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Seven-day food records were used to elicit dietary consumption data for 43 Finnish rheumatoid arthritis patients to explore their food and nutrient intakes on a fixed uncooked vegan diet. Urinary sodium excretion and the information on the intake of specific food items such as rejuvelac drink and wheatgrass juice were used to evaluate the adherence to the vegan diet. The intakes of energy and several nutrients greatly improved upon switching to the uncooked vegan diet.

Healthcare needs assessment of a local population combines national and local health registries with practice-based data, surveys and qualitative methods. A working group in Finland has developed a system of key indicators for local needs assessment based on a comparative approach. It uses 45 key indicators within four different fields: demography, health behaviour, health status and use of health services. Indicators had to: describe an aspect of health affecting large groups; be available and accessible in existing data files; and be valid, reliable and easy to interpret. A user interface is needed to extract the indicators via the Internet. An educational package of instructions and exercises will be prepared. The use of evidence in health service planning needs to be strengthened. The project offers a new toolkit for healthcare needs assessment, planning of local health services and public health development. © 2004 SAGE Publications [ABSTRACT FROM AUTHOR]

Objective: To identify the most important referring parties in the Finnish health care system. Design: A record linkage study based on nationwide administrative registers. Setting: The hospital discharge register during 1996 to 2000. Subjects: The total Finnish population and the population of four hospital districts. Main outcome measures Discharges of individuals by the most important referring parties. Results: The five most important referring parties in order of magnitude are as follows: health centre, no referral, clinic/unit of the same hospital, hospital other than a health centre, and private health care. The five most important referring parties for those aged over 75 are the same mentioned above. There were regional differences in referral practices. Conclusions: Differences or changes in referral profiles as a function of time cannot be taken as a direct measure of the impact of possible interventions or as an indication of an actual difference between the areas compared. One should also always be aware about any related metaknowledge. [ABSTRACT FROM AUTHOR]

The effect of a strict, low-salt, uncooked vegan diet rich in lactobacteria on symptoms in 18 fibromyalgia patients during and after a 3-month intervention period in an open, non-randomized controlled study was evaluated. As control 15 patients continued their omnivorous diet. The groups did not differ significantly from each other in the beginning of the study in any other parameters except in pain and urine sodium. The results revealed significant improvements in Visual analogue scale of pain (VAS) (p=0.005), joint stiffness (p=0.001), quality of sleep (p=0.0001), Health assessment questionnaire (HAQ) (p=0.031), General health questionnaire (GHQ) (p=0.021), and a rheumatologist's own questionnaire (p=0.038). The majority of patients were overweight to some extent at the beginning of the study and shifting to a vegan food caused a significant reduction in body mass index (BMI) (p=0.0001). Total serum cholesterol showed a statistically significant lowering (p=0.003). Urine sodium dropped to 1/3 of the beginning values (p=0.0001) indicating good diet compliance. It can be concluded that vegan diet had beneficial effects on fibromyalgia symptoms at least in the short run. [ABSTRACT FROM AUTHOR]

To clarify the role of the faecal flora in the diet-induced decrease of rheumatoid arthritis (RA) activity, 43 RA patients were randomized into two groups: the test group to receive living food, a form of uncooked vegan diet rich in lactobacilli, and the control group to continue their ordinary omnivorous diets. Based on clinical assessments before, during and after the intervention period, a disease improvement index was constructed for each patient. According to the index, patients were assigned either to a group with a high improvement index (HI) or to a group with a low improvement index (LO). Stool samples collected from each patient before the intervention and at 1 month were analysed by direct stool sample gas-liquid chromatography of bacterial cellular fatty acids. This method has proved to be a simple and sensitive way to detect changes and differences in the faecal microbial flora between individual stool samples or groups of them. A significant, diet-induced change in the faecal flora (P = 0.001) was observed in the test group, but not in the control group. Further, in the test group, a significant (P = 0.001) difference was detected between the HI and LO categories at 1 month, but not in the pre-test samples. We conclude that a vegan diet changes the faecal microbial flora in RA patients, and changes in the faecal flora are associated with improvement in RA activity. [ABSTRACT FROM PUBLISHER]

The effects of a strict uncooked vegan diet on serum lipid and sterol concentrations were studied in patients with rheumatoid arthritis. The subjects were randomized into a vegan diet group (n 16), who consumed a vegan diet for 2???3 months, or into a control group (n 13), who continued their usual omnivorous diets. Serum total and LDL-cholesterol and -phospholipid concentrations were significantly decreased by the vegan diet. The levels of serum cholestanol and lathosterol also decreased, but serum cholestanol:total cholesterol and lathosterol:total cholesterol did not change. The effect of a vegan diet on serum plant sterols was divergent as the concentration of campesterol decreased while that of sitosterol increased. This effect resulted in a significantly greater sitosterol:campesterol value in the vegan diet group than in the control group (1.48 (SD 0.39) V. 0.72 (sd 0.14); P<0.001). A higher concentration of campesterol compared with sitosterol is normal in omnivorous subjects and can be explained by lower absorption and esterification rates of sitosterol. Our results suggest that a strict uncooked vegan diet changes the relative absorption rates of these sterols and/or their biliary clearance. [ABSTRACT FROM PUBLISHER]

Background: Diffusion tensor imaging (DTI) is prone to numerous systemic confounding factors that should be acknowledged to avoid false conclusions., Purpose: To investigate the possible effects of age, gender, smoking, alcohol consumption, and education on cerebral DTI parameters in a generally healthy homogenous sample with no neurological or psychiatric diseases., Material and Methods: Forty (n = 40) subjects (mean age, 40.3 years; SD, 12.3) underwent brain DTI with 3 T magnetic resonance imaging (MRI). At enrolment, all the subjects were interviewed with respect to general health, education, history of smoking, and alcohol consumption. Studied DTI parameters included: (i) fractional anisotropy (FA); and (ii) apparent diffusion coefficient (ADC). Region-of-interest (ROI)-based measurements were estimated at 13 anatomical locations bilaterally on the axial images, except for the corpus callosum in which the ROIs were placed on the sagittal images. Circular ROI measurements were mainly used. Freehand ROI method was used with the forceps minor, uncinate fasciculus, and thalamus. Intra-observer variability and repeatability were assessed., Results: The most consistent finding was that aging decreased FA values in the frontal brain regions. Regarding the other confounding factors, the results were discontinuous and no concrete conclusions could be drawn from these findings. In general, intra-observer repeatability of the DTI measurement was considered relatively good., Conclusion: Age should be noted as considerable confounding factors in ROI-based DTI analysis. More research on the effects of gender, smoking, alcohol consumption, and education is needed.

Background: The aim was to evaluate the effect of a 12-month individualized health coaching intervention by telephony on clinical outcomes., Methods: An open-label cluster-randomized parallel groups trial. Pre- and post-intervention anthropometric and blood pressure measurements by trained nurses, laboratory measures from electronic medical records (EMR). A total of 2594 patients filling inclusion criteria (age 45 years or older, with type 2 diabetes, coronary artery disease or congestive heart failure, and unmet treatment goals) were identified from EMRs, and 1535 patients (59%) gave consent and were randomized into intervention or control arm. Final analysis included 1221 (80%) participants with data on primary end-points both at entry and at end. Primary outcomes were systolic and diastolic blood pressure, serum total and LDL cholesterol concentration, waist circumference for all patients, glycated hemoglobin (HbA1c) for diabetics and NYHA class in patients with congestive heart failure. The target effect was defined as a 10-percentage point increase in the proportion of patients reaching the treatment goal in the intervention arm., Results: The proportion of patients with diastolic blood pressure initially above the target level decreasing to 85 mmHg or lower was 48% in the intervention arm and 37% in the control arm (difference 10.8%, 95% confidence interval 1.5-19.7%). No significant differences emerged between the arms in the other primary end-points. However, the target levels of systolic blood pressure and waist circumference were reached non-significantly more frequently in the intervention arm., Conclusions: Individualized health coaching by telephony, as implemented in the trial was unable to achieve majority of the disease management clinical measures. To provide substantial benefits, interventions may need to be more intensive, target specific sub-groups, and/or to be fully integrated into local health care., Trial Registration: ClinicalTrials.gov Identifier: NCT00552903.

The present study focuses on a subtype of Finnish nouns that appear only as complements in idiomatic verb phrases. In addition to the idioms as their sole environment, these idiomatic isolates, as we call them, are typically frozen to a single case form. In two experiments, in a subjective rating task and a lexical decision task, the isolates are pitted against ordinary nouns and nouns that appear as frozen forms in idioms in addition to being ordinary, free words. The experiments show that the isolates, in spite of their defective syntactic and morphological properties, are processed like ordinary lexical items., (Copyright 1999 Academic Press.)

We have performed a number of studies including dietary interventions and cross-sectional studies on subjects consuming uncooked vegan food called living food (LF) and clarified the changes in several parameters related to health risk factors. LF consists of germinated seeds, cereals, sprouts, vegetables, fruits, berries and nuts. Some items are fermented and contain a lot of lactobacilli. The diet is rich in fiber. It has very little sodium, and it contains no cholesterol. Food items like berries and wheat grass juice are rich in antioxidants such as carotenoids and flavonoids. The subjects eating living food show increased levels of carotenoids and vitamins C and E and lowered cholesterol concentration in their sera. Urinary excretion of sodium is only a fraction of the omnivorous controls. Also urinary output of phenol and p-cresol is lowered as are several fecal enzyme levels which are considered harmful. The rheumatoid arthritis patients eating the LF diet reported amelioration of their pain, swelling of joints and morning stiffness which all got worse after finishing LF diet. The composite indices of objective measures showed also improvement of the rheumatoid arthritis patients during the intervention. The fibromyalgic subjects eating LF lost weight compared to their omnivorous controls. The results on their joint stiffness and pain (visual analogue scale), on their quality of sleep, on health assessment questionnaire and on general health questionnaire all improved. It appears that the adoption of vegan diet exemplified by the living food leads to a lessening of several health risk factors to cardiovascular diseases and cancer. Rheumatoid patients subjectively benefited from the vegan diet which was also seen in serum parameters and fecal analyses.

We tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and control groups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to an omnivorous diet aggravated symptoms. Half of the patients experienced adverse effects (nausea, diarrhoea) during the diet and stopped the experiment prematurely. Indicators of rheumatic disease activity did not differ statistically between groups. The positive subjective effect experienced by the patients was not discernible in the more objective measures of disease activity (Health Assessment Questionnaire, duration of morning stiffness, pain at rest and pain on movement). However, a composite index showed a higher number of patients with 3-5 improved disease activity measures in the intervention group. Stepwise regression analysis associated a decrease in the disease activity (measured as change in the Disease Activity Score, DAS) with lactobacilli-rich and chlorophyll-rich drinks, increase in fibre intake, and no need for gold, methotrexate or steroid medication (R2=0.48, P=0.02). The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis. Large amounts of living lactobacilli consumed daily may also have positive effects on objective measures of rheumatoid arthritis.

The fatty acid composition of erythrocytes, platelets, and serum lipids was compared between subjects who had been eating a strict uncooked vegan diet ("living food") for years and omnivore controls. The vegan diet contains equal amounts of fat but more monounsaturated and polyunsaturated and less saturated fatty acids than the mixed diet of the control group. In vegans, the proportion of linoleic acid was greater in all lipid fractions studied. Also, the levels of other n-6 fatty acids were greater, with the exception of arachidonic acid levels, which were similar in most fractions. In erythrocytes, platelets and serum phospholipid fractions, this increase was mainly at the expense of the n-3 fatty acids. The proportions of eicosapentaenoic and docosahexaenoic acid were only 29-36% and 49-52% of those in controls, respectively. In vegans the ratio of n-3 to n-6 fatty acids was only about half that in omnivores. In addition to the lower levels of n-3 fatty acids, the proportions of palmitic and stearic acids were lower in serum cholesteryl esters, triglycerides and free fatty acids of vegans. The proportion of oleic acid was slightly lower only in serum cholesteryl esters and erythrocyte phosphatidylserine. The results show that, in the long term, the vegan diet has little effect on the proportions of oleic and arachidonic acids, whereas the levels of n-3 fatty acids are depressed to very low levels with prolonged consumption of the high linoleic and oleic acid components of this diet.

Background: High salt intake is a risk factor for essential hypertension in man. There is evidence that, in hypertension, intracellular sodium content and univalent cation transport across erythrocyte membranes are changed. It has been proposed that a low-sodium diet has an antihypertensive effect; this may be related to changes in cation fluxes across plasma membranes., Methods: Sodium and potassium fluxes and the composition of fatty acids were studied in the erythrocytes of people who had eaten a low-sodium vegan diet for many years (n = 9) and in those of controls who had consumed a mixed diet (n = 11) to investigate the dependence of these variables on dietary factors. Both systolic and diastolic blood pressures were lower in vegans than in controls., Results: The passive permeability to sodium (P < 0.05) ,Na+,K+ cotransport (P < .001) and the intracellular content of exchangeable sodium (P = 0.076) were decreased in the erythrocytes of those who had consumed the low-sodium diet compared with the controls. The activity of the Na+-K+ pump, Na+-H+ exchange and the passive permeability to potassium were unaltered. Swelling-induced K+,C1- cotransport was increased in the erythrocytes of those who had eaten the low-sodium vegan diet compared with controls (P < 0.01). The proportion of linoleic acid was increased (P < 0.01) at the expense of eicosapentaenoic and docosahexaenoic acids (P < 0.001) in the erythrocyte membranes of the vegans., Conclusion: Our results show that levels of intracellular sodium and Na+,K+ cotransport activity, which increase in patients with hypertension, decreased in those consuming a low-sodium vegan diet. This suggests that the risk of essential hypertension was diminished in the vegan participants, confirming our observation that systolic and diastolic blood pressures were lower in the strict vegans than in the controls.

Dietary intake data of 43 Finnish rheumatoid arthritis patients were collected using 7-day food records. The subjects were randomized into a control and a vegan diet groups, consisting of 22 and 21 subjects, respectively. The subjects in the vegan diet group received an uncooked vegan diet ('living food') for 3 months, and they were tutored daily by a living-food expert. The subjects in the control group continued their usual diets and received no tutoring. Adherence to the strict vegan diet was assessed on the basis of urinary sodium excretion and by the information on consumption of specific food items (wheatgrass juice and the rejuvelac drink). The use of these drinks was variable, and some boiled vegetables were consumed occasionally. However, only one of the subjects in the vegan diet group lacked a clear decrease in urinary sodium excretion. Rheumatoid patients had lower than recommended intakes of iron, zinc and niacin, and their energy intake was low compared to mean daily energy intake of the healthy Finnish females of the same age. Shifting to the uncooked vegan diet significantly increased the intakes of energy and many nutrients. In spite of the increased energy intake, the group on the vegan diet lost 9% of their body weight during the intervention period, indicating a low availability of energy from the vegan diet.

Biochemical and metabolic indicators were monitored in a group of volunteers suffering from a variety of chronic illnesses participating in a week's course on a special uncooked vegetable diet, known as "living food". Unmatched healthy controls ate the same diet cooked for 2 min in a microwave oven. After 1 week on the regimen, serum protein and urea contents decreased and alanine aminotransferase (ALAT) activity increased in both groups, although all within the normal range. Blood glucose increased in both groups to slightly above normal limits but total serum cholesterol dropped about 1 mmol/l from normal starting levels. Serum tocopherol and retinol increased only in the group eating the uncooked diet. In both groups urinary sodium dropped drastically without a significant change in potassium. Serum and urinary phenol and p-cresol diminished also significantly. It is concluded that this vegetable diet may be of some benefit in the short term but any longer-term use requires evaluation.