Background: Eventual differences of expiratory nitric oxide (F_ENO) levels in general populations of Nordic countries may reflect differences in eosinophilic inflammation at population level.

Aim: To study the differences in F_ENO of Nordic regions and their epidemiological associations.

Methods: From 1997 to 2003 we measured F_ENO (ppb) and conducted skin prick-tests for a random sample of adults (n=1498), aged 20-60 years from Finland (Helsinki), Sweden (Stockholm and Örebro) and Estonia (Narva and Saaremaa). We compared differences between regions by estimating odds ratios (OR) and 95% confidence intervals (CIs) for high F_ENO (>25 ppb) using logistic regression adjusted for gender, smoking and allergy. Finally, we estimated crude ORs and 95% CIs for high F_ENO and for asthma, rhinitis, current asthma symptoms and asthma medication.

Results: The mean and standard deviation (SD) for F_ENO was 19(14) in Finland, 18(12) in Sweden and 16(15) in Estonia (p<0.001). Estonia had a lower mean F_ENO than other countries, with no differences between Finland and Sweden. Compared to Helsinki, the adjusted OR (95%CI) for high F_ENO was 0.42(0.21-0.81) in Stockholm, 0.65(0.43-0.98) in Örebro, 0.53(0.32-0.84) in Narva and 0.45(0.28-0.71) in Saaremaa. In Estonia, high F_ENO was associated with asthma, allergy, rhinitis, current asthma, and asthma medication; in Finland with rhinitis and use of short acting β-agonist; in Sweden with asthma and asthma medication. Smoking was associated with low F_ENO. Mean F_ENO in asthmatics was 24(19) in Finland, 20(12) in Sweden, and 43(49) in Estonia (p=0.07).

Conclusions: We observed a higher mean F_ENO in Finland and Sweden compared to Estonia, and found no overall differences of F_ENO levels in asthmatics.

INTRODUCTION: Addressing tobacco use is an important issue in general health care. In order to improve smoking cessation advice, spirometry values can be displayed to the smoker to demonstrate possible lung function impairment. The estimate of so-called lung age may show a decrease in lung function associated with smoking. It has been suggested that performing spirometry on patients who smoke but are asymptomatic can be a useful way to show the adverse effects of smoking. The aim of this systematic review was to determine if providing spirometry results in combination with smoking cessation counselling can increase smoking cessation rates compared to what is achieved through counselling alone.

METHODS: In this systematic review, we included randomized controlled trials (RCTs) evaluating smoking cessation interventions for adult smokers. The systematic search was performed in PubMed, Medline, Cochrane Library, Cinahl, Embase, Amed and PsycInfo.

RESULTS: The literature search resulted in 946 studies, which, after reading by two independent reviewers, were reduced to seven trials that matched the inclusion criteria. Two RCTs showed significant improvement in smoking cessation when giving patients feedback on spirometry results in combination with smoking cessation counselling, compared to patients who received only smoking cessation counselling. In both studies, the spirometry results were expressed as lung age. In the other five studies no difference was found. Five further published study protocols for ongoing RCT studies in the field have been found, and therefore this systematic overview will likely need to be updated within a few years.

CONCLUSIONS: Few studies have been undertaken to examine the efficacy of spirometry in increasing smoking quit rates. Studies conducted to date have shown mixed results, and there is currently limited evidence in the literature that smoking cessation counselling that includes feedback from spirometry and a demonstration of lung age promotes quit rates.

The capacity to learn and reproduce vocal sounds has evolved in phylogenetically distant tetrapod lineages. Vocal learners in all these lineages express similar neural circuitry and genetic factors when perceiving, processing, and reproducing vocalization, suggesting that brain pathways for vocal learning evolved within strong constraints from a common ancestor, potentially fish. We hypothesize that the auditory-motor circuits and genes involved in entrainment have their origins in fish schooling behavior and respiratory-motor coupling. In this acoustic advantages hypothesis, aural costs and benefits played a key role in shaping a wide variety of traits, which could readily be exapted for entrainment and vocal learning, including social grouping, group movement, and respiratory-motor coupling. Specifically, incidental sounds of locomotion and respiration (ISLR) may have reinforced synchronization by communicating important spatial and temporal information between school-members and extending windows of silence to improve situational awareness. This process would be mutually reinforcing. Neurons in the telencephalon, which were initially involved in linking ISLR with forelimbs, could have switched functions to serve vocal machinery (e.g. mouth, beak, tongue, larynx, syrinx). While previous vocal learning hypotheses invoke transmission of neurons from visual tasks (gestures) to the auditory channel, this hypothesis involves the auditory channel from the onset. Acoustic benefits of locomotor-respiratory coordination in fish may have selected for genetic factors and brain circuitry capable of synchronizing respiratory and limb movements, predisposing tetrapod lines to synchronized movement, vocalization, and vocal learning. We discuss how the capacity to entrain is manifest in fish, amphibians, birds, and mammals, and propose predictions to test our acoustic advantages hypothesis.

Almost 90% of humans are right handed, but why is unclear. It has been suggested that right handedness evolved in the context of escalating motor and cognitive demands related to tool use. Literature indicates that homicide may have been common in early hominins. Since, in combat with sharp implements, handedness may influence the relative level of exposure of left and right thorax, the hypothesis presented here is that thoracic anatomic asymmetry resulted in a survival advantage for right handed individuals. While fighting with sharp tools, a left hand unilateral grip will rotate the left hemi-thorax towards an opponent. The aims of this study were to quantify the degree of thoracic/cardiac asymmetry in humans and to estimate any difference in risk of injury from a sharp implement attack to the left and the right human thorax. CT-scans of 37 men showed a mean of 73% (SD 7%) of the heart volume to be situated in the left hemi-thorax. Nineteen physicians unaware of the hypothesis estimated the outcome of weapons penetrating the left and right thorax/abdomen at random points. The difference in estimated mortality for left and right thorax was significant, p\0.001 (Wilcoxon- signed-ranks-test for two related samples). These results suggest greater vulnerability of the left side of the body in combat, and, accordingly, an adaptive value of right-handedness. Thoracic asymmetry may have contributed to the development of right hand preference in humans.

Schooling fish, swarms of starlings, plodding wildebeest, and musicians all display impressive synchronization. To what extent do they use acoustic cues to achieve these feats? Could the acoustic cues used in movement synchronization be relevant to the treatment of movement disorders such as Parkinson’s disease (PD) in humans? In this paper, we build on the emerging view in evolutionary biology that the ability to synchronize movement evolved long before language, in part due to acoustic advantages. We use this insight to explore potential mechanisms explaining why music therapy has beneficial effects for PD patients. We hypothesize that rhythmic auditory cues, particularly music, can stimulate neuronal and behavioral processes that ease the symptoms and potentially the causes of PD because the neural circuits used in auditory entrainment at individual and group levels are associated with dopamine production. We summarize current treatment of PD and outline how new insights from an evolutionary perspective could improve understanding and eventual treatment of movement disorders in humans.

Smoking-cessation support and anti-tobacco-legislation have the potential to generate substantial health improvements, and reduce socioeconomic differences. It is exceedingly cost-effective. Current smoking is an important risk-indicator, influencing prognosis and treatment e.g. in patients with rheumatoid arthritis, heart disease, air-way diseases, and before elective surgery.  Raising the question timely, empathy and professional support are crucial factors. It is essential to ask and document tobacco habits of all patients, including ex-smokers and never users. Behavioral counseling and pharmacotherapy, given in combination, significantly increase long-term abstinence rates. First-line pharmacotherapy to support quit attempts are nicotine replacement therapy, bupropion and varenicline. Health-care professionals are trusted and have unique possibilities to raise the tobacco issue in meetings with patients and in the society debate.

Rökavvänjning och antitobakslagar kan genera betydande hälsoeffekter och reducera socioekonomiska klyftor till mycket låg kostnad. Pågående rökvanor är en betydande riskfaktor och påverkar prognos och behandling till exempel vid rheumatoid arthrit, hjärt- och luftvägssjukdom och inför elektiv kirurgi.  Fråga därför om tobak i patientmöten; dokumentera även tidigare rökning, ex-rökning och ”aldrig-rökning”. Ställ tobaksfrågan tidigt och med timing, ”Har du någonsin använt tobak?” fungerar ofta bra. Generös rådgivningstid, strukturerad samtalsmetodik (till exempel Motiverande Samtal), empatiskt förhållningssätt är framgångsfaktorer. Kvalificerat rökavvänjningsstöd, gärna kombinerat med farmaka, förbättrar möjligheten att bli och förbli rökfri. Första linjens farmaka är nikotinläkemedel, vareniklin och bupropion. Hälso- och sjukvårdspersonal har stort förtroende och unika möjligheter att ta upp frågan om tobak i patientmöten och i samhällsdebatt.