Childhood and adolescent antecedents of work stress and early atherosclerosis

Work stress is after musculoskeletal disorders the second most common work-related health problem in the European Union, affecting 28% of EU employees. Furthermore, a 50% excessive cardiovascular disease risk among employees with work stress is reported. High job demands combined with low job control according to the Job Demands-Job Control model, or high effort combined with low rewards according to Effort-Reward Imbalance model, are likely to produce work stress in the majority of employees. Atherosclerotic wall thickening is a validated marker of an increased risk of cardiovascular disease. This study examined the role of childhood and adolescent factors as antecedents of work stress and early atherosclerosis, and in the relationship between them. The Cardiovascular Risk in Young Finns Study, (the CRYF project) started in 1980 when the participants were at the age of three to 18 years. Follow-ups have been conducted every three years until 1992, after that in 1997 and 2001, and the latest is ongoing in 2008. The participants parents reported their socioeconomic position in 1980 and 1983, and their life satisfaction in 1983. Biological risk factors were measured in 1980 and 2001. Type A behaviour was reported in 1986, 1989 and 2001. In the 2001 follow-up when the participants were aged 24 to 39, work stress was assessed from responses to questionnaires on job demands-job control and effort-reward imbalance, and education. Ultrasound measurement of the carotid intima-media thickness (CIMT) was used to assess atherosclerosis. There were 755, 746, 1014 and 494 participants in studies I-IV, respectively. The results showed that low parental socioeconomic position and parental life dissatisfaction during childhood and adolescence predicted higher levels of job strain 18 years later, and that education mediated the relationship between parental socioeconomic position and job strain. Childhood and adolescent family factors were not related to the effort-reward imbalance. Parental life satisfaction was associated with high rewards at work among the men, and high parental socioeconomic position was associated with high reward among the women. Among the men, the eagerness-energy component of Type A behaviour across different developmental periods predicted increased CIMT. Among the women, hard-driving component of Type A behaviour predicted decreased CIMT. Low leadership characteristic in adolescence and early adulthood was associated with both high job strain and increased CIMT, and attenuated the relationship between job strain and CIMT to non-significance in men. The current findings add to the literature on the relationship between job strain and health literature in adopting a developmental perspective. The results imply that work stress does not completely originate from work. There are childhood and adolescent environmental and dispositional effects on work stress and CIMT several years later, and these partly seem to operate through educational attainment.

Preadolescents and Their Mothers as Oral Health-Promoting Actors : Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents

Is oral health becoming a part of the global health culture? Oral health seems to turn out to be part of the global health culture, according to the findings of a thesis-research, Institute of Dentistry, University of Helsinki. The thesis is entitled as “Preadolescents and Their Mothers as Oral Health-Promoting Actors: Non-biologic Determinants of Oral Health among Turkish and Finnish Preadolescents.” The research was supervised by Prof.Murtomaa and led by Dr.A.Basak Cinar. It was conducted as a cross-sectional study of 611 Turkish and 223 Finnish school preadolescents in Istanbul and Helsinki, from the fourth, fifth, and sixth grades, aged 10 to 12, based on self-administered and pre-tested health behavior questionnaires for them and their mothers as well as the youth’s oral health records. Clinically assessed dental status (DMFT) and self-reported oral health of Turkish preadolescents was significantly poorer than the Finns`. A similar association occurred for well-being measures (height and weight, self-esteem), but not for school performance. Turkish preadolescents were more dentally anxious and reported lower mean values of toothbrushing self-efficacy and dietary self-efficacy than did Finns. The Turks less frequently reported recommended oral health behaviors (twice daily or more toothbrushing, sweet consumption on 2 days or less/week, decreased between-meal sweet consumption) than did the Finns. Turkish mothers reported less frequently dental health as being above average and recommended oral health behaviors as well as regular dental visits. Their mean values for dental anxiety was higher and self-efficacy on implementation of twice-daily toothbrushing were lower than those of the Finnish. Despite these differences between the Turks and Finns, the associations found in common for all preadolescents, regardless of cultural differences and different oral health care systems, assessed for the first time in a holistic framework, were as follows: There seems to be interrelation between oral health and general-well being (body height-weight measures, school performance, and self-esteem) among preadolescents: • The body height was an explanatory factor for dental health, underlining the possible common life-course factors for dental health and general well-being. • Better school performance, high levels of self-esteem and self-efficacy were interrelated and they contributed to good oral health. • Good school performance was a common predictor for twice-daily toothbrushing. Self-efficacy and maternal modelling have significant role for maintenance and improvement of both oral- and general health- related behaviors. In addition, there is need for integration of self-efficacy based approaches to promote better oral health. • All preadolescents with high levels of self-efficacy were more likely to report more frequent twice-daily toothbrushing and less frequent sweet consumption. • All preadolescents were likely to imitate toothbrushing and sweet consumption behaviors of their mothers. • High levels of self-efficacy contributed to low dental anxiety in various patterns in both groups. As a conclusion: • Many health-detrimental behaviors arise from the school age years and are unlikely to change later. Schools have powerful influences on children’s development and well-being. Therefore, oral health promotion in schools should be integrated into general health promotion, school curricula, and other activities. • Health promotion messages should be reinforced in schools, enabling children and their families to develop lifelong sustainable positive health-related skills (self-esteem, self-efficacy) and behaviors. • Placing more emphasis on behavioral sciences, preventive approaches, and community-based education during undergraduate studies should encourage social responsibility and health-promoting roles among dentists. Attempts to increase general well-being and to reduce oral health inequalities among preadolescents will remain unsuccessful if the individual factors, as well as maternal and societal influences, are not considered by psycho-social holistic approaches.

Mothers, your's is a sacred work! Naiskysymys adventistijulistaja Ellen Whiten profeetallisessa terveysopetuksessa vuosina 1866 1878

Tarkastelen pro gradu -tutkielmassani naiskysymystä Seitsemännen päivän adventtikirkon oppiäiti Ellen Whiten (1827 1915) terveysopetuksessa. White tunnetaan ennen kaikkea näyistään, joiden välityksellä hän koki saavansa Jumalalta hyvinvointiin liittyviä ohjeita. White kirjoitti näkyjensä innoittama terveysoppaita ja julisti pääasiassa Yhdysvalloissa yli 70 vuotta. Päälähteenäni ovat kaksi Whiten omaelämäkertaa vuosilta 1880 ja 1915 sekä 83 artikkelia, jotka hän julkaisi adventistien johtavassa terveyslehdessä, Health Reformerissa, vuosina 1866 1878. Tutkimuskysymykseni ovat, miksi White osoitti lähes kaiken terveyteen liittyvän opetuksensa naisille ja miten hän ymmärsi terveyden osana naisen roolia ja tehtäviä. Tulkintani mukaan White julisti naisille, sillä hän uskoi, että naisen asema oli selkeytettävä. Yhdysvallat teollistui ja kaupungistui nopeasti 1800-luvulla, mikä aiheutti naisille taloudellisia, sosiaalisia ja terveyteen liittyviä ongelmia. Lisäksi toinen suuri herätys (1800 1830) synnytti keskustelua naisen roolista. Monet kirkot antoivat naisille luvan esimerkiksi saarnaamiseen, mutta Yhdysvalloissa vahvistui samaan aikaan myös käsitys naisesta kodin uskonnollisena johtajana. Ymmärrän, että Whiten mukaan ratkaisu naisen sekavaan asemaan oli terveys. Uskon, että Whiten mukaan nainen pystyi ottamaan oman paikkansa yhteiskunnassa, mikäli hän pysyi terveenä ja oppi tuntemaan terveyden periaatteet. Toisaalta White sai vaikutteita naisten yhteiskunnallisten oikeuksien puolustajilta. He ajattelivat, että vain koulutettu ja terve nainen kykeni vapautumaan avioliitosta. Toisaalta White oli naisasianaisia maltillisempi. Hän ymmärsi, että vain terve ja terveyskoulutuksen saanut nainen saattoi olla hyvä äiti. Ellen White osallistui terveysopetuksellaan keskusteluun myös naisen uskonnollisesta roolista. White oli itse kiertelevä terveyssaarnaaja. Silti hän ymmärsi, että muiden naisten kutsumus oli olla terve ja koulutettu äiti. White korosti äitien pyhyyttä luultavasti siksi, että hän pyrki turvaamaan oman auktoriteettiasemansa Adventtikirkossa. White myös luultavasti ymmärsi roolinsa ja tehtävänsä poikkeuksellisiksi ja arvosti vilpittömästi äitiyttä. Whiten mukaan äidin tehtävä oli kasvattaa terveitä ja moraalisia kansalaisia. Tehtävän arvon hän perusteli aikansa tieteellisillä teorioilla. White korosti luonnontieteilijä Charles Darwinin (1809 1882) evoluutioteorian mukaisesti, että äidin velvollisuus oli siirtää lapsilleen hyvä terveys. Käsityksensä terveyden ja moraalin suhteesta hän selitti frenologialla, jonka mukaan ihmisen elämäntavat vaikuttivat hänen luonteenpiirteisiinsä. White oli myös todennäköisesti kiinnostunut sosiaalitieteilijä Herbert Spencerin (1820 1903) ajatuksista, joiden mukaan kansalaisten kehittyessä myös yhteiskunta jalostui yhä paremmaksi. Vaikka White perusteli opetustaan modernilla tieteellä, hän oli ennen kaikkea uskonnollinen julistaja. Hän kuului 1840-luvulla herätyssaarnaaja William Millerin (1782 1849) liikkeeseen, jonka jäsenet uskoivat, että Jumala tuhoaa Yhdysvallat viimeisellä tuomiolla, mikäli kansan moraalin tila ei nopeasti kohene. Millerin liikkeen painotukset säilyivät Adventtikirkossa, joka perustettiin vuonna 1863. Siten White ymmärsi, ettei äiti ollut vastuussa vain perheensä ja kansansa maallisesta hyvinvoinnista vaan myös heidän pelastuksestaan. Whiten käsitys äidistä on mielestäni ristiriitainen. White antoi äideille paljon valtaa, mutta myös suuren vastuun. Hän korosti äitien arvokkuutta, mutta toisaalta he eivät olleet hänen mukaansa korvaamattomia. White ei myöskään huomioinut naisia, jotka eivät olleet äitejä.

Testicular function in adolescent boys with Klinefelter syndrome

Klinefelter syndrome (KS) is the most frequent karyotype disorder of male reproductive function. Since its original clinical description in 1942 and the identification of its chromosomal basis 47,XXY in 1959, the typical KS phenotype has become well recognized, but the mechanisms behind the testicular degeneration process have remained unrevealed. This prospective study was undertaken to increase knowledge about testicular function in adolescent KS boys. It comprised a longitudinal follow-up of growth, pubertal development, and serum reproductive hormone levels in 14 prepubertal and pubertal KS boys. Each boy had a testicular biopsy that was analyzed with histomorphometric and immunohistochemical methods. The KS boys had sufficient testosterone levels to allow normal onset and progression of puberty. Their serum testosterone levels remained within the low-normal range throughout puberty, but from midpuberty onwards, findings like a leveling-off in testosterone and insulin-like factor 3 (INSL3) concentrations, high gonadotropin levels, and exaggerated responses to gonadotropin-releasing hormone stimulation suggest diminished testosterone secretion. We also showed that the Leydig cell differentiation marker INSL3 may serve as a novel marker for onset and normal progression of puberty in boys. In the KS boys the number of germ cells was already markedly lower at the onset of puberty. The pubertal activation of the pituitary-testicular axis accelerated germ cell depletion, and germ cell differentiation was at least partly blocked at the spermatogonium or early primary spermatocyte stages. The presence of germ cells correlated with serum reproductive hormone levels. The immature Sertoli cells were incapable of transforming to the adult type, and during puberty the degeneration of Sertoli cells increased markedly. The older KS boys displayed an evident Leydig cell hyperplasia, as well as fibrosis and hyalinization of the interstitium and peritubular connective tissue. Altered immunoexpression of the androgen receptor (AR) suggested that in KS boys during puberty a relative androgen deficiency develops at testicular level. The impact of genetic features of the supernumerary X chromosome on the KS phenotype was also studied. The present study suggests that parental origin of the supernumerary X chromosome and the length of the CAG repeat of the AR gene influence pubertal development and testicular degeneration. The current study characterized by several means the testicular degeneration process in the testes of adolescent KS boys and confirmed that this process accelerates at the onset of puberty. Although serum reproductive hormone levels indicated no hypogonadism during early puberty, the histological analyses showed an already markedly reduced fertility potential in prepubertal KS boys. Genetic features of the X chromosome affect the KS phenotype.