The study aimed to investigate the associations between different levels of depression with different aspects of school performance. The target population included 2516 7th–9th grade pupils (13–17 years) of whom 90% completed the questionnaire anonymously in the classroom. Of the girls 18.4% and of the boys 11.1% were classified as being depressed (R‐Beck Depression Inventory (BDI), the Finnish version of the 13‐item BDI). The lower the self‐reported grade point average (GPA) or the more the GPA had declined from the previous term, the more commonly the adolescents were depressed. Depression was associated with difficulties in concentration, social relationships, self‐reliant school performance and reading and writing as well as perceiving schoolwork as highly loading. The school performance variables had similar associations with depression among both sexes when a wide range of depression was studied but gender differences appeared when studying the severe end of the depression scale. Our study indicates that pupils reporting difficulties in academic performance should be screened for depression.

Background Concurrent head-to-head comparisons of healthcare interventions regarding cost-utility are rare. The concept of favorable cost-effectiveness of total hip or knee arthroplasty is thus inadequately verified.Patients and methods In a trial involving several thousand patients from 10 medical specialties, 223 patients who were enrolled for hip or knee replacement surgery were asked to fill in the 15D health-related quality of life (HRQoL) survey before and after operation.Results Mean (SD) HRQoL score (on a 0-1 scale) increased in primary hip replacement patients (n = 96) from 0.81 (0.084) preoperatively to 0.86 (0.12) at 12 months (p < 0.001). In revision hip replacement (n = 24) the corresponding scores were 0.81 (0.086) and 0.82 (0.097) respectively (p = 0.4), and in knee replacement (n = 103) the scores were 0.81 (0.093) and 0.84 (0.11) respectively (p < 0.001). Of 15 health dimensions, there were statistically significant improvements in moving, usual activities, discomfort and symptoms, distress, and vitality in both primary replacement groups. Mean cost per quality-adjusted life year (QALY) gained during a 1-year period was € 6,710 for primary hip replacement, € 52,274 for revision hip replacement, and € 13,995 for primary knee replacement. Interpretation Hip and knee replacement both improve HRQoL. The cost per QALY gained from knee replacement is twice that gained from hip replacement.

Background-Trigger mechanisms for the onset of paroxysmal atrial fibrillation (AF) in patients without structural heart disease are not well established. New analysis methods of heart rate (HR) variability based on nonlinear system theory may reveal features and abnormalities in R-R interval behavior that are not detectable by traditional analysis methods. The purpose of this study was to reveal possible alterations in the dynamics of R-R intervals before the spontaneous onset of paroxysmal AF. Methods and Results-Traditional time and frequency domain HR variability indices, along with the short-term scaling exponent ␣ 1 and approximate entropy (ApEn), were analyzed in 20-minute intervals before 92 episodes of spontaneous, paroxysmal AF in 22 patients without structural heart disease. Traditional HR variability measures showed no significant changes before the onset of AF. A progressive decrease occurred both in ApEn (1.09Ϯ0.26 120 to 100 minutes before AF; 0.88Ϯ0.24 20 to 0 minutes before AF; PϽ0.001) and in ␣ 1 (1.01Ϯ0.28 120 to 100 minutes before AF, 0.89Ϯ0.28 20 to 0 minutes before AF; PϽ0.05) before the AF episodes. Both ApEn (0.89Ϯ0.27 versus 1.02Ϯ0.30; PϽ0.05) and ␣ 1 (0.91Ϯ0.28 versus 1.27Ϯ0.21; PϽ0.001) were also lower before the onset of AF compared with values obtained from matched healthy control subjects. Conclusions-A decrease in the complexity of R-R intervals and altered fractal properties in short-term R-R interval dynamics precede the spontaneous onset of AF in patients with no structural heart disease. Further studies are needed to determine the physiological correlates of these new, nonlinear HR variability measures. (Circulation. 1999;100:2079-2084.)

This was the first time the independent association between alexithymia and somatization was established in a large, nationally representative nonclinical sample of both young and old adults with and without mental disorders and somatic diseases.