BACKGROUND: Familial hypercholesterolemia is one of the most common inherited metabolic diseases; the average worldwide prevalence of heterozygous familial hypercholesterolemia is about 1 in 500. Diagnosis of familial hypercholesterolemia in children is based on two measurements of low-density lipoprotein cholesterol level above 4.0 mmol/L or a DNA-based analysis. Coronary stenosis has been detected in men with familial hypercholesterolemia as young as 17 years old and in women with familial hypercholesterolemia at 25 years old. Atherosclerosis and its clinical complications occur prematurely, especially in men, thus lifelong hypolipidemic measures, started in childhood, are needed to reduce the risk of cardiovascular diseases. In children with familial hypercholesterolemia children, so far diet has been the main mode of treatment. Anion exchange resins, such as cholestyramine and colestipol, have also been found to be effective but are generally considered unpalatable and therefore poorly tolerated. Since the 1990s statin trials have been carried out among children with familial hypercholesterolemia (aged 7 to 17 years), and statins reduced their serum low-density lipoprotein cholesterol levels by 23% to 40%. The safety of statins among children is not well known even though statins seem to be safe and well-tolerated in adults. OBJECTIVES: To assess the effectiveness and safety of statins in children with familial hypercholesterolemia. SEARCH STRATEGY: Relevant trials were identified from the Group's Inborn Errors and Metabolism Trials Register and Medline.Date of most recent search: 11 March 2010. SELECTION CRITERIA: Randomized and controlled clinical trials including participants up to 18 years old comparing a statin to placebo or to diet alone. DATA COLLECTION AND ANALYSIS: Two authors independently assessed studies for inclusion and extracted data. MAIN RESULTS: We found 19 potentially eligible studies of which we included eight randomized placebo-controlled trials (897 participants). Statins reduced the mean low-density lipoprotein cholesterol concentration at all time points. There was no difference between serum aspartate and alanine aminotransferase as well as creatine kinase concentrations at any time-point. The risks of myopathy and clinical adverse events were also similar in both groups. In one study simvastatin was shown to improve flow-mediated dilation of the brachial artery. AUTHORS' CONCLUSIONS: Statin treatment is an efficient lipid-lowering therapy in children with familial hypercholesterolemia. It seems to be safe in the short term but long-term safety is unknown. Children treated with statins should be carefully followed up by their pediatricians. Large long-term randomized controlled trials are needed to establish the long-term safety of statins.

Abstract. Purpose: It is necessary to develop tools for patient selection to target cataract surgery to patients with the best expected outcomes. We used visual acuity, visual functioning 14 (VF-14) test, the 15-dimension health-related quality-of-life questionnaire (15D) and the New Zealand priority criteria to evaluate the criteria for cataract surgery in a post hoc setting. Material and methods: Ninety-three consecutive patients living in a defined rural area in Finland had cataract surgery as a part of the Pyhäjärvi Cataract Study in 2003. Success of cataract surgery was defined as improvement of visual acuity by at least 2 lines and/or improvement of visual function measured by questionnaires. Results: The patients with a visual acuity of 0.30 logMAR (0.5 Snellen decimal) or worse in the better eye and/or 0.52 logMAR (0.3 Snellen decimal) in the worse eye had successful surgery in 59-83% of cases depending on the definition of success. When subjective judgement was added, the success rates varied between 63% and 91%. Conclusion: Setting indication criteria, it seems sufficient to use two global questions in addition to visual acuity: one on the subjective view on disability, and one on a more neutral view on visual function, such as the 15D item on vision. The VF-14 did not perform any better than the single item counterparts.

OBJECTIVE: To evaluate the effects of rehabilitation on sickness absenteeism, return to work and disability pensions among persons of working age. METHOD: Original articles published during 1970-2005 indexed in Medline and PsycINFO databases were studied systematically. The main search terms were rehabilitation, sick leave and disability pension. Out of 576 references, 41 potentially eligible publications were retrieved; other sour-ces producing 21 articles. Forty-five studies were included in the analysis. RESULTS: There is moderate evidence that return-to-work programmes decrease long sick leaves (risk ratio (RR) 0.46, range 0.25-1.10) and multimodal rehabilitation decreases the risk of disability pension (RR 0.64, range 0.52-1.14), counselling, exercise, multimodal medical rehabilitation or return-to-work programmes having no effect on return to work. Based on mainly weak evidence, early rehabilitation seems to reduce both absenteeism and disability pension.CONCLUSION: Any type of rehabilitation may have an effect at an early stage of decreased work ability, being ineffective later on if applied as the only mode of rehabilitation. Where chronic disability is already present, multimodal medical rehabilitation needs to be combined with vocational rehabilitation in order to reduce absenteeism and disability pensions. It is essential that the workplace is integrated into rehabilitation.

OBJECTIVE:: The aim of this systematic literature analysis was to study the association between work health promotion and job well-being, work ability, absenteeism, and early retirement. This systematic review is a part of a large research project studying multiple workplace factors and interventions that may affect workers' health and well-being. METHODS:: Original articles published in 1970 to 2005 were searched in Medline and PsycINFO databases, the main search terms being health promotion, well-being, work ability, sick leave, and disability pension. Out of 1312 references and 35 potentially eligible publications, 10 studies were included in the analysis. Other sources producing 36 eligible studies, 46 studies in total were included in the analysis. RESULTS:: There is moderate evidence that work health promotion decreases sickness absences (risk ratio [RR], 0.78; range, 0.10 to 1.57) and work ability (RR, 1.38; range, 1.15 to 1.66). It also seems to increase mental well-being (RR, 1.39; range, 0.98 to 1.91), but not physical well-being. There is no evidence on disability pension. Exercise seems to increase overall well-being (RR, 1.25; range, 1.05 to 1.47) and work ability (RR, 1.38; range, 1.15 to 1.66), but education and psychological methods do not seem to affect well-being or sickness absences. Sickness absences seem to be reduced by activities promoting healthy lifestyle (RR, 0.80; range, 0.74 to 0.93) and ergonomics (RR, 0.72; range, 0.13 to 1.57). CONCLUSIONS:: Work health promotion is valuable on employees' well-being and work ability and productive in terms of less sickness absences. Activities involving exercise, lifestyle, and ergonomics are potentially effective. On the other hand, education and psychological means applied alone do not seem effective. Work health promotion should target both physical and psychosocial environments at work.

BACKGROUND: Systematic reviews on the association between statin therapy and cancer have focused on randomised trials without assessing the quality of evidence. We aimed to review the overall evidence taking study quality into consideration. METHODS: Publications of original studies on the effect of statin treatment on cancer in adult patients were searched on MEDLINE, EMBASE and CENTRAL databases upto October 2007. Our search yielded 37 eligible original studies out of 3607 references. Five studies were additionally found through manual search. Thus, 42 studies were included in the analyses: 17 randomised controlled trials, 10 cohort studies, and 15 case-control studies. FINDINGS: Statins had no effect on the overall incidence of cancer (median risk ratio (RR) 0.96, range 0.72 to 1.2), or on the incidence of lung (median RR 0.92, range 0.83 to 3.0), breast (median RR 1.04, range 0.74 to 19) or prostate cancer (median RR 0.96, range 0.33 to 1.7). They seemed to protect from stomach (median RR 0.59, range 0.40 to 0.88) and liver cancer (median RR 0.62, range 0.33 to 1.2), and from lymphoma (median RR 0.74, range 0.28 to 2.2). They increased the incidence of both melanoma (median RR 1.5, range 1.3 to 1.7) and non-melanoma skin cancer (median RR 1.6, range 1.2 to 2.2). The effect varied, yet inconsistently, by statin type. The median follow-up time was 4 years. The strength of evidence was mostly weak. INTERPRETATION: The evidence suggests that statins do not have short-term effects on cancer risk. The evidence on potentially protective or harmful effects is inconclusive. High quality cohort studies with long follow-up are needed to resolve the issue.

OBJECTIVE:: The aim of this systematic literature analysis was to study the association between leadership and well-being at work and work-related health. These intermediate outcomes are supposed to predict work-related loss of productivity and disability at work. METHODS:: Original articles published in 1970 to 2005 were searched in MEDLINE and PsycINFO databases in a systematic manner. The main search terms were leadership, job satisfaction, well-being, sick leave, and disability pension. Out of 303 references, 93 publications were retrieved. In addition, other sources produced 69 articles. The strength of evidence was evaluated comprehensively. Altogether, 109 articles were thoroughly analyzed; our conclusions are based on 27 articles providing the best evidence. RESULTS:: There was moderate evidence that leadership is associated with job well-being (risk ratio [RR] 1.40, range 1.36 to 1.57), sick leave (RR 0.73, range 0.70 to 0.89), and disability pension (RR 0.46, range 0.42 to 0.59). The evidence was weak on that leadership is associated with job satisfaction (median RR 2.23, range 1.30 to 3.51) but not with job performance (RR 1.13, range 0.55 to 1.20). CONCLUSIONS:: There is a relative lack of well-founded prospective studies targeting the association between leadership and employee health, but the few available good studies suggest an important role of leadership on employee job satisfaction, job well-being, sickness absences, and disability pensions. The relationship between leadership and job performance remains unclear.

Purpose: The Pyhäjärvi Cataract Study aims to study demand for cataract surgery in the population of a rural town in Finland. Methods: A random, population-based sample of 881 persons aged >/= 60 years were interviewed by telephone to obtain a Visual Function-14 (VF-14) score. A total of 294 persons were invited for an ophthalmic examination based on three categories of VF-14 score. Of these, 230 (78%) responded, 10 of whom were excluded as a result of prior bilateral surgery. The New Zealand Priority Criteria (NZPC) and the 15-Dimension Quality of Life (15-D) instruments were administered. In addition, another group of 96 patients waiting for cataract surgery were examined and scored using the VF-14, NZPC and 15-D instruments. A modified Lens Opacities Classification System (LOCS) III classification was used for grading the cataract. Results: Only one (0.5%) of the 220 examined subjects was referred for cataract surgery. Many patients with relatively good visual acuity (VA), including six people with a 100-point VF-14 score suggesting no visual symptoms, were waiting for surgery. Demographic factors were not associated with access to cataract surgery. The patients examined from the waiting list for cataract surgery had more cataractous changes in the lens(es), poorer VA, were older, and scored higher on the NZPC instrument than the population sample examined. Conclusions: Practically no hidden demand for cataract surgery was found in the study population as defined by the national criteria for cataract surgery in Finland. This reflects the fact that the current Finnish health care system appears to recognize and treat cataract patients very well, even in rural areas. Although VA tests may not be sufficient for evaluating need for cataract surgery, the role of questionnaires is not clear either.