Browsing by Subject " adverse effects"

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  • Kumpula, Eeva-Katri (Helsingfors universitet, 2009)
    Anticholinergic medicines are commonly used to treat e.g. incontinence. These medicines have side effects, which may cause and also exacerbate e.g. dryness of the mouth, increased heart rate, and even cognitive impairment. Older people may be more at risk for these side effects as they may be experiencing similar symptoms as a natural effect of aging, and because they may be using several medicines causing these effects. Older people often have a high medicine burden and also a high disease burden. Measuring anticholinergic effects to change medicine regimens and to reduce the symptoms is difficult as there is no golden standard method. This thesis investigated the published methods available for estimating anticholinergic burden in the literature review part, and used one anticholinergic scoring system, the Anticholinergic Risk Scale, in a cross-sectional study to test the effects of anticholinergics on mortality in 1004 older institutionalised patients from Helsinki area public hospitals. Cross-tabulations and Kruskal-Wallis or Chi square methods were used to detect differences between variables such as nutritional status or certain diagnoses when the patients were stratified according to their anticholinergic use. Cox Proportional Hazard regression, the logrank test and Kaplan-Meier curve were used to investigate the effects of anticholinergics on 5-year all-cause mortality. An in vitro serum assay and seven anticholinergic scoring systems were identified in the literature search. Also, 17 anticholinergic lists were identified, which covered 278 medicines, of which 21 appeared on at least eight of the lists. In the empirical study, the women's (n = 745) mean (± SD) age was 83.35 (± 9.99) years, and they were older than the men (n = 241, mean age ± SD 75.11 ± 11.48, p < 0.001). The 1004 patients (response rate 70 %) were using a mean (± SD) number of 7.1 ± 3.4 regular medicines (range 0-20). 455 patients used no anticholinergics, 363 had some anticholinergic burden (score 1 or 2), and 186 had a high burden, with anticholinergic scores of 3 or more. The mean ARS score (± SD) was 1.2 ± 1.5 (range 0-10). When three anticholinergic lists were compared, all three lists identified only 280/791 of patients who were anticholinergic users according to at least one list. No association was found between anticholinergic medicine use and mortality. There are several methods available for measuring anticholinergic burden, but there is a need for a consensus method. This was highlighted by the lack of agreement on medicines on different lists and when three anticholinergic lists tested identified different patients when compared to each other. Anticholinergic use was common in this frail, older patient sample, but no effect on mortality was shown in this study setting. The cross-sectional nature of the data limits the reliability of the study, and any conclusions beyond older patients in Helsinki area must be done very cautiously. Future research should define anticholinergics better and investigate their possible effect on mortality in a prospective, randomised, and controlled setting.
  • Athanasiou, Antonios; Veroniki, Areti Angeliki; Efthimiou, Orestis; Kalliala, Ilkka; Naci, Huseyin; Bowden, Sarah; Paraskevaidi, Maria; Martin-Hirsch, Pierre; Bennett, Philip; Paraskevaidis, Evangelos; Salanti, Georgia; Kyrgiou, Maria (2019)
    Introduction Local treatments for cervical intraepithelial neoplasia (CIN) and microinvasive disease remove or ablate a cone-shaped part of the uterine cervix containing the abnormal cells. A trend toward less radical techniques has raised concerns that this may adversely impact the rates of precancerous and cancerous recurrence. However, there has been no strong evidence to support such claims. We hereby describe a protocol of a systematic review and network meta-analysis that will update the evidence and compare all relevant treatments in terms of efficacy and complications. Methods and analysis Literature searches in electronic databases (CENTRAL, MEDLINE, EMBASE) or trial registries will identify published and unpublished randomised controlled trials (RCTs) and cohort studies comparing the efficacy and complications among different excisional and ablative techniques. The excisional techniques include cold knife, laser or Fischer cone, large loop or needle excision of the transformation zone and the ablative radical point diathermy, cryotherapy, cold coagulation or laser ablation. The primary outcome will be residual/recurrent disease defined as abnormal histology or cytology of any grade, while secondary outcomes will include treatment failure rates defined as high-grade histology or cytology, histologically confirmed CIN1+ or histologically confirmed CIN2+, human papillomavirus positivity rates, involved margins rates, bleeding and cervical stenosis rates. We will assess the risk of bias in RCTs and observational studies using tools developed by the Cochrane Collaboration. Two authors will independently assess study eligibility, abstract the data and assess the risk of bias. Random-effects meta-analyses and network meta-analyses will be conducted using the OR for dichotomous outcomes and the mean difference for continuous outcomes. The quality of the evidence for the primary outcome will be assessed using the CINeMA (Confidence In Network Meta-Analysis) tool. Ethics and dissemination Ethical approval is not required. We will disseminate findings to clinicians, policy-makers, patients and the public. PROSPERO registration number CRD42018115508.
  • Jokelainen, J.; Ismail, S.; Kylänpää, L.; Udd, M.; Mustonen, H.; Lindström, O.; Pöyhiä, R. (2020)
    Background and Aims: Several studies and guidelines are questioning routine preoperative laboratory tests in surgical and endoscopic procedures. Their effect in endoscopic retrograde cholangiopancreatography is not currently known. This study was carried out to evaluate the risk of adverse effects in endoscopic retrograde cholangiopancreatography and their association with preoperative lab tests. Materials and Methods: A single-center, prospective observational study on all 956 patients undergoing 1196 endoscopic retrograde cholangiopancreatographies in the Endoscopy Unit of Helsinki University Central Hospital from 1 March 2012 to 28 February 2013. Routine preoperative laboratory test results (basic blood count, creatinine, potassium, sodium, international normalized ratio/thromboplastin time, and amylase), health status, medication, and demographic information of all patients were analyzed in relation to adverse effects related to endoscopic retrograde cholangiopancreatography and procedural sedation. Results: Multivariate analysis showed post-endoscopic retrograde cholangiopancreatography pancreatitis (43 cases, 3.6%) to have no association with abnormal routine preoperative laboratory tests. Respiratory depression caused by sedation (128 cases, 11%) was not associated with abnormal routine preoperative laboratory tests, and anemia was found to be a slightly protecting factor. Cardiovascular depression caused by sedation was associated with thrombocytopenia (odds ratio = 1.87, p = 0.025) and, in male patients, hyponatremia (odds ratio = 3.66, p <0.001). Incidence of other adverse effects was too low for statistical analysis. Conclusion: Routine universal preoperative lab testing was not found to be successful in predicting adverse effects in endoscopic retrograde cholangiopancreatography procedures. Laboratory testing should be done focusing on each patient's individual needs.
  • Saloranta, Tuire H.; Gyllenberg, Frida K.; But, Anna; Gissler, Mika; Laine, Merja K.; Heikinheimo, Oskari (2020)
    BACKGROUND: Since 2013, the residents of the city of Vantaa, Finland, have been offered their first long-acting reversible contraceptive method (levonorgestrel-releasing intrauterine system, implant, and copper intrauterine device) free of charge. OBJECTIVE: The primary aim of this study was to assess the 2-year cumulative discontinuation rates of long-acting reversible contraceptive methods when provided free of charge for first-time users in a real-world setting. Additional aims were to describe factors associated with discontinuation and to evaluate the reasons for discontinuation. STUDY DESIGN: This is a retrospective register-based cohort study of 2026 nonsterilized women aged 15 to 44 years, who initiated a free-of-charge long-acting contraceptive method in 2013-2014 in the city of Vantaa. Removals within 2 years after method initiation and reasons for discontinuation were obtained from electronic health records and from national registers. We calculated the 2-year cumulative incidence rates of discontinuation with 95% confidence intervals for each method. Furthermore, we assessed crude and adjusted incidence rate ratios of discontinuation with 95% confidence interval by Poisson regression models comparing implants and copper intrauterine device with levonorgestrel-releasing intrauterine systems. RESULTS: During the 2 -year follow-up, 514 women discontinued, yielding a cumulative discontinuation rate of 28.3 per 100 women-years (95% confidence interval, 26.2-30.4). Among the 1199 women who initiated the levonorgestrel-releasing intrauterine system, the cumulative discontinuation rate was 24.2 per 100 women-years (95% confidence interval, 21.7-26.9); among the 642 implant users, 33.3 per 100 women-years (95% confidence interval, 29.5-37.4); and among the 185 copper intrauterine device users, 37.8 per 100 women-years (95% confidence interval, 31.0-45.7). Compared with women aged 30 to 44 years, women aged 15 to 19 years (adjusted incidence rate ratio, 1.58; 95% confidence interval, 1.17-2.14) and 20 to 29 years (adjusted incidence rate ratio, 1.35; 95% confidence interval, 1.11-1.63) were more likely to discontinue. We observed a higher discontinuation rate in women who had given birth within the previous year (adjusted incidence rate ratio, 1.36; 95% confidence interval, 1.13-1.65), spoke a native language other than Finnish or Swedish (adjusted incidence rate ratio, 1.31; 95% confidence interval, 1.06-1.63), and had a history of a sexually transmitted infection (adjusted incidence rate ratio, 1.62; 95% confidence interval, 1.07-2.46). No association was found in marital status, overall parity, history of induced abortion, socioeconomic status, education level, or smoking status. The most common reason for discontinuation was bleeding disturbances, reported by 21% of women who discontinued the levonorgestrel-releasing intrauterine system, by 71% who discontinued the implant, and by 41% who discontinued the copper intrauterine device. One in 4 women who discontinued the copper intrauterine device reported heavy menstrual bleeding, whereas only 1% who discontinued the levonorgestrel-releasing intrauterine system and none who discontinued implants reported this reason. Abdominal pain was the reported reason for discontinuation in 20% of both intrauterine device users and in only 2% who discontinued implants. CONCLUSION: At 2 years, the use of implants and copper intrauterine devices was more likely to be discontinued than that of the levonorgestrelreleasing intrauterine system. Women younger than 30 years and those who gave birth in the preceding year, spoke a native language other than Finnish or Swedish, or had a history of sexually transmitted infections were more likely to discontinue. The levonorgestrel-releasing intrauterine system was least likely to be removed owing to bleeding disturbances.Y
  • Löfstedt-Horn, Emma (Helsingin yliopisto, 2022)
    Njurcancer är bland de tio vanligaste cancersjukdomarna och påträffas oftast i åldersgruppen 50+. En del former av njurcancer associeras med nedärvda syndrom, exempelvis med Von Hippel-Lindaus sjukdom. Den vanligaste typen är klarcellig njurcancer. Den molekylära bakgrunden till njurcancer ligger i störningar i gener som kodar proteiner, vilka ansvarar för blodkärlsförsörjning, metastasbildning och tillväxt av tumörcellen. Medicinsk behandling av metastaserad njurcancer ämnar hämma intracellulära signaleringsrutter, vilket kallas målinriktad vård. Vården av metastaserad njurcancer har det senaste decenniet utvecklats och ett läkemedel som introducerats inom området är kabozantinib, en multireceptortyrosinkinashämmare. Kabozantinib inhiberar tumörcellens blodkärlsförsörjning och tillväxt via blockering av flera signaleringsrutter. Syftet med studien är att undersöka vilka biverkningar rapporterades på Helsingfors universitetssjukhus onkologiska klinik av de patienter som fick kabozantinib som första linjens medicinska behandling i spridd njurcancer och ifall detta överensstämmer med tidigare forskning. Forskningen är en observationsstudie/registerstudie. Datainsamlingen skedde via patientdatasystemet och innefattar patienter vårdade 2019-2020. Data analyserades med Excel. Eftersom den slutliga patientmängden efter tillämpning av inklusionskriterier var 16, kunde ingen avancerad statistiskt hållbar analys göras. Studiens resultat var överens med tidigare forskning – de vanligaste biverkningarna var diarré och trötthet. Vidare forskning med större patientmängd kunde ge statistiskt pålitliga resultat och det vore intressant att utreda ifall fler biverkningar associeras med bättre vårdresultat. (205 ord)
  • Tapiala, Jesse; Hyvärinen, Antti; Toppila-Salmi, Sanna; Suihko, Eero; Penttilä, Elina (2021)
    Objectives To explore the opinions, the usage and the patient education given on nasal saline irrigation by physicians and pharmaceutical personnel working in Finland. Design An internet-based survey with predetermined, multiple-choice answers. Setting Primary care centres, occupational health centres and private care centres in Eastern Finland as well as pharmacies in Finland. Main outcome measures Healthcare professionals views, practice and general knowledge of nasal irrigation for sinonasal symptoms and conditions. Results We received 595 completed surveys (110 physicians, 485 pharmacists). The majority of the respondents recommended nasal saline irrigation for their patients either as a symptomatic treatment (98.0%) or to treat a specific condition (97.5%) such as acute rhinosinusitis, chronic rhinosinusitis and allergic rhinitis. Nasal saline irrigation was also often recommended as a prophylaxis for airway-infections (71.9%) and to enhance the health of the nasal mucosa (58.2%). In general, the possible adverse effects were recognised poorly by both professions. There was a clear difference between the two professions, as physicians were more conservative in recommending nasal saline irrigation and recognised possible adverse effects, such as epistaxis, pain, and dryness of the nose, better (75% vs. 59%, p = 0.002). Conclusions Nasal saline irrigation seems to be a popular treatment recommended by many health care professionals in Finland. Physicians and pharmaceutical personnel had variable opinions on the indications, utility and risks of nasal saline irrigation. There are also clear differences between physicians and pharmaceutical personnel's practices. There is a need to better educate professionals about nasal saline irrigation and to further study whether nasal saline irrigation is efficient and safe option for the different common sinonasal conditions.
  • Nummi, Antti (Helsingin yliopisto, 2018)
    Objectives: The objective was to evaluate tolerability of BCG treatment and to determine if interruption impacts on treatment outcome. Furthermore, the incidence and characteristics of severe complications were recorded. Methods: We included 418 patients who received BCG instillations in our institution during 2009-2015. Reason for interruption, treatment outcome, number of instillations and diagnosis of BCG infection were recorded retrospectively. Results: Of the 418 patients who started BCG, 176 (42.1%) interrupted and discontinued BCG treatment, 23 (5.5%) interrupted due to suspicion of BCG infection. Systemic BCG infection was found in 7 (1.7%) patients and local in 5 (1.2%) patients. Other reasons for interruption were other adverse effects in 71 patients (17.0%), BCG failure in 46 patients (11.0%) and other reasons in 36 patients (8.6%). 86% of interruptions due to adverse effects occurred within the first 18 instillations. The probability of tumor recurrence (20.0% vs 10.7%) and disease progression (5.4% vs 1.2%) was higher with patients whose BCG treatment was interrupted. Conclusions: Severe complications are encountered in only <5% of patients. The propability of adverse effects and severe complications depend mostly on the host’s characteristics rather than on the BCG dose or the number of BCG instillations.
  • Johansson, Anna (Helsingin yliopisto, 2018)
    Artificial light that produces some adverse effects is called light pollution. Light pollution has only recently been recognized as an environmental problem – it has been noticed to have adverse effects to organisms, ecosystems, human health and their well-being. The purpose of this study is to combine two aspects of light pollution that have so far gained little attention: the public’s point of view and the lighting solutions of municipalities and forest industry enterprises. These two aspects can be connected to each other through a concept called condition of lighting. Here the conditions of lighting consist of three areas with notable differences in lighting: city centers, countryside and forest industry production plants along with their surroundings. The study was conducted in South Karelia, Finland, and it was divided into two sections. The first section dealt with the public’s point of view on light pollution. The objective was to find out how South Karelians perceive the effects and obtrusiveness of artificial light both generally and also within areas of differing conditions of lighting. In addition, the intention was to uncover other factors that might influence the opinions of people. The second section of the study concerned the lighting solutions of municipalities and forest industry enterprises. The objective was to examine their lighting planning and implementation as well as the role of light pollution in the process. Interview was selected as the method of research in both sections of the study. The public considered electronic billboards and car headlights as the most obtrusive sources of light pollution. Bright lights and glare, on the other hand, were considered the most obtrusive types of light pollution. Most valued benefits of artificial light were its influence on safety, crime prevention and its positive effect on mood. Not being able to see the stars or experience natural darkness were considered as the biggest disadvantages of artificial light. The conditions of lighting in different areas also influenced the respondents’ experiences: people living in the countryside did not feel insecure in dark places outside the cities and did not consider abundant lighting pleasant. They also felt that being able to experience natural darkness was important. Among other factors, nature orientedness, light sensitivity, environmental attitudes and gender strongly affected the views of the respondents. In the municipalities and forest industry enterprises, the lighting planning concentrated on territorial plans. All but one of the municipalities and enterprises had taken light pollution into consideration at some level at least, but the forms and means varied. In the future both municipalities and forest industry enterprises will invest more in LED technology. The results show that artificial light can cause inconvenience to people who live outside the brightly lighted areas and who were not particularly interested in light pollution. Behind the inconvenience and disturbance were mostly the experiences, habits, values and attitudes of the respondents. The municipalities and enterprises have a lot to improve when it comes to light pollution. They should, for example, invest in comprehensive lighting planning, avoid over-illumination and pay attention to suitable direction and positioning of the light fixtures. In the future, it is important to examine the public’s opinion and to map the landscape of lights at a local scale. This would help in finding the most suitable lighting solutions for different areas. In the opinion polls, the subjective characteristics affecting the views of the respondents should be taken into consideration. Research regarding the municipalities and enterprises should be directed to the areas where light pollution is not regulated, in order to gather information on motivation and implementation of the voluntary activities reducing light pollution.