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The aim of the study was to explore the relationship between degree of participation and learning outcomes in an e-learning course on medical informatics. Overall activity in using course materials and degree of participation in the discussion forums of an online course were studied among 39 medical students. Students were able to utilise the course material in discussion groups focusing on the lectures, quizzes and students’ own notes. Each student’s data recording of activities and individual participation in discussion in the online course was analysed in order to assess which activities predicted learning outcome. Higher course grades were associated with studying the course material frequently and also with regular participation in reading postings and replying to them. There were no connections between learning outcome and the students’ original contributions to the discussion forums. There were no statistically significant differences between male and female students in how they utilised the various components of the learning material.

There is controversial evidence of the impact of individual learning style on students' performance in computer-aided learning.We assessed the association between the use of multimedia materials, such as video clips, and collaborative communication tools with learning outcome among medical students.One hundred and twenty-one third-year medical students attended a course in medical informatics (0.7 credits) consisting of lectures, small group sessions and eLearning material. The eLearning material contained six learning modules with integrated video clips and collaborative learning tools in WebCT. Learning outcome was measured with a course exam.Approximately two-thirds of students (68.6%) viewed two or more videos. Female students were significantly more active video-watchers. No significant associations were found between video-watching and self-test scores or the time used in eLearning. Video-watchers were more active in WebCT; they loaded more pages and more actively participated in discussion forums. Video-watching was associated with a better course grade.Students who watched video clips were more active in using collaborative eLearning tools and achieved higher course grades.

Objective: To study the nature of the relationship of life events with depressiveness. Method: In 1990, 9947 Finnish adult twins aged 33–60 years participated in a questionnaire study, with no missing data on the analysed variables. The relationship between stressful life-events and depressiveness, based on Beck Depression Inventory (BDI) classified as normal, mild or moderate, was analysed using multinomial regression for all subjects with adjustment for the effect of age, sex, health status, social support, marital status, social class, and personality variables. These same factors were analyzed among 643 twin pairs discordant for depressiveness. Results: High BDI score categories were strongly associated with stressful life events in all individuals and equally strongly within discordant twin pairs, both monozygotic and dizygotic. Poor somatic health and lack of social support also increased depressiveness. Conclusion: The effect of life events predicting depressiveness was independent of social support, somatic disease, sex and genetic liability.

Clinical studies have shown a relationship between allergic disorders and depression, panic disorder, attention deficit/hyperactivity disorder, and social anxiety for a significant subset of patients with these disorders. The nature of the relationship, whether due to shared environmental or biologic vulnerabilities or as a result of the stress of chronic illness, has been less clear. By examining the covariance of atopic disorders and depressive symptoms in a community sample of monozygotic (MZ) and dizygotic (DZ) twins, the contribution of genetic and/or shared environmental etiological factors can be established. A Finnish sample of 1337 MZ and 2506 DZ twin pairs, ages 33–60 years, was sent questionnaires inquiring about history of asthma, eczema, and atopic rhinitis, as well as the Beck Depression Inventory (BDI). The nature of the covariation between twins of these symptoms was investigated by fitting competing genetic and environmental models. Within-person correlation between atopic symptoms and BDI was 0.103 (P < 0.001) for the total sample. Using the Mx statistical modeling program to fit the data to competing quantitative genetic models, the best fitting model estimated that 64% of the association between atopy and BDI was due to shared familial vulnerability, primarily additive genetic influences. Although the measures for allergic disorders and depression are crude, this study supports the hypothesis that there is a small shared genetic risk for atopic and depressive symptoms, and if replicated, may open research for common mechanisms between allergic and depressive disorders. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:146–153, 2000. © 2000 Wiley-Liss, Inc.

Background: Electrocardiographic (ECG) analysis can be taught in eLearning programmes with suitable software that permits the effective use of basic tools such as a ruler and a magnifier, required for measurements.Aims: The Flash-ECG (Research & Development Unit for Medical Education, University of Helsinki, Finland) was developed to enable teachers and students to use scanned and archived ECGs on computer screens and classroom projectors.Results: The software requires only a standard web browser with a Flash plug-in and can be integrated with learning environments (Blackboard/WebCT, Moodle). The Flash-ECG is freeware and is available to medical teachers worldwide.

Electromagnetic fields have been suggested to contribute to the risk of depression by causing pineal dysfunction. Some epidemiologic studies have supported this possibility but have generally reported crude methods of exposure assessment and nonsystematic evaluation of depression. Using two available nationwide data sets, the authors identified from the Finnish Twin Cohort Study 12,063 persons who had answered the 21-item Beck Depression Inventory of self-rated depressive symptoms in 1990. The personal 20-year histories of exposure (i.e., distance and calculated annual average magnetic fields) before 1990 to overhead 110- to 400-kv power lines were obtained from the Finnish Transmission Line Cohort Study. The adjusted mean Beck Depression Inventory scores did not differ by exposure, providing some assurance that proximity to high-voltage transmission lines is not associated with changes within the common range of depressive symptoms. However, the risk of severe depression was increased 4.7-fold (95% confidence interval 1.70-13.3) among subjects living within 100 m of a high-voltage power line. This finding was based on small numbers. The authors recommend that attempts be made to strive for a better understanding of the exposure characteristics in relation to the onset and course of depression.

This 6-year follow-up study investigates the impact of interpersonal conflict at work on work disability among 8,021 male and 7,327 female employees aged 24 to 65 years at baseline. Marital status, marital conflict, monotonous work, hectic work pace, hostility, neuroticism, life dissatisfaction, and experienced stress of daily activities were included in survival analyses, which were adjusted for age, social status, and general health status. Interpersonal conflict at work predicted work disability only among women (RR 1.56, CL 1.01-2.39). This risk was confined to women who reported simultaneous marital conflicts (RR 2.54, CL 1.03-6.22). When included in further analyses, life dissatisfaction was a significant risk factor among both genders, but monotonous work, neuroticism, and experienced stress of daily activities were risk factors only among men. These data suggest that interpersonal conflict could be a determinant of work disability, and this indicates the importance of gender and marital factors.

We studied the cumulative incidence, concordance rate and heritability for diabetes mellitus in a nationwide cohort of 13,888 Finnish twin pairs of the same sex. The twins were born before 1958 and both co-twins were alive in 1967. Data on diabetes were derived through computerized record linkage from death certificates, the National Hospital Discharge Register and the National Drug Register. Records were reviewed in order to assign a diagnostic category to the 738 diabetic patients identified. Of these patients 109 had Type 1 (insulin-dependent) diabetes, 505 Type 2 (non-insulin-dependent) diabetes, 46 gestational diabetes, 24 secondary diabetes, 38 impaired glucose tolerance and 16 remained unclassified. The cumulative incidence of diabetes was 1.4 % in men and 1.3 % in women aged 28–59 years and 9.3 % and 7.0 % in men and women aged 60 years and over, respectively. The cumulative incidence did not differ between monozygotic and dizygotic twins. The concordance rate for Type 1 diabetes was higher among monozygotic (23 % probandwise and 13 % pairwise) than dizygotic twins (5 % probandwise and 3 % pairwise). The probandwise and pairwise concordance rates for Type 2 diabetes were 34% and 20% among monozygotic tiwns and 16% and 9 % in dizygotic twins, respectively. Heritability for Type 1 diabetes was greater than that for Type 2 where both genetic and environmental effects seemed to play a significant role.

BACKGROUND Depression is associated with smoking, but the causality of the relationship is debated. The authors examine smoking behaviour as a predictor of depression among the Finnish adult twin population. METHOD Based on responses to surveys in 1975 and 1981, the authors characterized the subjects as never smokers, persistent former smokers, quitters, recurrent smokers and persistent smokers. The Beck Depression Inventory (BDI) was applied in 1990 to measure depression (BDI score >9). Although the population consisted of twins, the authors first considered the subjects as individuals. Logistic regression models were computed for 4164 men and 4934 women. In order to control for family and genetic background, conditional logistic regression analyses were conducted among twin pairs discordant for depression. Bivariate genetic modelling was used to examine genetic and environmental components of the correlation between smoking and depression. RESULTS Among the men, persistent smoking (OR 1 x 42, 95% CI 1 x 07-1 x 89) and smoking in 1975 but quitting by 1981 (OR 1 x 68, 95% CI 1 x 17-2 x 42) was associated with a higher risk of depression, while among the women only the quitters had an elevated risk (OR 1 x 38, 96% CI 1 x 01-1 x 87). The gender x smoking interaction showed persistent smoking to be a stronger risk for men. When family and genetic background were controlled, smoking remained a predictor of depression. Genetic modelling among the men suggested a modest correlation (rg=0 x 25) between genetic components of smoking and depression. CONCLUSIONS Smoking behaviour may be a gender-sensitive predictor of depression, the stronger association in men being partly accounted for by having underlying genes in common.

Background To evaluate medical and dental students' utilization of electronic information resources. Methods A web survey sent to 837 students (49.9% responded). Results Twenty-four per cent of medical students and ninteen per cent of dental students searched MEDLINE 2+ times/month for study purposes, and thiry-two per cent and twenty-four per cent respectively for research. Full-text articles were used 2+ times/month by thirty-three per cent of medical and ten per cent of dental students. Twelve per cent of respondents never utilized either MEDLINE or full-text articles. In multivariate models, the information-searching skills among students were significantly associated with use of MEDLINE and full-text articles. Conclusion Use of electronic resources differs among students. Forty percent were non-users of full-text articles. Information-searching skills are correlated with the use of electronic resources, but the level of basic PC skills plays not a major role in using these resources. The student data shows that adequate training in information-searching skills will increase the use of electronic information resources.

Summary Objective: The purpose of this study is to compare whether students’ learning outcomes would be better in a designed learning environment (WebCT) than in a conventional web site (WWW) with similar course material but without special learning tools. Context: Third-year medical students in an introductory course on medical informatics at the University of Helsinki, Finland. Methods: Students were randomly assigned to a WebCT group (n = 39) and a WWW group (n = 46). The students in the WebCT group utilized the course material in general discussion groups, special discussions about lectures, quizzes and students’ own notes. The WWW group had access only to the course material. The learning outcome was assessed by administering an on-line examination and the learning experience of the students was assessed by an on-line quiz. Results: The course grade was significantly higher in the WebCT group as compared to the WWW group. This finding was more prominent among females. The students of the WebCT group also experienced significantly more improvement in collaboration with the use of computers than the students in the WWW group. Conclusions: Based on our results, web-based learning seems to be more effective when students are provided with specially designed learning tools. © 2005 Elsevier Ireland Ltd. All rights reserved.

Relationships between psychiatric morbidity and interpersonal conflict at work among 15,530 Finnish employees aged 24 to 64 years were studied in a prospective follow-up: 4 years for all psychiatric hospitalizations, 5 years for suicide, and 6 years for long-term medication due to chronic psychosis. The association between interpersonal conflict at work and physician-diagnosed psychiatric morbidity was significant (RR 2.18, 95% CI 1.34-3.54) when results were adjusted for general health status, social class, and mental instability/stress. Results remained significant in additional models adjusted for neuroticism, marital status, conflict with spouse, and high alcohol consumption. The results were similar for both sexes.

The association of self-reported hostility with morbidity and mortality due to external causes, including suicidal acts, was analyzed in 10,586 Finnish men and 10,857 Finnish women aged 24 to 59 years. Hostility was assessed from self-ratings on irritability, ease of anger-arousal, and argumentativeness. Three groups, low (33.6% of subjects), intermediate (50.6%), and extreme (15.9%), were formed from the self-reported hostility scores. A 6-year mortality follow-up yielded 76 violent deaths among men and 11 among women. A 4-year morbidity follow-up found 399 hospitalizations due to external causes among men and 169 among women. Among men, the risk ratio between the highest and lowest hostility groups was 1.51 (95% confidence interval, 1.16-1.96) for all events due to external causes and 3.6 (95% confidence interval, 1.63-7.89) for suicidal behavior, when effects of age, marital status, social status, and self-reported alcohol use were controlled in a multivariate model. No association was observed between traffic-related injuries and hostility. Hostility did not predict accidents or accidental deaths or suicidal behavior among women. Language: en

The use of tranquilizers, hypnotics, and analgesics was assessed by a postal questionnaire in a nationwide sample of 18,592 adults aged from 24 to 65 years: 14,800 employees, 2105 housewives and 687 unemployed persons. The use of tranquilizers was most frequent among unemployed persons whereas housewives did not use the studied medicines more than the employed women. In the multivariate analyses (adjusted for age, social class and neuroticism) unmarried status was associated with the use of tranquilizers and hypnotics among both genders. Reported recent interpersonal conflicts both at work and with a spouse were associated with the use of tranquilizers among men, whereas among women significant associations were found only for conflicts with a spouse. These results indicate that domestic factors are more likely to predict women's tranquilizer use.

Associations of psychosocial factors with interpersonal conflicts at work were studied in a sample drawn from the Finnish population using a mailed questionnaire. The sample consisted of 14,578 employees aged 24-64 years. The frequency of interpersonal conflicts at work was equal among both sexes. Our results suggest that occupational factors such as hectically paced work, monotonous work and white collar status are associated with interpersonal conflicts at work; and more conflicts are found in the younger age-groups. In the multivariate analyses, dissatisfaction with life, daily stress, neuroticism and hostility were found to be the significant risk factors for interpersonal conflicts at work for both sexes, whereas a higher educational level was a considerable risk factor only for men, and low self-assurance only for women. Among men the combination of hectically paced and monotonous work was also found to be a significant risk factor. The results indicate complexity of the concept of human relationships at work, and the importance of both occupational factors and psychological characteristics.

The self-reported alcohol use of 12994 Finnish adults were followed up six years and the changes of alcohol consumption among males and females were analysed.

The effect of migration on pairwise concordance for disease was assessed in 11,154 twin pairs of the Finnish Twin Cohort Study by comparing the pairs living in the same province to the pairs which members were living in different provinces of Finland. The cumulative incidence of psychosis and hypertension for the years 1972-1985 were analyzed. The cumulative concordance of psychosis for those MZ twin pairs living in the same province were higher than for those MZ pairs living further apart. Similar findings were found among DZ pairs for psychosis. The cumulative concordance of hypertension was only slightly higher among those MZ and DZ pairs living in the same province compared with pairs living in different provinces. These results indicate an overestimation of concordance of psychosis caused by selective migration. This bias in twin studies is likely to influence heritability estimates in a sample of limited geographical area.

The traditional role of twin studies has been to assess the relative role of genetic factors as a first step in defining the genetic architecture of complex traits. This has been based on the realization that monozygotic pairs (MZ) share all their genes, while dizygotic pairs (DZ) share 50% of their genes on average. Thus, greater similarity of MZ pairs compared to DZ pairs has been taken as prima facie evidence of the role of genetic factors. This is true provided the environmental similarity of MZ pairs is not greater than for DZ pairs for effects relevant to the trait in question. This first step in genetic studies was carried out long ago in many research areas, but not in others. More detailed knowledge of the genetic architecture of traits is then obtained by other means. In this paper, we give a brief overview of some results for metabolic diseases (ischaemic heart disease, hypertension, subarachnoid haemorrhage, NIDDM and IDDM) using the classical twin approach in a large, unselected population-based twin cohort. We also outline approaches to using twins that we believe will continue to be useful, particularly for the study of environmental effects.

A nationwide epidemiologic study among 5512 men and 6551 women aged 33–60 years in Finland included the 21-item Beck Depression Inventory (BDI). Of the men, 13.5% and, of the women, 20.2% had BDI scores of more than 9, indicating at least mild depression. A BDI score of more than 18 was found in 2.6% of the men and 4.0% of the women, indicating at least moderate depression. Mean BDI scores were higher for women than for men and increased significantly with age. In threc-factor analysis, factor 1 (Performance Impairment) scores increased with age. Increased rates of depression in older subjects might be due to increased somatic symptoms mapping on to Factor 1, which included items such as fatigue, work inhibition, and sleep disturbance. Factor 2 (Negative Attitudes Toward Self) scores with items such as self-dislike, sense of failure, and guilt feelings did not increase with age. When assessing depression in older middle-aged adults, their increased tendency to report somatic symptoms should be noted.

We have extended linkage of the population-based Finnish Twin Cohort to alcohol-related hospital discharge data through 1985. The sample included 10,680 individual male twinsor = age 30 at time of linkage; 269 of these twins (2.5%) had received an alcohol-related hospital diagnosis. Twin analyses confirm significant genetic variance in alcohol-related disorders, but suggest that concordance for these disorders is greater for twins living within limited geographic areas, perhaps due to restricted social mobility among those who abuse alcohol.

To evaluate genetic influences on the use and abuse of alcohol, we compared questionnaire measures of the frequency, quantity, and density of social drinking, and the frequency of alcohol-induced passouts self-reported by 879 monozygotic (MZ) and 1940 dizygotic (DZ) pairs of twin brothers, aged 24–49 yr. The measures of frequency, quantity, and density (heavy drinking once or more a month) significantly intercorrelate, and the self-reported alcohol consumption by this sample is satisfactorily stable and consistent with nationwide sales figures. None of the drinking measures was associated with twin type (zygosity), and only density correlated with age. Similarity of drinking habits among twin brothers was evaluated as a function of their genetic resemblance and age, the frequency of their social contact with one another, and the interactions of these terms. The effects were estimated from hierarchical linear regressions of a double-entry data matrix from which each twin's drinking was predicted from that of his twin brother, and that pair's age, zygosity, cohabitation status, and frequency of social contact. Significant genetic variance was found for each of the drinking measures with heritability estimates ranging from 0.36 to 0.40. Co-twins in more frequent social contact with one another reported greater similarity in their use of alcohol, but heritable variance remained after the effects of age and social contact were removed from both mean levels and co-twin resemblance. Reported frequency of pass-outs yielded significant, but equivalent, correlations in both MZ and DZ twins and no evidence of genetic influence.

The Finnish Twin Cohort study (27,776 individuals; all twins of the same sex born before 1958 and alive in 1967) detected 316 cases of epileptic seizures occurring in 310 twin pairs: 89 monozygotic pairs and 221 dizygotic pairs, including three concordant monozygotic pairs and three concordant dizygotic pairs. The ratio of the observed to expected number of concordant pairs for epileptic seizures was 5.48 (90% CL 1.5-14.2) in monozygotic and 2.12 (90% CL 0.6-5.5) in dizygotic pairs. The results suggest that 8% to 27% of the incidence of epileptic seizures is related to genetic variability. The study of environmental differences in discordant monozygotic pairs should provide insights into the etiology of this group of disorders.

Network-based training can provide continuing medical education with methods, whose implementation by means of traditional training is difficult or practically impossible. By virtue of its chronological and geographical flexibility, educational application of the network may provide extra advantage for the trainee and the trainer. Implementation of network-based training is, however, demanding and laborious both technically and pedagogically, whereby organizations should strive for collaboration in organizing the training. In addition, the status of network-based continuing education in relation to the physician's working time should be clearly defined.

In 1975 and again in 1981, all adult twins in the population-based Finnish Twin Cohort were administered postal questionnaires yielding data on self-reported frequency and quantity of alcohol use. The longitudinal results provide information on the age-to-age stability of social drinking patterns among 13,404 (twin) individuals aged 18 to 43 at baseline; model-fitting the cross-temporal consistency of the twins' reported alcohol use yields unique estimates of the contribution of genetic and environmental factors to their individual age-to-age stabilities. Mean consumption levels did not change between 1975 and 1981. Patterns of social drinking were more stable in older (aged 24-43 at baseline) than younger (aged 18-23 at baseline) adult twins, and were more stable among men than women. Heritabilities were significant at both baseline and follow-up for all three alcohol measures in both genders and both age groups, with a median magnitude of 0.48. Both longitudinal genetic and environmental covariances were significant, and both were generally higher among older pairs. Genetic covariances (median magnitude = 0.68) were significantly higher than environmental covariances (median = 0.36). Analyses of absolute changes in alcohol use revealed heritable influences on the disposition to change. We conclude that genes contribute to both consistency and change in patterns of alcohol use from early to midadulthood.

To study the nature of the relationship of life events with depressiveness.In 1990, 9947 Finnish adult twins aged 33-60 years participated in a questionnaire study, with no missing data on the analysed variables. The relationship between stressful life-events and depressiveness, based on Beck Depression Inventory (BDI) classified as normal, mild or moderate, was analysed using multinomial regression for all subjects with adjustment for the effect of age, sex, health status, social support, marital status, social class, and personality variables. These same factors were analyzed among 643 twin pairs discordant for depressiveness.High BDI score categories were strongly associated with stressful life events in all individuals and equally strongly within discordant twin pairs, both monozygotic and dizygotic. Poor somatic health and lack of social support also increased depressiveness.The effect of life events predicting depressiveness was independent of social support, somatic disease, sex and genetic liability.