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The aim of this study was to evaluate the effectiveness of vocationally oriented medical rehabilitation (VOMR) carried out in institutions with regard to the use of health-care services, work absenteeism, leisure-time physical activity, musculoskeletal symptoms and physical performance during 112 years of follow-up. The prospective cohort study consisted of 265 patients from four different occupational groups (loggers, hairdressers, police officers and female farmers) who took part in VOMR courses in three inhouse phases, financed by the Finnish Social Insurance Institution, and who had chronic musculoskeletal symptoms in their back and neck. The subjective physical and mental strain of work, subjective neck-shoulder and low-back pain, use of health-care services and leisure-time physical activity were assessed with a questionnaires. The muscle strength of the upper and lower extremities and trunk was determined and maximal VO2 was measured using the direct maximal bicycle ergometer test. The subjective physical and mental strain of work, subjective neck-shoulder and low-back pain and physical performance showed positive significant development and improvement. The changes in the use of health-care services and work absenteeism were minor or insignificant. The general finding was that the results from the second phase of the VOMR courses did not differ from those of the third phase. VOMR courses had a beneficial effect on physical performance and subjective pain caused by neck and back musculoskeletal diseases of farmers, loggers, police officers and hairdressers within 112 years of follow-up, but VOMR courses did not decreased the use of health-care services.

We assessed the determinants of onset of hypertension in a large, prospective population-based study of perimenopausal women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study. The data collection started in 1989, when a baseline postal inquiry was sent to all women aged 47-56 years (n=14 220) residing in the Kuopio Province in Eastern Finland. Names, social security numbers and addresses were obtained from the Population Register Centre of Finland. A total of 11 798 women responded at baseline and at 5-year follow-up in 1994. After the exclusion of 1777 women with prevalent hypertension at baseline and women with missing height or weight information, the study population consisted of 9485 without established hypertension at baseline. New cases of established hypertension during the follow-up (n=908) were ascertained with the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution (SII). According to the National Health Insurance, the SII granted 90% reimbursement for drug costs in defined chronic illnesses necessitating continuous medication, like arterial hypertension. Weight and weight gain both raised the risk by 5% per kg (P

The concentration of fecal mucin and the adhesion of specific probiotics and their combinations in the intestinal mucus of infants during and after rotavirus diarrhea and in healthy children were determined. Mucus was prepared from fecal samples from 20 infants during and after rotavirus diarrhea and from 10 healthy age-matched children. Mucin concentration was determined, and the adhesion of five probiotics— Lactobacillus rhamnosus GG, Lactobacillus casei Shirota, Lactobacillus paracasei F19, Lactobacillus acidophilus LA5, and Bifidobacterium lactis Bb12—and their combinations was tested in vitro. The mean concentrations of fecal mucin during and after rotavirus diarrhea, 15.2 and 14.1 mg/g, were comparable to that in healthy children, 14.9 mg/g. The adherence of probiotics ranged from 1 to 34% in healthy subjects as indicated for the following strains: L. rhamnosus GG, 34%; B. lactis Bb12, 31%; L. acidophilus LA5, 4%; L. paracasei F19, 3%; and L. casei Shirota, 1% ( P = 0.0001). The distinctive pattern of probiotic adherence was not influenced by rotavirus diarrhea. The adhesion of Bb12 in the presence of GG increased from 31 to 39% in healthy infants ( P = 0.018) and in episodes of diarrhea increased from 26 to 44% ( P = 0.001). Rotavirus diarrhea does not decrease the production of fecal mucin or with respect to the adhesion of probiotic bacteria tested in vitro. Combination of specific probiotic strains may enhance adherence in a synergistic manner. Optimal clinical application of these interactions may offer novel therapeutic guidelines for the treatment and prevention of gastrointestinal infections.

The effects of early home management of acute diarrhea followed by rapid in-hospital realimentation on intestinal permeability were studied in 41 children aged 3-25 months with acute gastroenteritis (73% rotavirus). After oral rehydration, a 100 ml oral load containing 4 g of lactulose and 0.8 g of mannitol was administered, and an aliquot of urine excreted in the subsequent 5 h was analyzed with gas-liquid chromatography. The mean lactulose/mannitol recovery ratio was significantly higher than in 28 nondiarrheal controls, which was due to decreased mannitol excretion. The gastroenteritis patients who had received uninterrupted feeding in addition to adequate fluid replacement before hospitalization had a normal urinary lactulose/mannitol ratio, with a mean of 0.04, and a 95% confidence interval (CI) of [0.03, 0.07], whereas in fasted children with inadequate or adequate fluid replacement, the respective mean ratios were 0.24, 95% CI of [0.14, 0.43], and 0.14, 95% CI of [0.09, 0.20] (F = 12.63, p less than 0.001). The fasting-associated rise was caused by increased lactulose excretion. At retesting of gastroenteritis patients after 2 days of in-hospital realimentation, the lactulose/mannitol ratios did not differ significantly from the level on admission. The study indicated that fasting maintains the increased intestinal permeability associated with acute gastroenteritis whereas early feeding at home may promote reduction of permeability and hasten recovery.

62 NUTRITIONAL MANAGEMENT MODIFIES THE INTESTINAL PERMEABILITY CHANGES IN ACUTE GASTROENTERITIS