Three controlled dietary intervention studies were carried out in 1981-1983 in North Karelia, Finland, to asses the impact of dietary fat intake modification on blood pressure (BP). All these studies involved middle-aged men and women in rural or semirural areas and comprised a baseline period, a six week (or 12 weeks in the third study) intervention period and a four to six week return to baseline. During the intervention period the total fat intake was reduced from 39% to 24% of energy and the polyunsaturated/saturated (P/S) ratio increased from 0.2 to 0.4-1.2. In all groups energy intake was kept constant. For the present report data from the three studies were pooled for a series of stepwise regression analyses to predict changes in BP with different dietary changes. For both systolic (SBP) and diastolic (DBP) blood pressure, change in polyunsaturated fatty acid intake was the strongest dietary predictor of BP change. Changes in body weight, total fat intake, urinary sodium and potassium did not have significant predictive power in any of the analyses. The findings support the hypothesis that modification of dietary fat intake is a significant predictor of change in BP.
During a three-year follow-up study of 235 risk-group people living in Finland, we found a slow increase in the proportion of HIV seropositives (from 9.8% to 14.0%) and a slow but continuous advance in symptoms typical of HIV infection among them. The first immunological changes after HIV seroconversion were an increase in Ts-cells and a decline in antigen-induced T-cell functions (proliferation, IL-2 production). A further decline in antigen-induced responses was seen before early clinical symptoms and signs of HIV infection developed. During later phases of HIV infection the decrease of Th-cells and the elevation of serum Beta-2 microglobulin correlated most strongly with the progression of HIV infection. The mitogen-induced lymphocyte functions of the HIV-infected correlated to Th-cell levels, while the antigen-induced proliferation and IL-2 production showed correlation neither to Th-cells nor to Ts-cells. The poor antigen-induced T-cell responses might be caused by abnormally functioning monocytes, known to be infected by HIV. Our results suggest that in HIV infection there is a continuous but slow disease progression, although individual variation may be great. The immunological parameter best predicting the prognosis of an infected person in the early phases of infection was the antigen-induced lymphocyte functions, and later the amount of Th-cells.
All visits to physicians in the Orivesi Region Federation of Municipalities for Public Health Work in Finland paid due to symptomatic osteoarthrosis of the knee joint were prospectively recorded over a period of one year. Two hundred and thirty four visits were made, accounting for 0.63% of all visits. The prevalence of knee osteoarthrosis was 1.11% (men 0.45%, women 1.72%), and the incidence was 0.60%. The disease occurred almost twice as often in the right knee than in the left. The study provides basic information about patients needing medical help because of symptomatic knee osteoarthrosis. The results can be used as an aid to the planning of examination and treatment resources and in assessment of the need for such services.
The annual mortality rate of cystic fibrosis patients with chronic Pseudomonas aeruginosa lung infection at the Danish CF-centre ranged from 10 to 20% in the years 1970-1975. In this period the patients received antipseudomonal chemotherapy only during acute exacerbations of infection. From 1976 99 patients acquired chronic P. aeruginosa infection and were given regular and intensive antipseudomonal treatment 3-4 times per year. The patients were followed for 612 patient-years; 7 died and the 10-year survival rate after onset of P. aeruginosa infection was 90% +/- 4%. The annual mortality rate is now 1-2%. Although precipitating antibodies against P. aeruginosa increased significantly, pulmonary function did not deteriorate with duration of infection. Cross-infection between patients caused an increased incidence of chronic P. aeruginosa infection which was reduced by hygienic measures.
The composition of fatty acids in serum lipids has been shown to reflect the quality of dietary fat. In order to examine the long-term stability (tracking) of the serum (and hence dietary) fatty acid composition serum cholesteryl ester fatty acids were analysed by gas chromatography in a randomly selected population sample of 1029 Finnish boys and girls aged 3, 6, 9, 12, 15 and 18 years, and again from the same individuals 3 years later. The tracking was evaluated by calculating linear correlation coefficients for the percentages of individual fatty acids between the 2 time points. For all fatty acids the correlations were highly significant, e.g. for linoleate and arachidonate they were 0.58 and 0.61, respectively. In 1980 the means of the percentages of some fatty acids showed certain differences between the various age and sex groups; in 1983 these differences had become smaller and had largely shifted towards three years older age groups, implying that the differences were due to dietary differences between the cohorts rather than to age and sex per se. The present results indicate that serum fatty acid composition has a fairly good biological reproducibility (tracking) and suggest that age and sex as such are only minor determinants of the serum fatty acid composition.
Kozlowski and Page have criticized a study published in 1982 in CMAJ on the effects of supportive follow-up on the rate at which patients quit smoking cigarettes. We agree with some of their general sentiments about the need for establishing a consensus on the evaluation of smoking cessation programs. More specifically, we defend the particular analysis originally used, given the state of knowledge and constraints on the study. We examine their main objections: the definition of successful cessation, the design of the study, the exclusion of patients lost to follow-up, the methods of statistical analysis used and the strength of more recent evidence on the usefulness of follow-up visits. We believe that the role of supportive follow-up deserves further evaluation.
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One hundred and ninety-nine cases of sarcoidosis were diagnosed from July 1970 to December 1976 in a defined geographical area in northern Finland. At the follow-up examination at least 5 years later (range 5-12 years) a chest röntgenogram was obtained from 179 patients (90%) and lung function tests were performed by 169 patients (85%). A normal röntgenogram was achieved by 94 of the 113 patients with stage I sarcoidosis (83%), and by 36 of the 62 patients with stage II (58%). Two patients in the former group (2%) and 14 in the latter (23%) had progressed to the fibrotic stage III, but the fibrosis was usually slight. FEV1 and FVC had increased during the follow-up period, DCO showing the largest number of abnormal results in the final examination. Lung function largely normalized with a normal röntgenogram, whereas the functional outcome was worst where fibrosis had developed. Only two patients had been granted a disability pension because of sarcoidosis. Six patients had died, but none of sarcoidosis. The results show a favourable prognosis for sarcoidosis in this comprehensive series of patients.