Finland is famous for having one of the best educational systems in the world, always ranking in the top10. This has not made them complacent, however, as they has recently unveiled a plan to majorly shake up their system.
Educational officials have proposed a plan in which ‘school subjects’ as such no longer exist, meaning there will be no one class dedicated to math, geography, history or science, but instead they will learn in terms of different concepts and ideas.
There are schools that are teaching in the old-fashioned way which was of benefit in the beginning of the 1900s — but the needs are not the same, and we need something fit for the 21st century.
The students will instead study in more of a broad-reaching kind of concept. A proposed example would be the Second World War which would be looked at through the perspective of history, geography, and math, and not just as an event in ‘history’ as it has previously been seen. Another example given is the course ”Working in a Cafe,” in which the students will learn the skills of English language, economics, and communication in an all-encompassing experience.
These options will be available for students above the age of 16, which is the important age at which most teenagers are urged to start seriously considering a career. Instead of choosing a subject, say Physics, and be forced to learn all of the fact without the knowledge of applying them to the real world, the student will be learning alongside the experience of using this knowledge in a real-life event thus making it more applicable.
The teacher-pupil format is to be discarded also, with no rows of desks all listening to the one teacher, instead pupils will be learning in small groups, discussing problems and subjects with the help of the teacher.
Around 70% of teachers in Helsinki have already began preparations for this change, and the school system is relying on the teachers to be co-operative throughout this massive over-haul.
The teachers that are already on board are being given a pay increase as an incentive. The change is expecting to be implemented completely by the year 2020.
One legacy that most men could do without is an inherited risk for prostate cancer, but a massive cohort study shows that for some men, genetic history hints at oncologic destiny.
Data on both identical (monozygotic) and fraternal (dizygotic) twins from the comprehensive birth-to-death registries in Denmark, Finland, Norway, and Sweden show that a man whose monozygotic twin has prostate cancer has a 32% risk for the disease himself, whereas a dizygotic twin whose brother has prostate cancer has only a 16% risk, said Jaakko Kaprio, MD, PhD, professor of genetic epidemiology at the University of Helsinki.
The estimated heritability of prostate cancer — the degree to which genes contribute to risk — was 58% (95% confidence interval, 52 – 63), which is the highest for any malignancy studied, Dr. Kaprio reported here at the American Society of Human Genetics 63rd Annual Meeting.
“These estimates for common cancers are greater than previously estimated. For rare cancers, such as testicular cancer, the concordance risk was substantial. We believe it provides an accurate estimate of familial risk prediction,” Dr. Kaprio toldMedscape Medical News.
Table. Cancers With Significant Heritability
|Cancer Type||Heritability Estimate, %||95% Confidence Interval|
The magnitude of the genetic contribution to prostate cancer found in this study is higher than the estimated 42% seen in a previous study of Nordic twins (N Engl J Med. 2000;343:78-85). Dr. Kaprio explained that this difference can be attributed to the fact that his team expanded the original cohort to include data from Norway, had 10 additional years of follow-up data, and had an aging cohort, with a resultant increase in incident cancers.
Dr. Kaprio’s team looked at data on 133,689 monozygotic and dizygotic pairs as part of the Nordic Twin Registry of Cancer. They used time-to-event analysis to estimate heritability and familial cancer risk.
What’s Going On?
This study raises important questions about the interplay between genetics and environment in cancer, said Richard Stevens, PhD, professor of cancer epidemiology at the University of Connecticut Health Center in Farmington.
“It’s a very strong study. The exciting thing about this study with prostate cancer is that it’s certainly saying something about mechanism that we don’t get,” he explained.
The study supports the presence of genetic polymorphisms in prostate cancer, and to a lesser degree breast cancer, that can cumulatively contribute to risk, he said.
“The specific polymorphisms we’re aware of — familial syndromes — account for very little breast cancer or prostate cancer. There are other genes where allelic variation and risk is moderate. There must be a lot of those genes with moderate risk; you put them together and it makes you more susceptible,” Dr. Stevens said.
This is a new campaign by the Cancer Society of Finland, whose objective, according to the website of their ad agency, is to use this as a tool to show teenagers “to think critically about smoking.” The idea is to move beyond the black lungs, gooey tar and damaged livers, and use technology to “make the shock effect more shocking.”
And pretty shocking it is. Before-lady and Before-man are indeed much better-looking than After-lady and the After-man.
The strategy employed is clear: teens today don’t care about lungs, livers and cancer, or if they do, the constant exposure to such warnings has rendered them ineffective. What they do care about is appearances. So let’s show them how ugly smoking makes them.
On one hand you can’t argue with facts: smoking does give you spots, increase your testosterone levels, give you bad breath and unhealthy hair, yellow your teeth and nails, etc. Fact-wise there’s not much to dispute in the Tobacco Body website. But how advisable is it to resort to telling teenagers what is beautiful/popular/acceptable and what is not, even if it is towards the noble cause of telling them to not smoke?
Sample these snippets taken from the website:
[Man & Woman] “Dear Smoker, we’re sorry to inform you that according to nail fashion experts, nicotine yellow is not this season’s colour.”
[Woman] “Hey non-smoking girl, you are on a wonder-diet and you don’t even know it! Your body shape is closer to the average, whereas research shows that smokers weigh more and are rounder around the abdominal area.”
[Woman] “The non-smoking woman is less-likely to have as much hair growing on her arms as a smoker.”
[Woman] “The non-smoking woman usually has no additional hairs growing under her nose… No need for a five-bladed special razor.”
[Man & Woman] “Smokers have bad breath. As many as 20 per cent of people have ended relationships because of smoking. In Burn Magazine’s interviews several celebrities reveal they prefer kissing non-smokers.”
[Man & Woman] “A weary face is not a popular one: out of the 100 most popular profile pictures in a dating service only 2 were pictures of smokers.”
Basically, the Cancer Society of Finland is telling youngsters that smoking makes you hairy, fat, yellow-toothed and gives you bad breath. I found it slightly bothersome how features that are quite normal in several healthy teenagers, like rounded abdomens and hair on arms (for women), was being grouped with those which are blatantly undesirable and unhealthy, like yellowing teeth, bad breath and damaged lungs.
I wondered if this ad could be sending negative body image messages to kids who are naturally fat or hairy – are they implying that these kids are not as desirable?
But the more I thought about it the harder I realised it was to completely buy into that line of reasoning. Because, as a friend pointed out, this may be a case where the end could perhaps justify the means.
It was different in the case of the Dove ‘You’re more beautiful than you think you are’ campaign which also used a similar strategy to sell their product. They too inadvertently (?) went about setting definitions for beauty. The glaring difference of course was that Dove, at the end of the day, was trying to sell us soap under the guise of the noble motive of wanting women to feel good about themselves.
In the case of Tobacco Body, there’s no such deception. As questionable as their strategy might be, we can probably be sure that all this campaign wants is for teenagers to say no to smoking. They are, after all, the Cancer Society of Finland.
But aside from all the sordid history, the suppression of scientific concern, and the labeling of dissenters as off-balanced “fluorophobes,” what should a sensible person do? Here are three appropriate actions for regular daily life, especially if you are bothered by feeling fat, fuzzy, frazzled, fatigued, depressed, beset by intolerance to heat or cold, annoyed by problems with skin-hair-nails, or suffering with severe constipation, low libido, infertility, or uncomfortable menopause.
First, if you are not a thyroid patient, have your thyroid status carefully checked. Insist on more testing than the simple AMA panel of TSH and Free T4. Add a Free T3 and the Thyroid Antibody Panel. You may be one of the millions of people whose fluoride exposure over the years has finally made you low thyroid.
Second, if you are already a thyroid sufferer and treatment is not going as well as you would like, consider an enhanced fluoride avoidance program. Stop drinking and cooking with tap water if it is fluoridated. Well-chosen bottled water is preferable. Start buying non-fluoridated tooth paste. It’s available at the health food store if you really look closely. Decline the fluoride dental treatments and make sure it is not in your mouth wash. The various other food sources are probably not a significant factor.
Commentary on 2006 Research Findings
Third, start speaking out against the unhealthy practice of fluoridation. Don’t expect that the Public Health Service will ever willingly admit to the most colossal error ever in the history of government science. The change will instead occur as more and more local communities decide against fluoridating their city water. They will thereby join those whole countries that have rejected or banned the practice, such as Japan, India, Finland, Denmark, Sweden, and Holland. Be guided by the credo of health professionals, “Above all, do no harm.” If fluoridated water is now highly suspected of harm, then let’s put a moratorium on proceeding further with it.
Sauli Ninistö, President of Finland, opened the conference stressing that health is important for achieving other goals, but also has value in its own right. He spoke of Finland’s huge improvements in health since the 1940s achieved through investing the fruits of economic development in social and health infrastructure.
Congratulations to Margaret Chan, director general of the World Health Organization, for her powerful opening speech saying corporate interests on health pose a daunting challenge for health. She noted health is shaped by the “globalisation of unhealthy lifestyles,” leading to an epidemic of NCDs which is blowing out health budgets—e.g. diabetes consumes 15% of health budgets. Previously, progress has meant diseases vanished, whereas now NCDs are flourishing along with urbanisation and economic growth.
Chan said public health has been used to fighting Big Tobacco, but now also have to fight “Big Alcohol,” “Big Food,” and “Big Soda.” She cast industry involvement in policy making as dangerous and leading to distortions. She pointed to the many tactics industry uses to water down public health measures. These include: civil society “front groups;” promising that self-regulation will be effective; industry funded research, which confuses the evidence; positioning government action to promote health as curbs on individual liberty. Her speech defined the problem well. Solutions are needed now!
On the opening panel, Alireza Marandi talked of Iran’s success in designing an effective primary healthcare system, which included reform of medical education. The Secretary of the Finnish Ministry of Agriculture and Forestry, Jaana Husu-Kallio, called for the “borders between professions” to be demolished in the interests of health and noted the need for a whole of government approach to food policy covering food security, production, safety, and nutrition. Tarja Halonen, former President of Finland, said education and health are “the tools of wellbeing.” There was much discussion about how the lessons from the Framework Convention on Tobacco Control can be applied to other areas and agreement that legal instruments should be more widely used to protect public health.
The afternoon’s panel on political will for Health in All Polocies (HiAP) disappointingly has gave few clues about how to create the will. The best suggestion was from Abdellatif Mekki, minister of health of Tunisia, who suggested that ministers of health should be vice presidents to give them more power, which they can then use against, for example, trade ministers who promote unhealthy industries like sugar.
I ended the day in a session on agriculture policy, food, and health. Bibi Giyose, from the African Union, reminded us that women make up more than 75% of food producers in Africa. Priorities for nutritional sensitive agriculture are female empowerment, ensuring product diversity, and that processing sees food retaining its nutritional value. Yet we heard that global food chains dominate, rather than local food for local consumption, and that free trade agreements encourage unhealthy food supply. Fast food and supermarkets have increased massively. How do we change our food supply away from ultra processed food? Eating it seems to be killing people around the world!
It was good to hear Pekka Puska present Finland’s health promotion success which has resulted in an 80% reduction in cardiovascular disease over 30 years. He stressed that this has been a long term complex process. The Finns realised early on that victim blaming doesn’t work and that changing the environment is vital. So they regulated food supply so it was lower in fat and salt and worked with the food industry to encourage them to make food healthier. Subsidies for dairy products were reduced and dairy farmers were encouraged to change to berry farming. Finland’s experience raises the question of how governments globally can get “Big Food” to change its addiction to sugar and fat?
Ravi Narayan presented a civil society perspective and noted the rapidly increasing inequities occurring everywhere. He spoke of the importance of listening to people at the grassroots and hearing their concerns. He stressed the importance of solidarity to social movements and the crucial importance of involving civil society in all policy making. He documented the mechanism society uses including “watches” such as the People’s Health Movement Global Health Watch, health tribunals, health assemblies, and campaigns. He spoke of the importance of social vaccines that build active civil society movements to protect health. Ravi also stressed the importance of seeing people not just as patients and customers, but also as citizens who can help plan and shape the style of health and other services. He also spoke of his work training “activist health professionals.”
The next plenary was on capacity bullding. Viroj Tangcharoensathien described the sophisticated Thai approach to Health in All Policies (HiAP) which uses constitutional mandates, regulation, citizen engagement through the Thai National Health Assembly, and organisational capacity development. Thailand offers many lessons for progressive health policy. Ilona Kickbusch (described by the chair as “the mother of health promotion”) talked about health as an overall societal goal which needs whole of government commitment. She stressed speed and agility as crucial skills to navigate health promotion systems. She also noted that complexity science and political science are essential to understanding HiAP processes because policy processes are chaotic and political. She says HiAP is an ever moving target and its work is never done. Stakeholder and network analysis and management are also crucial skills for HiAP. Learning systems are required where people can experiment and make mistakes and so keep their courage for challenging the status quo. She also spoke of the need for both hard (law) and soft (incentives) governance. This session would have benefited from a sharper analysis of how power interacts within and outside organisations to restrict capacity for action.
Work is progressing on the Helsinki Declaration and participants are invited to comment on drafts in plenary sessions and by email. It will be hard to come up with as robust a document as the Ottawa Charter. The conference is flagged as a green conference, but I wonder about the excessive use of bottled water when Finnish tap water perfectly is fine to drink!
Fran Baum is a professor of public health. She is the director of the Southgate Institute of Health Society and Equity, Flinders University, Adelaide, Australia, and is a member of the Global Steering Committee, People’s Health Movement. She is an Australian Research Council Federation fellow.
This February, the UK joined the list of countries reporting a spike of increased incidence of narcolepsy after vaccination against pandemic influenza A H1N1 2009 with Pandemrix. This study adds to the epidemiological data indicating a possible causal association, with a several-fold increased risk of the rare and debilitating sleep disorder after vaccination.
A possible link was first identified in Finland and Sweden in the summer of 2010; subsequently, cases of narcolepsy after vaccination were reported from France, Germany, Iceland, Ireland, Norway, the UK, and North America—many, but not all, were children or adolescents. Epidemiological studies first appeared in peer-reviewed journals in 2012, followed by more reports this year. However, before then, the prominent view, adopted by the European Medicines Agency, was that any association might be anomalous to Finland and Sweden.
Terhi Kilpi, director of the department of vaccination and immune protection at Finland’s National Institute for Health and Welfare (THL) told TLID that “the first thing we met was a huge silence from the scientific community, and we had a feeling that no one wanted to hear about this”. The recent reports are extremely important, she says, “because a growing number of experts and scientists are now willing to acknowledge that this actually happened. We now need to evaluate what this means in the field of vaccination, and to understand the mechanism behind this, rather than continue arguing whether or not it happened.” Kilpi recalls how most children in Finland were immunised in a massive 6 week effort in late 2009. In July, 2010, neurologist Markku Partinen from the Helsinki Sleep Clinic (Helsinki, Finland) called Kilpi to voice his concerns over a cluster of seven cases of childhood narcolepsy within 6 months of vaccination. Soon after, the Swedish Medical Products Agency reported a possible six cases of childhood narcolepsy after vaccination with Pandemrix. By August, known Finnish cases numbered 14, vaccination of the at-risk age group was halted in Finland, and studies were initiated.
In July, 2011, the European Vaccine Adverse Event and Surveillance Communication (VAESCO) network reported preliminary findings from a case-control study that pooled data from eight EU countries, and could not confirm an association between Pandemrix and narcolepsy outside of Finland and Sweden. On the basis of Finnish and Swedish data, the European Medicines Agency changed the indication for Pandemrix: “In persons under 20 years of age Pandemrix to be used only in the absence of seasonal trivalent influenza vaccines, following link to very rare cases of narcolepsy in young people.” The agency also concluded that overall the benefit-to-risk balance of Pandemrix remains positive, and Pandemrix continues to be licensed in the EU.
In Finland, calculations suggest that vaccination probably prevented 80 deaths as a cautious estimate, plus saving at least one pregnant woman and her unborn child. The current count of narcolepsy cases in Finland is around 100, while in Sweden the number may be double that, mainly in children but also younger adults. “The benefit compared to the harm now seems borderline in the vulnerable age group”, says Kilpi. “If I had known then what I know now, I would not have recommended the Pandemrix vaccine for children. But I did not.”
The manufacturer, GSK, has received almost 800 reports of narcolepsy that developed after Pandemrix immunisation, and, says company spokesman David Daley, “we have been working hard [since 2010] to better understand the research emerging from a select number of countries suggesting an association between Pandemrix and an increased risk of narcolepsy”. GSK is committed to further research into the potential role of the vaccine, he told TLID. “However”, he points out, “we currently believe that the available data are insufficient to assess the likelihood of a causal association. There is a need for further investigations, to disentangle the other factors—such as genetic, environmental, circulating infections—that we know are also associated with narcolepsy and may have played a role.”
What is known is that genetic risk, vaccine use, and means to detect cases varies between populations. Prevalence of the HLA type that confers susceptibility to narcolepsy is highest in northern Europeans, so lower population risk is likely to have weakened any signal in more diverse or ethnically different populations. Second, in countries such as the UK, where Pandemrix uptake was lower than in Finland, no link was found with passive surveillance but subsequently was with more rigorous study. THL is continuing immunological research to understand why some susceptible individuals reacted differently to the rest of the population.
Recent genetic research indicates that narcolepsy could be an autoimmune disorder resulting from defective antigen presentation by HLA to T cells. And, in China, research suggests that H1N1 infection could also precipitate narcolepsy, independent of vaccination. Emmanuel Mignot (Stanford University, CA, USA) told TLID that “there is little doubt seasonal infections and Pandemrix vaccination with H1N1 have contributed to triggering narcolepsy together with specific genetic factors”.
“Getting narcolepsy is probably a lot of accumulated bad luck, and in some cases Pandemrix has been one of the factors, with the adjuvant probably acting as an amplifier of the effect of the H1N1 vaccine”, Mignot concludes. One potential concern is the likelihood of detecting such an event when an immunisation campaign occurs over a longer period. “What if this had been a routine vaccine, how long would it have taken to detect it?” Kilpi asks. “So we need to invest strongly in our vaccine safety surveillance systems, and we need registry based follow-up to detect such events, we cannot rely on spontaneous reporting.” Finland and the UK are investigating any increase in other autoimmune disorders after Pandemrix, but data from Sweden are reassuring. Ongoing studies in Canada will attempt to elucidate why Arepanrix, which has the same adjuvant as Pandemrix, so far has not been found to carry the same risk of triggering narcolepsy.
In Finland, seasonal influenza vaccine uptake has gone down by about 10 percentage points in all age groups, and few children younger than 3 years have been vaccinated with free seasonal influenza vaccine. “Vaccines are traditionally well accepted here, but the failure to communicate explicitly that there is a tiny, tiny chance that something unexpected could happen, has left the parents of the children who fell ill feeling somehow betrayed”, notes Kilpi. “So we need to learn to communicate our recommendations more effectively and we will need to communicate explicitly that recommendations are based on best knowledge at that time but there is always the small chance that something unexpected occurs.”
When Scientific American heard from chemist Ray Baughman a year ago, he and his international team of nanotechnologists had taken artificial-muscle technology to the next level. Their innovation relied on spinning lengths of carbon nanotubes into buff yarns whose twisting and untwisting mimicked natural muscles found in an elephant’s trunk or a squid’s tentacles.
Now the researchers are reporting a new artificial muscle–building technique that makes their carbon nanotube yarns several times faster and more powerful. These qualities could help deliver on the technology’s promise of developing compact, lightweight actuators for robots, exoskeletons and other mechanical devices, although several challenges remain.
The latest breakthrough comes from infusing the carbon nanotube yarns with paraffin wax that expands when heated, enabling the artificial muscles to lift more than 100,000 times their own weight and generate 85 times more mechanical power during contraction than mammalian skeletal muscles of comparable size, according to the researchers, whose latest work is published in the November 16 issue of Science.
The previous-generation artificial muscles were electrochemical and functioned like a supercapacitor. When a charge was injected into the carbon nanotube yarn, ions from a liquid electrolyte diffused into the yarn, causing it to expand in volume and contract in length, says Baughman, director of the University of Texas at Dallas‘s Alan G. MacDiarmid NanoTech Institute. Unfortunately, using an electrolyte limited the temperature range in which the muscle could function. At colder temperatures the electrolyte would solidify, slowing down the muscle; if too hot, the electrolyte would degrade. It also needed a container, which added weight to the artificial-muscle system.
The wax eliminates the need for an electrolyte, making the artificial muscle lighter, stronger and more responsive. When heat or a light pulse is applied to a wax-impregnated yarn about 200 microns in diameter (roughly twice that of a human hair), the wax melts and expands. In about 25 milliseconds this expansion creates pressure causing the yarn’s individual nanotube threads to twist and the yarn’s length to contract. Any weightlifter will tell you that the success of any muscle—artificial or natural—depends in part on the degree of this contraction. Depending on the force exerted, the Baughman team’s muscle strands could contract by up to 10 percent.
Muscles are also judged by the weight they can lift relative to their size. “Our muscles can lift about 200 times the weight of a similar-size natural muscle,” Baughman says, adding that the wax-infused artificial muscles can also generate 30 times the maximum power of their electrolyte-powered predecessors.
The researchers’ latest artificial muscles move the technology closer to commercialized products such as environmental sensors, aerospace materials and even textiles that take can take advantage of nanoscale actuators, University of Cincinnati mechanical engineering professor Mark Schulz, wrote in a related SciencePerspectives article. This new artificial muscle outperforms existing ones, allowing possible applications such as linear and rotary motors; it also might replace biological muscle tissue if biocompatibility can be established, he adds.
However, Schulz points out—and Baughman is quick to acknowledge—that even this new crop of artificial muscles faces many challenges before they can be a practical alternative to mini–electric motors in many of the products we buy. Despite their improvements, the latest artificial muscles are for the most part inefficient and limited in the combinations of force, motion and speed they can generate, according to Schulz.
Indeed, these new artificial muscles operate at about 1 percent efficiency, a number Baughman and his colleagues want to increase at least 10-fold. An option for improving efficiency is to use a chemical fuel rather than electricity to power the muscles. “One way to compensate for a lack of efficiency is to use fuel like methanol instead of a battery,” he says. “You could store more than 20 percent more energy in a fuel like methanol than you can in a battery.”
Another challenge is that the artificial muscles must be heated and cooled to contract and release, respectively. Short lengths of yarn can cool on their own in a matter of seconds, but longer pieces would need to be actively cooled using water or air, otherwise the muscle would not relax. “Or you’d need [to use a] material that doesn’t require thermal actuation,” Baughman says. “If you keep making the [carbon nanotube] yarn longer and longer, your cooling rate increases.”
This issue of scale poses perhaps the greatest challenge. A one-millimeter length of artificial muscle can lift about 50 grams, according to Baughman. That means lifting several tons would require a greater length of carbon nanotube yarn than is practical. “We’d like our artificial muscles to be used in exoskeletons that help workers or soldiers lift objects weighing tons,” he says. But the researchers are still working out ways to pack enough yarn to perform such tasks into the length of an exoskeletal limb.
Carbon nanotube artificial muscles are more likely to first appear in products requiring only short lengths. Baughman envisions artificial muscles used in a catheter for minimally invasive surgery, “where you want to have lots of functionality on the end of the catheter to do surgical manipulations.” Another application with flex appeal—”smart” fabrics that can automatically react to their environments, becoming more or less porous when they detect heat or harmful chemicals in the air.
Objective Low socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus.
Design Population-based register study.
Setting Finland, nationwide individual-level data.
Participants All persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database).
Methods Three outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios.
Results The risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively.
Conclusions According to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups.