mortality than the non-depressive group [0.82 (95% CI: 0.73-0.93)]., Conclusions: Melancholic depressive symptoms are most strongly related to a higher mortality risk., (© 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)

Background: The opioid system of the central nervous system plays an essential role in the regulation of the rewarding effects of alcohol. Alcohol affects mu-opioid receptor (MOR) function. Enhanced MOR function inhibits the GABAergic inhibition of the nucleus accumbens (Nac), which leads to a release of dopamine in the Nac. Of the few pharmaceutical treatments for alcoholism, the MOR antagonists naltrexone and nalmefene benefit most a subset of alcoholics who are characterized with early onset and impulsivity. Our aim was to investigate possible differences in the binding density of [³H]naloxone, a MOR competitive antagonist, between Cloninger type 1 anxiety-prone and harm-avoidant alcoholics, Cloninger type 2 impulsive and antisocial alcoholics, and healthy controls in brain areas that are essential for reward, learning, impulse-control, and mood regulation., Methods: We used postmortem whole-hemisphere autoradiography with [³H]naloxone, as a binding ligand. A subsequent autoradiography was performed with [³H]DAMGO, a selective MOR agonist., Results: Cloninger type 1 alcoholics displayed decreased [³H]naloxone binding density in all studied brain areas. This trend reached statistical significance in the dentate gyrus, where type 1 alcoholics' [³H]naloxone binding density was significantly decreased (p = 0.019) when compared to controls. A similar trend of decreased binding in type 1 alcoholics was observed in the [³H]DAMGO study., Conclusions: Our finding suggest that Cloninger type 1 anxiety-prone alcoholics may have an altered [³H]naloxone binding in brain areas related to reward, impulse-control, mood, and learning. The finding lends support to the idea of Cloninger type 1 anxiety-prone alcoholics responding weaker to the opioidergic pharmaceuticals of the treatment of alcoholism than Cloninger type 2 impulsive alcoholics., (Copyright © 2015 by the Research Society on Alcoholism.)

Aim: To evaluate the occurrence of autoimmune diseases in first-degree relatives of children with juvenile idiopathic arthritis (JIA) and to compare the figures with published population data., Materials and Methods: Families of the 362 children with recently diagnosed JIA admitted to Rheumatism Foundation Hospital, Finland, from 1996 to 2001 were contacted by questionnaires regarding autoimmune diseases in family members. Data were collected on type 1 diabetes, coeliac disease, multiple sclerosis and chronic arthritis, consisting mainly of JIA, rheumatoid arthritis, spondyloarthropathy or psoriatic arthritis., Results: In all, 21.4% of the 355 families with a patient with JIA had members with type 1 diabetes, coeliac disease, multiple sclerosis or chronic arthritis. Thirty-three mothers and 23 fathers had type 1 diabetes, coeliac disease, multiple sclerosis or chronic arthritis in 15.2% (95% CI 11.6-19.4) of the families, and 23 mothers and 15 fathers had chronic arthritis in 10.7% (95% CI 7.7-14.5) of the families. When compared with available research data, the prevalences of rheumatoid arthritis, spondyloarthropathy, psoriatic arthritis, paediatric type 1 diabetes and JIA (in siblings) were increased in JIA families. Coeliac disease was as prevalent as in the population., Conclusion: Autoimmune diseases cluster in families with a child with JIA., (© 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.)

Objective: To compare the performance of different definitions of remission in a large multinational cross-sectional cohort of patients with rheumatoid arthritis (RA)., Methods: The Questionnaires in Standard Monitoring of Patients with RA (QUEST-RA) database, which (as of January 2008) included 5,848 patients receiving usual care at 67 sites in 24 countries, was used for this study. Patients were clinically assessed by rheumatologists and completed a 4-page self-report questionnaire. The database was analyzed according to the following definitions of remission: American College of Rheumatology (ACR) definition, Disease Activity Score in 28 joints (DAS28), Clinical Disease Activity Index (CDAI), clinical remission assessed using 42 and 28 joints (Clin42 and Clin28), patient self-report Routine Assessment of Patient Index Data 3 (RAPID3), and physician report of no disease activity (MD remission)., Results: The overall remission rate was lowest using the ACR definition of remission (8.6%), followed by the Clin42 (10.6%), Clin28 (12.6%), CDAI (13.8%), MD remission (14.2%), and RAPID3 (14.3%); the rate of remission was highest when remission was defined using the DAS28 (19.6%). The difference between the highest and lowest remission rates was >or=15% in 10 countries, 5-14% in 7 countries, and <5% in 7 countries (the latter of which had generally low remission rates [<5.5%]). Regardless of the definition of remission, male sex, higher education, shorter disease duration, smaller number of comorbidities, and regular exercise were statistically significantly associated with remission., Conclusion: The use of different definitions of RA remission leads to different results with regard to remission rates, with considerable variation among countries and between sexes. Reported remission rates in clinical trials and clinical studies have to be interpreted in light of the definition of remission that has been used.

Aim: To compare the neuromuscular function and balance of blind prepuberty- and puberty-aged boys to those with normal sight., Methods: Thirty-three prepubertal (aged 9-13 y) and pubertal (aged 15-18 y) blind and sighted boys were tested for muscle mass thickness, electromyography and maximal isometric strength, dynamic explosive actions, and balance., Results: There was no difference in the muscle mass thickness, maximal strength or vertical jump between the blind and sighted boys. However, fitness-ball throwing and five-jump distances were significantly shorter in both blind groups compared to the sighted groups. One-leg stance of the prepuberty-aged sighted boys was 109 (67) s and in blind boys 32 (12) s, and in the puberty-aged boys 120 (57) s and 31 (8) s, respectively. When vision was blocked in the sighted boys, differences between the blind and sighted boys disappeared., Conclusion: The results showed comparable performance between prepubertal and pubertal blind and sighted boys in the static physical fitness tests. However, balance and performance in dynamic multi-joint tests did not improve similarly in the blind groups compared to sighted groups, indicating that maturation, learning and experience by themselves cannot compensate for the loss of sight.

Relationships between adolescent physical fitness and adult health-related fitness were investigated. Forty-five subjects (20 males, 25 females) participated in physical fitness tests in 1976 and again in 2001. The adolescent physical fitness tests were distance running (2,000 m for boys or 1,500 m for girls), 50 m run, pull-ups (boys) or flexed arm hangs (girls), shuttle run, a 30-sec sit-up test, standing broad jump, hand grip-test, and sit-and-reach test. The adult health-related physical fitness index (APFI), stratified by sex, was formed by summing the z-scores of a bicycle ergometer test, sit-up test, hand-grip test, and sit-and-reach test. Height- and weight-adjusted correlations between adolescence and adulthood for exactly similar tests for men and women were, respectively, 0.74 (95% CI, 0.44-0.89) and 0.53 (95% CI, 0.17-0.76) in sit-and-reach tests, 0.41 (95% CI, -0.04 to 0.72) and 0.55 (95% CI, 0.20-0.78) in sit-up tests, and 0.53 (95% CI, 0.11-0.44) and 0.44 (95% CI, 0.05-0.71) in hand-grip tests. When all adolescent tests were put in regression analysis together with BMI in 2001, the significant explanatory factors for APFI were distance running ability and the sit-and-reach test for men and sit-up test, flexed arm hang, and BMI in 2001 for women.

Objective: A comprehensive quantitative analysis of measures of disease activity and joint damage has not been available to compare patients in different eras in the same clinical setting. This study was undertaken to determine whether the clinical status of patients with rheumatoid arthritis (RA) has improved on average in recent years., Methods: A quantitative cross-sectional evaluation, which included joint count, radiographic, laboratory, patient questionnaire, and physical function measures, and therapies, was performed in 125 consecutive RA patients seen from 1984 through 1986 ("1985 cohort"). A virtually identical assessment was performed in 150 patients seen from 1999 through 2001 ("2000 cohort"), in the same weekly academic clinic. Measures were compared using descriptive statistics and a median regression model, adjusted for age, duration of disease, level of formal education, and rheumatoid factor., Results: Patients in 1985 had significantly poorer status compared with those in 2000: median 12 versus 5 swollen joints, Larsen radiographic score 20 versus 3, erythrocyte sedimentation rate 33 mm/hour versus 20, and modified Health Assessment Questionnaire 1.0 versus 0.4 (P < 0.019). Severe Disease Activity Scores >5.1 were seen in 69% of 1985 patients, compared with 30% in 2000. Methotrexate was taken by 10% of patients in 1985, versus 76% in 2000. The proportion of patients not taking any disease-modifying antirheumatic drugs was 66% in 1985 versus 13% in 2000., Conclusion: Patients receiving standard care for RA in this setting had significantly better status, including radiographic scores, in 2000 than in 1985, associated with aggressive treatment strategies, prior to the introduction of biologic agents.

Objective: To study the impacts of 1) the delay from the onset of symptoms to the institution of disease-modifying antirheumatic drug (DMARD) therapy, 2) two treatment strategies (treatment with a combination of DMARDs or with a single drug), and 3) the presence of HLA-DRB1 alleles (shared epitope) on the prediction of disease remission after 2 years in patients with early rheumatoid arthritis (RA)., Methods: In the FIN-RACo (FINnish Rheumatoid Arthritis Combination therapy) trial, 195 patients with recent-onset RA (median duration 6 months) were randomly assigned to receive either 1) a combination of DMARDs (sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone) or 2) a single DMARD with or without prednisolone. The presence of a shared epitope was tested for in 165 of the 178 patients completing the study. The additional variables of age, sex, presence of rheumatoid factor, number of fulfilled American College of Rheumatology criteria for the classification of RA, and length of delay from onset of symptoms to institution of therapy were entered into a logistic regression model to determine the significant predictors for remission at 2 years., Results: The delay to therapy (cut point of 4 months) was the only significant predictor for remission in patients treated using the single-DMARD strategy, while no variable was a significant predictor for remission in those treated using the combination-DMARD strategy. The frequency of achieving remission in the combination-DMARD group after 2 years was similar in patients with short (0-4 months) and long (>4 months) delay periods (11 of 26 patients and 22 of 53 patients, respectively [approximately 42% in each group]), while the corresponding frequencies in the single-DMARD group were 8 of 23 patients (35%) and 7 of 63 patients (11%) (P = 0.021). The presence of a shared epitope was not related to the induction of remission., Conclusion: The delay of a few months from the onset of symptoms to institution of therapy decreases the ability of the traditional single-drug strategy to induce remission in early RA.

Objective: To compare the efficacy of combination therapy with disease-modifying antirheumatic drugs (DMARDs) versus single therapy with DMARDs in the prevention of early cervical spine changes in patients with rheumatoid arthritis (RA)., Methods: One hundred ninety-five patients with recent-onset RA (mean disease duration 8 months) were randomly assigned to receive a combination of DMARDs (sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone) or a single DMARD with or without prednisolone. After 2 years of followup, cervical spine radiographs were taken of 176 of these patients (85 in the combination-therapy group and 91 in the single-therapy group). These radiographs were evaluated, and the findings were correlated with the therapy strategies as well as with peripheral joint destruction and clinical and laboratory variables describing the disease activity., Results: Anterior atlantoaxial subluxation (aAAS), atlantoaxial impaction (AAI; i.e., vertical subluxation), and subaxial subluxation (SAS) were found in only 6 (3.4%), 2 (1.1%), and 5 (2.8%) of the patients, respectively. Interestingly, none of the patients in the combination-therapy group had aAAS or AAI. The incidences of aAAS and AAI in the single-therapy group were 6.6% and 2.2%, respectively. SAS was present in 2 patients (2.2%) in the single-therapy group and in 3 patients (3.5%) in the combination-therapy group. The difference in the incidence of aAAS between the treatment groups was statistically significant (P = 0.029). None of the patients with cervical spine changes achieved remission of RA during the study., Conclusion: In the present study, the incidence of cervical spine subluxations in patients treated with single-drug therapy was in accord with findings of previous studies. However, none of the patients in the combination-therapy group had aAAS or AAI. These findings suggest that early, aggressive combination-DMARD therapy with sulfasalazine, methotrexate, hydroxychloroquine, and prednisolone can prevent or retard the development of rheumatoid atlantoaxial disorders.