Browsing by Subject "PERSISTENCE"

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  • Lahdenperä, Sanni; Soilu-Hanninen, Merja; Kuusisto, Hanna-Maija; Atula, Sari; Junnila, Jouni; Berglund, Anders (2020)
    Objectives To explore adherence, persistence, and treatment patterns in patients with multiple sclerosis (MS) in Finland treated with disease-modifying therapies (DMTs) for active MS in 2005-2018. Materials and Methods The study cohort was identified using the Drug Prescription Register of Social Insurance Institute, Finland. All patients had at least one prescription of glatiramer acetate (GA), beta-interferons, teriflunomide, or delayed-release dimethyl fumarate (DMF). Adherence was calculated using proportion of days covered (PDC) (cutoff >= 0.8). Time to non-persistence was calculated by the number of days on index DMT treatment before the first treatment gap (>= 90 days) or switch and analyzed with time-to-event methodology. Results The cohort included 7474 MS patients (72.2% female; mean age 38.9 years). Treatment switches were steady over 2005-2012, peaked in 2015. PDC means (standard deviations) were GA, 0.87 (0.17); beta-interferons, 0.88 (0.15); DMF, 0.89 (0.14); teriflunomide, 0.93 (0.10). Adherence frequencies were GA, 78.4%; beta-interferons, 81.3%; DMF, 86.9%; teriflunomide, 91.7%. Logistic regression showed that age group, DMT and the starting year, sex, and hospital district independently affected adherence. Patients receiving teriflunomide and DMF, males, and older patients were more likely to persist on treatment. There was no difference in persistence between patients prescribed teriflunomide and DMF, or between GA and beta-interferons. Conclusions Oral DMTs had greater adherence and persistence than injectable DMTs.
  • Kudinov, A. A.; Mantysaari, E. A.; Aamand, G. P.; Uimari, P.; Stranden, I. (2020)
  • Jaisamrarn, Unnop; Castellsague, Xavier; Garland, Suzanne M.; Naud, Paulo; Palmroth, Johanna; Rowena Del Rosario-Raymundo, Maria; Wheeler, Cosette M.; Salmeron, Jorge; Chow, Song-Nan; Apter, Dan; Teixeira, Julio C.; Skinner, S. Rachel; Hedrick, James; Szarewski, Anne; Romanowski, Barbara; Aoki, Fred Y.; Schwarz, Tino F.; Poppe, Willy A. J.; Bosch, F. Xavier; de Carvalho, Newton S.; Germar, Maria Julieta; Peters, Klaus; Paavonen, Jorma; Bozonnat, Marie-Cecile; Descamps, Dominique; Struyf, Frank; Dubin, Gary O.; Rosillon, Dominique; Baril, Laurence; HPV PATRICIA Study Gp (2013)
  • Dickinson, Amy; Xu, Man; Silen, Suvi; Wang, Yilin; Fu, Yu; Sadeghi, Mohammadreza; Toppinen, Mari; Carpen, Timo; Hedman, Klaus; Mäkitie, Antti; Söderlund-Venermo, Maria (2019)
    PurposeApproximately 20% of cancers are estimated to have a viral etiology. We aimed to investigate whether DNA of 8 human parvoviruses [bocavirus 1-4 (HBoV1-4), parvovirus B19 (B19V), protoparvoviruses (bufa-, tusa-, and cutavirus)] and 13 human polyomaviruses (HPyV) can be detected in oropharyngeal and oral cavity squamous cell carcinoma (OPSCC/OSCC), and in juvenile nasopharyngeal angiofibroma (JNA) tissue samples.MethodsFresh samples of seven JNA tissues and ten paired tissues of OSCC/OPSCC tumor and adjacent healthy tissues were collected. DNA extraction and real-time PCRs were performed to detect HBoV1-4, B19V, bufa- tusa- and cutavirus, and HPyV genomes.ResultsJNA specimens were negative for all parvoviruses tested, whereas one JNA sample was Merkel cell polyomavirus (MCPyV) DNA positive. The OSCC/OPSCC samples were negative for the human protoparvoviruses, HBoV1-4, and all human polyomaviruses, except for one patient that was MCPyV DNA positive in both healthy and tumor tissues. Seven OSCC/OPSCC patients were positive for B19V DNA, three of them in both healthy and cancerous tissues and three in only healthy tissues. Three of the B19V DNA-positive patients harbored viral genotype 1, three genotype 2, and one genotype 3B.ConclusionsThese are the first reports of MCPyV and B19V DNA being detected in JNA and OPSCC. The significance of viral DNA positivity is unclear. B19V DNA is known to remain in the tissues lifelong, however, it is of interest that there are some patients with B19 DNA in healthy tissue, but not in the corresponding cancer tissue.
  • Rahkola-Soisalo, Paivi; Balcerzak, Marcin; Ruotsalainen, Jarno; Mikkola, Tomi S. (2019)
    Purpose: Mirabegron, a beta(3)-adrenoreceptor agonist, is used to treat overactive bladder. The factors affecting persistence of mirabegron use or symptom improvement are not thoroughly known, but could be related to patient characteristics. Therefore, we evaluated persistence of medication use, symptom improvement, and quality of life among Finnish mirabegron users. In addition, we assessed possible predictors of change in these variables. Materials and Methods: Participants (52 men, 118 women) with an initial mirabegron prescription were recruited nationwide from 79 pharmacies. Volunteers were interviewed at baseline and after 6 months. Subject and clinical characteristics, symptom severity, and quality of life (EQ-5D-5L) were assessed using a visual analogue scale. Results: Of 170 participants, 144 (84.7%) were reached after 6 months. The rate of persistent mirabegron use was 50.7%. Experiencing adverse effects (29.6%) was the most common reason for discontinuation of medication. A primary health care unit as a prescription site (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.03-4.9) was associated with increased risk for discontinuation. Mirabegron relieved symptoms in 45.2% and enhanced quality of life in 41.7% of the participants. Age Conclusions: In this Finnish population, 50.7% of the participants continued using mirabegron after 6 months. The prescription site seemed to be important for persistent use, which may be related to patient counseling. Younger patients were more likely to benefit from treatment with mirabegron.
  • Oristo, S.; Lee, H. -J.; Maunula, L. (2018)
    AimsDetection/Quantification of RNA viruses is mostly done by reverse-transcriptase (RT)-(q)PCR, but it does not distinguish between infectious and noninfectious viruses. Our aim was to test, how different pretreatments before RT-qPCR could eliminate positivity originated from external nucleic acids or genomes of damaged particles. Methods and ResultsHeat-inactivated (80 degrees C for 10min) rotavirus Wa strain and faecal samples containing rotavirus or norovirus were treated with PMA/PMAxx, benzonase or crude extract RNase prior to RT-qPCR. PMA/PMAxx pretreatments were not consistently efficient for RV, although they seemed to work to some extent for heat-inactivated norovirus. Benzonase and RNase provided consistently 22-28 log(10) reductions in the titre of faecal rotavirus. ConclusionsAll pretreatments need to be further validated for each virus separately, taking into account sample matrix and inactivation conditions. Although none of the pretreatments could completely render inactivated viruses undetectable, RNase worked most consistently for both rota- and norovirus. Significance and Impact of the StudyThis study sheds light on capacity of the most common pre-RT-qPCR treatments to eliminate damaged, noninfectious rotaviruses and noroviruses after thermal treatment. To our knowledge, this is the first time, when benzonase has been used in this context.
  • Vennerström, Pia; Maunula, Leena; Välimäki, Elina; Virtala, Anna-Maija (2020)
    After the first outbreak of viral haemorrhagic septicaemia virus (VHSV) in Finnish brackish water rainbow trout Oncorhynchus mykiss farms, infection spread rapidly between the farms. The infrastructure of fish farming did not take into account spreading of infectious fish diseases. To show the presence of VHSV in the environment, we tested seawater, sediment and wild blue mussels Mytilus edulis from VHSV-infected fish farms, and liquid waste from a processing plant that handled infected rainbow trout. Additionally, blue mussels were bath-challenged with VHSV (exposed to cultivated virus or naturally infected rainbow trout). To detect VHSV, virus isolation in cell culture and real-time reverse transcriptase polymerase chain reaction (qRT-PCR) were used. The virus or viral RNA was detected in sea water and in liquid waste from processing plants during wintertime when water temperature is close to 0 degrees C and sunlight is sparse. VHSV did not appear to replicate in blue mussels in our study. Therefore, blue mussels were not considered relevant carriers of VHSV. However, traces of viral RNA were detected up to 29 d post challenge in mussels. Contact with water from processing plants handling VHSV-infected fish populations increases the risk of the disease spreading to susceptible fish populations, especially during cold and dark times of the year.
  • Sabahi, Mohammadmahdi; Salehipour, Arash; Kazemi, Azin; Sadeghi, Mohammadreza; Decaro, Nicola; Mozhgani, Sayed-Hamidreza; Jalilian, Farid Azizi; Yaghoobi, Mojtaba Hedayat (2019)
    Aim: The prevalence of human parvovirus B19 (B19V) and its association with other diseases in Iran are yet to be systematically assessed. This study aimed to evaluate the prevalence and disease association of B19V across Iran from 2000 to 2019. Methods: The literature search, based on different keywords in different databases, was performed. A total of 29 eligible studies were included and the essential information was collected from each article. Results: The results of this study show a relatively high prevalence of the B19V-associated diseases in all age groups of the Iranian population. Conclusion: The transmission of B19V and its complications should be prevented by developing preventative strategies.
  • Mackenbach, Johan P.; Valverde, Jose Rubio; Bopp, Matthias; Brønnum-Hansen, Henrik; Costa, Giuseppe; Deboosere, Patrick; Kalediene, Ramune; Kovács, Katalin; Leinsalu, Mall; Martikainen, Pekka; Menvielle, Gwenn; Rodriguez-Sanz, Maica; Nusselder, Wilma J. (2019)
    Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.
  • Itäinen-Strömberg, Saga; Hekkala, Anna-Mari; Aro, Aapo L.; Vasankari, Tuija; Airaksinen, Kari Eino Juhani; Lehto, Mika (2020)
    Background Nonvitamin K antagonist oral anticoagulants (NOACs) are increasingly used in patients with atrial fibrillation (AF) undergoing elective cardioversion (ECV). The aim was to investigate the use of NOACs and warfarin in ECV in a real-life setting and to assess how the chosen regimen affected the delay to ECV and rate of complications. Methods Consecutive AF patients undergoing ECVs in the city hospitals of Helsinki between January 2015 and December 2016 were studied. Data on patient characteristics, delays to cardioversion, anticoagulation treatment, acute ( Results Nine hundred patients (59.2% men; mean age, 68.0 +/- 10.0) underwent 992 ECVs, of which 596 (60.0%) were performed using NOACs and 396 (40.0%) using warfarin. The mean CHA(2)DS(2)-VASc score was 2.5 (+/- 1.6). In patients without previous anticoagulation treatment, NOACs were associated with a shorter mean time to cardioversion than warfarin (51 versus. 68 days, respectively; p <.001). Six thromboembolic events (0.6%) occurred: 4 (0.7%) in NOAC-treated patients and 2 (0.5%) in warfarin-treated patients. Clinically relevant bleeding events occurred in seven patients (1.8%) receiving warfarin and three patients (0.5%) receiving NOACs. Anticoagulation treatment was altered for 99 patients (11.0%) during the study period, with the majority (88.2%) of changes from warfarin to NOACs. Conclusions In this real-life study, the rates of thromboembolic and bleeding complications were low in AF patients undergoing ECV. Patients receiving NOAC therapy had a shorter time to cardioversion and continued their anticoagulation therapy more often than patients on warfarin.
  • Cai, Yuhua; Geritz, Stefanus (2020)
    We study resident-invader dynamics in fluctuating environments when the invader and the resident have close but distinct strategies. First we focus on a class of continuous-time models of unstructured populations of multi-dimensional strategies, which incorporates environmental feedback and environmental stochasticity. Then we generalize our results to a class of structured population models. We classify the generic population dynamical outcomes of an invasion event when the resident population in a given environment is non-growing on the long-run and stochastically persistent. Our approach is based on the series expansion of a model with respect to the small strategy difference, and on the analysis of a stochastic fast-slow system induced by time-scale separation. Theoretical and numerical analyses show that the total size of the resident and invader population varies stochastically and dramatically in time, while the relative size of the invader population changes slowly and asymptotically in time. Thereby the classification is based on the asymptotic behavior of the relative population size, and which is shown to be fully determined by invasion criteria (i.e., without having to study the full generic dynamical system). Our results extend and generalize previous results for a stable resident equilibrium (particularly, Geritz in J Math Biol 50(1):67-82, 2005; Dercole and Geritz in J Theor Biol 394:231-254, 2016) to non-equilibrium resident population dynamics as well as resident dynamics with stochastic (or deterministic) drivers.
  • Castellsague, Xavier; Paavonen, Jorma; Jaisamrarn, Unnop; Wheeler, Cosette M.; Skinner, S. Rachel; Lehtinen, Matti; Naud, Paulo; Chow, Song-Nan; Del Rosario-Raymundo, Maria Rowena; Teixeira, Julio C.; Palmroth, Johanna; de Carvalho, Newton S.; Germar, Maria Julieta V.; Peters, Klaus; Garland, Suzanne M.; Szarewski, Anne; Poppe, Willy A. J.; Romanowski, Barbara; Schwarz, Tino F.; Tjalma, Wiebren A. A.; Bosch, F. Xavier; Bozonnat, Marie-Cecile; Struyf, Frank; Dubin, Gary; Rosillon, Dominique; Baril, Laurence; HPV PATRICIA Study Grp (2014)
  • Keto-Timonen, Riikka; Markkula, Annukka; Halkilahti, Jani; Huttunen, Reetta; Räsänen, Sirpa; Salmenlinna, Saara; Heikkilä, Anne; Puisto, Mia; Närhinen, Maria; Hakkinen, Marjaana; Korkeala, Hannu; Jalava, Katri (2019)
    In November 2016, an elderly patient was diagnosed with Listeria monocytogenes bacteremia in Finland. Grocery store loyalty card records and microbiological investigation of foods found in the home fridge and freezer of the patient revealed commercial, modified-atmosphere packaged meatballs as the source of the infection. Investigation of the meatball production plant revealed that the floor drain samples were contaminated with the same L. monocytogenes strain as those isolated from the patient and meatballs. Ready-to-eat meatballs were likely contaminated after heat treatment from the production environment before packaging. Long-term cold storage, modified-atmosphere conditions, and the absence of competing bacteria presumably enhanced the growth of L. monocytogenes. We recommend that collection of shopping details and home fridge and freezer sampling should be part of surveillance of all cases of L. monocytogenes infections to complement information obtained from in-depth interviews.
  • Kontio, Mia; Palmu, Arto A.; Syrjanen, Ritva K.; Lahdenkari, Mika; Ruokokoski, Esa; Davidkin, Irja; Vaarala, Outi; Melin, Merit (2016)
    Background. Measles-mumps-rubella (MMR) vaccinations have been offered to Finnish children at 14-18 months and 6 years of age. In May 2011, the recommended age for the first vaccine dose was lowered to 12 months because of the European measles epidemic. Methods. Fingertip capillary blood samples were collected from 3-year-old Finnish children vaccinated once with MMR vaccine at 11-19 months of age. The immunoglobulin G (IgG) antibodies to all 3 MMR antigens were measured with enzyme-linked immunosorbent assay. Neutralizing antibodies and the avidity of antibodies were measured for measles virus. Results. From April through October 2013, 187 children were enrolled. Equally high proportions of the samples were seropositive for measles virus, mumps virus, or rubella virus antibodies, and there were no significant differences in the IgG antibody concentrations in children vaccinated at 11-13 months of age, compared with those vaccinated at 17-19 months of age. However, among children vaccinated at 11-13 months of age, boys had lower antibody concentrations than girls. Neutralizing measles virus antibody titers were above the threshold for protective immunity in all 78 samples analyzed. The measles virus antibody avidity indexes were high for all children. Conclusions. MMR induces similar antibody responses in 12-month-old children as compared to 18-month-old children, but in boys increasing age appears to improve the antibody responses.
  • Taponen, Suvi; Nykäsenoja, Suvi; Pohjanvirta, Tarja; Pitkälä, Anna; Pyörälä, Satu (2016)
    Background: Coagulase-negative staphylococci (CoNS) are the most common bovine mastitis causing bacteria in many countries. It is known that resistance for antimicrobials is in general more common in CoNS than in Staphylococcus aureus but little is known about the antimicrobial resistance of specific CoNS species. In this study, 400 CoNS isolates from bovine mastitic milk samples were identified to species level using ribotyping and MALDI-TOF MS, and their antimicrobial susceptibility was determined using a commercially available microdilution system. The results were interpreted according to the epidemiological cut-off values by the European Committee on Antimicrobial Susceptibility testing. Results: The most common CoNS species were S. simulans, S. epidermidis, S. chromogenes and S. haemolyticus. Penicillin resistance was the most common type of antimicrobial resistance. Staphylococcus epidermidis was the most resistant among the four major species. Almost one-third of our S. epidermidis isolates were resistant to >2 antimicrobials and close to 7 % were multidrug resistant. The majority of S. epidermidis isolates were resistant to benzylpenicillin. On the contrary, only few S. simulans isolates were penicillin-resistant. Phenotypic oxacillin resistance was found in all four main species, and 34 % of the isolates were oxacillin resistant. However, only 21 isolates (5 %) were positive for the mecA gene. Of these, 20 were S. epidermidis and one S. sciuri. mecC positive isolates were not found. Conclusion: Staphylococcus epidermidis differed from the three other major CoNS species as resistance to the tested antimicrobials was common, several isolates were multidrug resistant, and 19 % of the isolates carried the mecA gene encoding methicillin resistance.
  • Suomenrinne-Nordvik, Anna; Vänskä, Simopekka (2021)
    The natural history of human papillomavirus (HPV) from infection to cervical cancer differs between HPV types. Accordingly, type-specific natural history parameters are crucial for the mathematical models used to optimize the nearly life-long series of disease prevention measures. These parameters are estimated from genotyped data from trials and population level screening programs, typically one type at a time, which requires projecting the multiple-type data to the single type. To analyze impacts of such projection methods on the estimates, we compared estimating one type at a time using different projection methods with estimating all types together. We simulated genotyped data with chosen parameter values for two HPV types and analyzed the identifiability of the chosen values using the different estimation methods. We found the success of estimating one type at a time to be excessively sensitive to the data projection method, with potential to falsely identify the parameters at wrong values. Estimating all types together identified the parameters well. Our results were consistent both when trial and population level data were used. In conclusion, the potential confounding by multi-type infections has to be considered when choosing an estimation method for type-specific natural history parameters.
  • van Bergen, Erik; Dallas, Tad; DiLeo, Michelle F.; Kahilainen, Aapo; Mattila, Anniina L. K.; Luoto, Miska; Saastamoinen, Marjo (2020)
    Abstract The ecological impacts of extreme climatic events on population dynamics and/or community composition are profound and predominantly negative. Here, using extensive data of an ecological model system, we test whether predictions from ecological models remain robust when environmental conditions are outside the bounds of observation. First, we report a 10-fold demographic decline of the Glanville fritillary butterfly metapopulation on the Åland islands (Finland). Next, using climatic and satellite data we show that the summer of 2018 was an anomaly in terms of water balance and vegetation productivity indices across the habitats of the butterfly, and demonstrate that population growth rates are strongly associated with spatio-temporal variation in climatic water balance. Finally, we demonstrate that covariates that have previously been identified to impact the extinction probability of local populations in this system are less informative when populations are exposed to (severe) drought during the summer months. Our results highlight the unpredictable responses of natural populations to extreme climatic events. Article impact statement: A demographic crash of an iconic metapopulation reveals that extreme climatic events reduce the value of predictive models. This article is protected by copyright. All rights reserved
  • Ovaskainen, Otso (2017)
    Stochastic models of closed populations predict eventual extinction with certainty. Consequently, their behavior is often characterized by the quasi-stationary state, i.e. the long-term distribution of population sizes conditional on non-extinction. In contrast, models which allow for immigration exhibit a regular stationary state. At the limit of a low immigration rate, a population is expected to alternate between three states: the quasi- stationary state of a closed population, the extinction state, and the transient phase during which a newly arrived immigrant either establishes a new population or fails to do so. We develop this argument into a simple and intuitive framework that can be used to assess the effect of immigration in a general class of population models. We exemplify the framework for models in which immigrants arrive either singly or in groups, for models with an Allee effect, for models with environmental stochasticity, and for models leading to metapopulation dynamics.
  • Eriksson, Pernilla; Schroder, Marika T.; Niiranen, Kirsi; Nevanlinna, Antti; Panelius, Jaana; Ranki, Annamari (2013)