The first human report of mobile colistin resistance gene, mcr-1, in Finland

Colistin resistance mediated by mobile mcr-1 gene has raised concern during the last years. After steep increase in mcr-1 reports, other mcr-gene variants (mcr-2 to mcr-5) have been revealed as well. In 2016, a clinical study was conducted on asymptomatic stool carriage of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae among Finnish adults. All suspected ESBL producing bacterial isolates were first tested by phenotypic ESBL-confirmation methods, and then further analyzed with whole genome sequencing to identify the resistance genes. We found one study subject carrying a colistin resistant E.coli with a transferrable mcr-1 gene. This multi-drug resistant isolate, although initially suspected to be an ESBL producer, did not carry any ESBL genes, but was proven to carry several other resistance genes by using whole genome sequencing. Sequence type was ST93. The mcr-1 gene was connected to IncX4 plasmid which suggests that the colistin resistance gene locates in the respective plasmid. Here, we report the finding of a mcr-1 harboring human E.coli isolate from Finland. Clinical antimicrobial resistance (AMR) rates are low in Finland, and mobile colistin resistance has not been reported previously. This highlights the importance of AMR surveillance also in populations with low levels of resistance

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The risk of having a depressive or anxiety disorder was 2.8 times higher in the low-income group than in the high-income group among men and 2.0 times higher among women. For men, non-work and work factors explained 20% and 31% of this association, respectively. For women, the corresponding figures were 65% and 23%. Conclusions: Low income is associated with frequent mental disorders among a working population. In particular, work factors among men and non-work factors among women contribute to the income differences in mental health. Mental disorders, such as depressive and anxiety disorders, are relatively common and predict work disability as much or even more than many other chronic conditions such as cardiovascular diseases. 1 2 The 12-month prevalence of depressive and anxiety disorders in general populations varies between 4% and 11%, and 4% and 19%, respectively. 3-5 Socioeconomic inequalities in mental health are well documented and indicate a higher prevalence and incidence of mental health problems in socially disadvantaged populations. 5-21 However, only a few studies have used the Composite International Diagnostic Interview (CIDI) or other standardised diagnostic interview methods to study the association between socioeconomic position and the most common mental disorders. 5-12 15 21 The Finnish Health 2000 Study showed no association between educational level and mental disorders. 19 In one study, socioeconomic position was measured by means of income per consumption unit which predicted incidence of psychiatric disorder. 7 While earlier studies have included unemployed and economically inactive subjects, it is not known whether socioeconomic inequalities in mental health can also be found among the working population. Socioeconomic inequalities in mental health have been explained by two theoretical frameworks. The social causation hypothesis states that barriers (eg, low income) to achieving highly valued goals (eg, goods, services, honour, job control) produce socioeconomic inequalities in health. 22 23 However, according to the social selection hypothesis, the rate of psychopathology among people in low socioeconomic positions is a function of an inter-and intragenerational sifting process in which unhealthy individuals tend to drift down from a high socioeconomic position or fail to rise from a low position. 36 Women seem to be more affected by crises involving children, housing and reproduction (eg, postpartum depression) rather than those involving work. In fact, work characteristics have been shown to be more strongly related to socioeconomic differences in psychological distress among men than among women. 14 16 20 However, as earlier reports have concerned self-reported psychological distress or symptoms, it is unclear if these results apply to clinically significant depressive and anxiety disorders, as defined by DSM-IV diagnostic criteria in a population-based sample. This study examined the contribution of non-work and work factors to the association between income and DSM-IV depressive and anxiety disorders in a working population. Based on earlier literature, we stratified our analyses by gender. The stratification and sampling were conducted as follows. The strata were five university hospital districts, each serving about 1 million inhabitants and differing in several features relating to geography, economic structure, health services and the socio-demographic characteristics of the population. First, the 15 largest cities were included with a probability of 1. Next, within the five districts, 65 other areas were sampled according to the probability proportional to population size (PPS) method. Finally, from each of these 80 areas, a random sample was drawn from the National Population Register. A total of 75% of the original sample participated in the CIDI interview. Compared to participants in the CIDI interview, those who only attended the home interview were found to score significantly more symptoms on the Beck Depression Inventory (BDI), were older, were more often single or widowed, and had a low level of education. METHODS Sample and procedure 37 The data collection phase started in August 2000 and was completed in June 2001. A total of 7419 persons (93% of the 7977 persons alive on the first day of the first phase of the survey) attended at least one phase of the study. They were interviewed at home, where they were also given a questionnaire to be returned at the clinical health examination. During the interview, the respondents received an information leaflet and their written informed consent was obtained. The Health 2000 Study was approved in 2000 by the Ethics Committee for Epidemiology and Public Health in the Hospital District of Helsinki and Uusimaa in Finland. Of the total sample, 5871 persons were of working age (30-64 years old). Of this base population, 5152 persons were interviewed (88%), 4935 persons returned the questionnaire (84%) and 4886 (83%) participated in the health examination, including the structured mental health interview (CIDI). The final sample of our study comprised the 3374 participants (1667 men, 1707 women) who were employed at the time of the interview. Income level We determined the income level of the participants using the definition of low income as suggested by the Organisation for Economic Co-operation and Development (OECD). In that definition, people have a low income if they belong to a household in which the income per consumption unit is either lower than 50% or lower than 60% of the national median income. In Finland, there is no official definition for low-income level. In this study, we used 50% of the median income as a cutoff point for low income. The cut point for the low-income consumption unit (J7340/year for 2001) was obtained from Statistics Finland (the government's official statistical office, personal information, June 2007). Because no official cut-off points have been defined for high income, the high-income group was derived from the highest tertile of the working population in our dataset, and the intermediate income group comprised those who fell between the low-and high-income groups. Information on household income and the number of adults and children in the household was derived from the home interview. Gross income was transformed to net income using a tax calculation programme (year 2001) developed for this purpose. As suggested in the OECD directive, the number of consumption units was calculated as follows: the first adult in the household was weighted by 1 and each following adult was weighted by 0.7. Each child in the household was weighted by 0.5. The income per consumption unit was calculated by dividing the household income by the number of consumption units. DSM-IV depressive and anxiety disorders Mental health status was based on a computerised version of the WHO Composite International Diagnostic Interview (M-CIDI) as a part of the comprehensive health examination. The standardised CIDI interview has been shown to be a valid instrument to assess common non-psychotic mental disorders. 38 The program uses operationalised criteria for DSM-IV diagnoses and allows the estimation of DSM-IV diagnoses for major mental disorders. Demographic factors Information on gender and age was collected in the home interview. Non-work factors Home interview Information on marital status was collected in the home interview and subjects were divided into two groups: those who were married or cohabiting and those who were divorced, widowed or single. Housing disadvantages were examined in the home interview with 12 questions with yes/no alternatives considering pro- Smoking status was obtained from home interview and subjects were classified as non-smokers versus current smokers. Survey Four survey questions based on the scale by Sarason et al 40 assessed social support outside work. In that measure, the participants marked who (spouse, close relative, friend, close neighbour, someone else close) would help or support them (1) when they were exhausted, (2) when they were depressed, (3) when they needed practical help, or (4) in any event. A sum score was calculated ranging from 0 to 20 and reversed to indicate lack of social support. In the survey, the participants were asked how many times during the past 12 months they had become a victim of violence which left visible signs or were victims of threatening intimidation. The respondents who had become victims of either of these alternatives at least once were identified as cases. Clinical health examination Somatic health was determined in a standard 30-min clinical health examination carried out by a physician. Abnormal somatic health meant an abnormal status of the skin, respiratory, cardiovascular, abdominal, musculoskeletal or neurological systems. Physical symptoms were queried during an interview before the physician's examination. Altogether, 13 questions with yes/ no alternative answers concerned respiratory symptoms (three questions), cardiovascular symptoms (four questions), allergic and other skin symptoms (four questions) and musculoskeletal symptoms (two questions). The number of symptoms was calculated as a simple sum of positive answers

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study

BACKGROUND: The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period. METHODS: A systematic sample of 224 patients from consecutive cases of attempted suicide referred to health care in four Finnish cities between 1 January and 31 July 1990 was interviewed. RESULTS: After 12 years of follow-up 22% of these patients had died, 8% by committing suicide. The only statistically significant risk factor for eventual suicide was high scores on Beck's Suicidal Intention Scale. Male gender, older age, physical illness or disability and high scores on Beck's Suicidal Intention Scale predicted death overall. CONCLUSIONS: Following attempted suicide, high intention to kill oneself is a significant risk factor for both death from all causes and suicide

Experience of a Preventive Experiment : Spatial Social Mixing in Post-World War II Housing Estates in Helsinki, Finland

The contingent of large housing estates built in the 1960s and 1970s accounts for almost a half of all high-rises in Finland. The primary ideology in their genesis was to combine industrially prefabricated urban housing development with the surrounding forest landscape—together with a policy of spatial social mixing—to prevent social disorder and segregation. These policies seemed to work as intended until the early 1990s, but have since proved to be insufficient. With Western integration and new information and communication-based economic growth, new trends of population differentiation have emerged. As new wealth has moved out to the fringes of cities, the large housing estates have declined socio-economically—and have been enriched ethnically. This differentiation is structurally produced, works through the regional housing market and, as such, is beyond the scope of the preventive policies pursued. Recent attempts at controlling the regional markets and new forms of spatial social mixing have so far proved difficult.The contingent of large housing estates built in the 1960s and 1970s accounts for almost a half of all high-rises in Finland. The primary ideology in their genesis was to combine industrially prefabricated urban housing development with the surrounding forest landscape—together with a policy of spatial social mixing—to prevent social disorder and segregation. These policies seemed to work as intended until the early 1990s, but have since proved to be insufficient. With Western integration and new information and communication-based economic growth, new trends of population differentiation have emerged. As new wealth has moved out to the fringes of cities, the large housing estates have declined socio-economically—and have been enriched ethnically. This differentiation is structurally produced, works through the regional housing market and, as such, is beyond the scope of the preventive policies pursued. Recent attempts at controlling the regional markets and new forms of spatial social mixing have so far proved difficult.Peer reviewe

Adipocyte-specific protein tyrosine phosphatase 1B deletion increases lipogenesis, adipocyte cell size and is a minor regulator of glucose homeostasis

Peer reviewedPublisher PD

A multicenter study on Leigh syndrome: Disease course and predictors of survival

Background: Leigh syndrome is a progressive neurodegenerative disorder, associated with primary or secondary dysfunction of the mitochondrial oxidative phosphorylation. Despite the fact that Leigh syndrome is the most common phenotype of mitochondrial disorders in children, longitudinal natural history data is missing. This study was undertaken to assess the phenotypic and genotypic spectrum of patients with Leigh syndrome, characterise the clinical course and identify predictors of survival in a large cohort of patients. Methods. This is a retrospective study of patients with Leigh syndrome that have been followed at eight centers specialising in mitochondrial diseases in Europe; Gothenburg, Rotterdam, Helsinki, Copenhagen, Stockholm, Brussels, Bergen and Oulu. Results: A total of 130 patients were included (78 males; 52 females), of whom 77 patients had identified pathogenic mutations. The median age of disease onset was 7 months, w

Strong Magnetic Field Fluctuations within Filamentary Auroral Density Cavities Interpreted as VLF Saucer Sources

The Geoelectrodynamics and Electro-Optical Detection of Electron and SuprathermalIon Currents (GEODESIC) sounding rocket encountered more than 100 filamentary densitycavities associated with enhanced plasma waves at ELF (3 kHz) and VLF (310 kHz)frequencies and at altitudes of 800990 km during an auroral substorm. These cavities weresimilar in size (20 m diameter in most cases) to so-called lower-hybrid cavities (LHCs)observed by previous sounding rockets and satellites; however, in contrast, many of theGEODESIC cavities exhibited up to tenfold enhancements in magnetic wave powerthroughout the VLF band. GEODESIC also observed enhancements of ELF and VLFelectric fields both parallel and perpendicular to the geomagnetic field B0 within cavities,though the VLF E field increases were often not as large proportionally as seen in themagnetic fields. This behavior is opposite to that predicted by previously published theoriesof LHCs based on passive scattering of externally incident auroral hiss. We argue thatthe GEODESIC cavities are active wave generation sites capable of radiating VLF wavesinto the surrounding plasma and producing VLF saucers, with energy supplied by cold,upward flowing electron beams composing the auroral return current. This interpretation issupported by the observation that the most intense waves, both inside and outside cavities,occurred in regions where energetic electron precipitation was largely inhibited orabsent altogether. We suggest that the wave-enhanced cavities encountered by GEODESICwere qualitatively different from those observed by earlier spacecraft because of thefortuitous timing of the GEODESIC launch, which placed the payload at apogee within asubstorm-related return current during its most intense phase, lasting only a few minutes

Neurocognitive impairment, employment, and social status in radiotherapy-treated adult survivors of childhood brain tumors

Background. Little is known of the cognitive functions, employment, and social status in adult survivors of childhood brain tumor (BT). We aimed to determine the long-term neurocognitive profile of radiotherapy-treated adult survivors of childhood BT and the relationship between cognitive functions and employment and social status. Methods. Neurocognitive profiles of survivors were assessed in a Finnish national cohort of 71 radiotherapy-treated survivors of childhood BT (median follow-up time: 21 years [range: 5-33 years]) using a cross-sectional design. Neurocognitive outcomes were compared to control (n = 45) and normative values. Tumor- and treatment-related data were collected from the patient files. Information on employment and social status was gathered. Results. Survivors' (median age: 27 years [range: 16-43 years]) median verbal and performance intelligence quotient (IQ) was 90 (range: 49-121) and 87 (range: 43-119), respectively. The cognitive domains with the greatest impairment were executive functions (median z score, 3.5 SD [range: -25.0 to 1.3 SD]), and processing speed and attention (median z score, -2.5 SD [range: -24.9 to 0.5 SD]). Executive functions were associated with employment, educational level, living independently, having an intimate relationship, and having a driving license. Processing speed and attention were related to educational level, living independently, having an intimate relationship, and having a driving license. Performance IQ was associated with educational level and employment status. Working memory was associated with educational level and living independently. Conclusions. Radiotherapy-treated adult survivors of childhood BT experience significant neurocognitive impairment, which is associated with difficulties related to employment and social status.Peer reviewe

Sleep in Psychotic Disorders: Results From Nationwide SUPER Finland Study

ObjectiveCharacterizing sleep in patients with schizophrenia, schizoaffective disorder, bipolar disorder, and psychotic depression.MethodsThis cross-sectional questionnaire study is based on the SUPER study sample, which is part of the Stanley Global Neuropsychiatric Genomics Initiative. The study is a multicentre, nationwide Finnish study consisting of patients (N = 8 623) both in primary and specialized health care. The main measurements were sleep duration, difficulties initiating sleep, early morning awakenings, and fatigue. These results were compared with a nationally representative sample of the Finnish population from the Health 2000 survey (N = 7 167) with frequency and logistic regression analyses.ResultsPatients had more sleep problems compared with the general population, especially young and middle-aged patients (Difficulties initiating sleep in young patients odds ratio = 12.3, 95% CI 9.8–15.4). Long sleep duration was the most deviating property of the sleep characteristics, being particularly common among young patients with schizophrenia (odds ratio = 27.9, 95% CI 22.1–35.2, 47.4% vs 3.3% prevalence). All sleep problems were associated with worse subjective health. We also conducted a latent class analysis, resulting in a cluster relatively free of sleep problems (58% of patients), an insomnia symptom cluster (26%), and a hypersomnia symptom cluster (15%).ConclusionsIn our sample, patients with psychotic disorders have more sleep problems—especially long sleep duration but also insomnia symptoms—compared with the general population. The patients can in a latent class analysis of their sleep symptoms be divided into groups with differing sleep profiles.</p