Browsing by Subject "CARE"

Sort by: Order: Results:

Now showing items 1-20 of 222
  • Kaatrakoski, Heli; Lahikainen, Johanna (2016)
    Change, transformation, the reassessment of services and professional capabilities are key concepts in the language of academic libraries today. We suggest that two intertwined rationales - technical development and the marketisation of the public sector along with a customer approach - are driving the change that is challenging academic libraries to rethink their work and services. In this article, we first discuss embedded librarianship and knotworking in libraries as participatory approaches to the arrangement of academic library work and services. Second, we presented the findings of the Knotworking project and its follow-up interviews and suggest knotworking as a method with which librarians can collaboratively analyse their own work and develop services with researchers and thus respond to changing working environments. Third, we discuss changes in the work identity of librarians. (C) 2016 Elsevier Inc. All rights reserved.
  • Nichols, Hazel J.; Arbuckle, Kevin; Sanderson, Jennifer L.; Vitikainen, Emma I. K.; Marshall, Harry H.; Thompson, Faye J.; Cant, Michael A.; Wells, David A. (2021)
    Personality traits, such as the propensity to cooperate, are often inherited from parents to offspring, but the pathway of inheritance is unclear. Traits could be inherited via genetic or parental effects, or culturally via social learning from role models. However, these pathways are difficult to disentangle in natural systems as parents are usually the source of all of these effects. Here, we exploit natural 'cross fostering' in wild banded mongooses to investigate the inheritance of cooperative behaviour. Our analysis of 800 adult helpers over 21 years showed low but significant genetic heritability of cooperative personalities in males but not females. Cross fostering revealed little evidence of cultural heritability: offspring reared by particularly cooperative helpers did not become more cooperative themselves. Our results demonstrate that cooperative personalities are not always highly heritable in wild, and that the basis of behavioural traits can vary within a species (here, by sex).
  • Levola, Jonna M.; Sailas, Eila S.; Saamanen, Timo S.; Turunen, Leena M.; Thomson, Annika C. (2019)
    Background: The focus of emergency room (ER) treatment is on acute medical crises, but frequent users of ER services often present with various needs. The objectives of this study were to obtain information on persistent frequent ER service users and to determine reasons for their ER service use. We also sought to determine whether psychiatric diagnoses or ongoing use of psychiatric or substance use disorder treatment services were associated with persistent frequent ER visits. Methods: A cohort (n = 138) of persistent frequent ER service users with a total of 2585 ER visits during a two-year-period was identified. A content analysis was performed for 10% of these visits. Register data including International Classification of Primary Care 2 (ICPC-2) -codes and diagnoses were analyzed and multivariable models were created in order to determine whether psychiatric diagnoses and psychosocial reasons for ER service use were associated with the number of ER visits after adjusting for covariates. Results: Patients who were younger, had a psychiatric diagnosis and engaged in ongoing psychiatric and other health services, had more ER visits than those who were not. Having a psychiatric diagnosis was associated with the frequency of ER visits in the multivariable models after adjusting for age, gender and ongoing use of psychiatric or substance use disorder treatment services. Reasons for ER-service use according to ICPC-2 -codes were inadequately documented. Conclusions: Patients with psychiatric diagnoses are overrepresented in this cohort of persistent frequent ER service users. More efficient treatments paths are needed for patients to have their medical needs met through regular appointments.
  • Wennlund, Klara Torlen; Kurland, Lisa; Olanders, Knut; Castren, Maaret; Bohm, Katarina (2022)
    Background The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. Methods A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. chi(2)-test was used for comparisons. P-levels < 0.05 were regarded as significant. Results A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). Conclusions A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.
  • Marshall, H. H.; Johnstone, R. A.; Thompson, F. J.; Nichols, H. J.; Wells, D.; Hoffman, J. I.; Kalema-Zikusoka, G.; Sanderson, J. L.; Vitikainen, E. I. K.; Blount, J. D.; Cant, M. A. (2021)
    Rawls argued that fairness in human societies can be achieved if decisions about the distribution of societal rewards are made from behind a veil of ignorance, which obscures the personal gains that result. Whether ignorance promotes fairness in animal societies, that is, the distribution of resources to reduce inequality, is unknown. Here we show experimentally that cooperatively breeding banded mongooses, acting from behind a veil of ignorance over kinship, allocate postnatal care in a way that reduces inequality among offspring, in the manner predicted by a Rawlsian model of cooperation. In this society synchronized reproduction leaves adults in a group ignorant of the individual parentage of their communal young. We provisioned half of the mothers in each mongoose group during pregnancy, leaving the other half as matched controls, thus increasing inequality among mothers and increasing the amount of variation in offspring birth weight in communal litters. After birth, fed mothers provided extra care to the offspring of unfed mothers, not their own young, which levelled up initial size inequalities among the offspring and equalized their survival to adulthood. Our findings suggest that a classic idea of moral philosophy also applies to the evolution of cooperation in biological systems. Obscuring knowledge of personal gains from individuals can theoretically maintain fairness in a cooperative group. Experiments show that wild, cooperatively breeding banded mongooses uncertain of kinship allocate postnatal care in a way that reduces inequality among offspring, suggesting a classic idea of moral philosophy can apply in biological systems.
  • Heino, Anssi; Björkman, Johannes; Tommila, Miretta; Iirola, Timo; Jäntti, Helena; Nurmi, Jouni (2022)
    Objectives Prehospital critical care physicians regularly attend to patients with poor prognosis and may limit the advanced therapies. The aim of this study was to evaluate the accuracy of poor prognosis given by prehospital critical care clinicians. Design Cohort study. Setting We performed a retrospective cohort study using the national helicopter emergency medical services (HEMS) quality database. Participants Patients classified by the HEMS clinician to have survived until hospital admission solely because of prehospital interventions but evaluated as having no long-term survival by prehospital clinician, were included. Primary and secondary outcome The survival of the study patients was examined at 30 days, 1 year and 3 years. Results Of 36 715 patients encountered by the HEMS during the study period, 2053 patients were classified as having no long-term survival and included. At 30 days, 713 (35%, 95% CI 33% to 37%) were still alive and 69 were lost to follow-up. Furthermore, at 1 year 524 (26%) and at 3 years 267 (13%) of the patients were still alive. The deceased patients received more often prehospital rapid sequence intubation and vasoactives, compared with patients alive at 30 days. Patients deceased at 30 days were older and had lower initial Glasgow Coma Scores. Otherwise, no clinically relevant difference was found in the prehospital vital parameters between the survivors and non-survivors. Conclusions The prognostication of long-term survival for critically ill patients by a prehospital critical care clinician seems to fulfil only moderately. A prognosis based on clinical judgement must be handled with a great degree of caution and decision on limitation of advanced care should be made cautiously.
  • Sturesson, L.; Lindstrom, V.; Castren, M.; Niemi-Murola, L.; Falk, A. -C. (2016)
    Background: Pain is one of the most common symptoms in the Emergency Department (ED) and is the cause of more than half of the visits to the ED. Several attempts to improve pain management have been done by using, for example, standards/guidelines and education. To our knowledge no one has investigated if and how different actions over a longitudinal period affect the frequency of pain documentation in the ED. Therefore the aim of this study was to describe the frequency of documented pain assessments in the ED. Method: A cross-sectional study during 2006-2012 was conducted. The care of patients with wrist/arm fractures or soft tissue injuries on upper extremities was evaluated. Result: Despite various actions our result shows that mandatory pain assessment in the patient's computerized medical record was the only successful intervention to improve the frequencies of documentation of pain assessment during care in the ED. During the study period, no documentation of reassessment of pain was found despite the fact that all patients received pain medication. Conclusion: To succeed in increasing the frequency of documented pain assessment, mandatory pain rating is a successful action. However, the re-evaluation of documented pain assessment was nonexisting. (C) 2016 Elsevier Ltd. All rights reserved.
  • Virkki, Tuija; Venäläinen, Satu (2020)
    Online discussions are rife with fear-evoking images and meaning making that highlight a perceived threat to the security of European nations and their inhabitants posed by migrants’ violence in the wake of increased immigration. This paper examines the role of emotions in shaping anti-immigration views as a response to the threat of violence attached to migrants in online conversations. Using a dataset of Finnish online discussion threads from 2015 to 2017 that were prompted by extensive media attention paid to various cases of violent crime in which migrants were suspects, we particularly analyse the affective dynamics of interpellation processes wherein discussants are invited to adopt anti-immigration orientations. This analysis demonstrates how emotions such as fear, hate, and love function together in complex ways to constitute and shift meanings constructed during these discussions. These processes afford the construction and adoption of affectively appealing identities that are based on the re-signification of anti-immigration orientations as morally and socially acceptable, such as ‘normal citizen’ and ‘caring parent’. The analysis thus provides insight into processes in which ‘ordinary’ citizens hear, and respond to the call for xenophobic positions, thereby illustrating how a sense of community and caring for a community is built within these affective processes.
  • Mattila, Tiina; Vasankari, Tuula; Rissanen, Harri; Knekt, Paul; Puukka, Pauli; Heliövaara, Markku (2018)
    Chronic obstructive pulmonary disease (COPD) has been associated with coronary mortality. Yet, data about the association between COPD and acute myocardial infarction (MI) remain scarce. We aimed to study airway obstruction as a predictor of MI and coronary mortality among 5576 Finnish adults who participated in a national health examination survey between 1978 and 1980. Subjects underwent spirometry, had all necessary data, showed no indications of cardiovascular disease at baseline, and were followed up through record linkage with national registers through 2011. The primary outcome consisted of a major coronary event-that is, hospitalization for MI or coronary death, whichever occurred first. We specified obstruction using the lower limit of normal categorization. Through multivariate analysis adjusted for potential confounding factors for coronary heart disease, hazard ratios (HRs) (with the 95% confidence intervals in parentheses) of a major coronary event, MI, and coronary death reached 1.06 (0.79-1.42), 0.84 (0.54-1.31), and 1.40 (1.04-1.88), respectively, in those with obstruction compared to others. However, in women aged 30-49 obstruction appeared to predict a major coronary event, where the adjusted HR reached 4.21 (1.73-10.28). In conclusion, obstruction appears to predict a major coronary event in younger women only, whereas obstruction closely associates with the risk of coronary death independent of sex and age.
  • Jones, Marjaana; Pietilä, Ilkka Veikko (2020)
    Health policies and strategies promote the involvement of people with illness experiences in service development and production, integrating them into settings that have traditionally been domains of health professionals. In this study, we focus on the perspectives of people with personal illness experiences and explore how they justify involvement, position themselves as legitimate actors and forge collaborative relationships with health professionals. We have used discourse analysis in analysing individual interviews conducted with peer support workers and experts by experience (n = 17) who currently work in Finnish health services. The interviewees utilised discourses of empowerment, efficiency and patient-centeredness, aligning themselves with the justifications constructed by patient movements additionally to those found in current health policies. Both groups wanted to retain critical distance from professionals in order to voice criticisms of current care practices, yet they also frequently aligned themselves with professionals in order to gain legitimacy for their involvement. They adopted professional traits that moved them further from being lay participants sharing personal experiences and adopted an expert position. Although national-level policies provided backing and legitimacy for involvement, the lack of local-level guidance could hinder the practical implementation and make involvement largely dependent of professionals' discretion.
  • Palojoki, Sari; Makela, Matti; Lehtonen, Lasse; Saranto, Kaija (2017)
    The aim of this study was to analyse electronic health record-related patient safety incidents in the patient safety incident reporting database in fully digital hospitals in Finland. We compare Finnish data to similar international data and discuss their content with regard to the literature. We analysed the types of electronic health record-related patient safety incidents that occurred at 23 hospitals during a 2-year period. A procedure of taxonomy mapping served to allow comparisons. This study represents a rare examination of patient safety risks in a fully digital environment. The proportion of electronic health record-related incidents was markedly higher in our study than in previous studies with similar data. Human-computer interaction problems were the most frequently reported. The results show the possibility of error arising from the complex interaction between clinicians and computers.
  • Dimitri, Paul; Fernandez-Luque, Luis; Banerjee, Indraneel; Bergada, Ignacio; Calliari, Luis Eduardo; Dahlgren, Jovanna; de Arriba, Antonio; Lapatto, Risto; Reinehr, Thomas; Senniappan, Senthil; Thomas-Teinturier, Cecile; Tsai, Meng-Che; Zaini, Azriyanti Anuar; Bagha, Merat; Koledova, Ekaterina (2021)
    Background: The use of technology to support health and health care has grown rapidly in the last decade across all ages and medical specialties. Newly developed eHealth tools are being implemented in long-term management of growth failure in children, a low prevalence pediatric endocrine disorder. Objective: Our objective was to create a framework that can guide future implementation and research on the use of eHealth tools to support patients with growth disorders who require growth hormone therapy. Methods: A total of 12 pediatric endocrinologists with experience in eHealth, from a wide geographical distribution, participated in a series of online discussions. We summarized the discussions of 3 workshops, conducted during 2020, on the use of eHealth in the management of growth disorders, which were structured to provide insights on existing challenges, opportunities, and solutions for the implementation of eHealth tools across the patient journey, from referral to the end of pediatric therapy. Results: A total of 815 responses were collected from 2 questionnaire-based activities covering referral and diagnosis of growth disorders, and subsequent growth hormone therapy stages of the patient pathway, relating to physicians, nurses, and patients, parents, or caregivers. We mapped the feedback from those discussions into a framework that we developed as a guide to integration of eHealth tools across the patient journey. Responses focused on improved clinical management, such as growth monitoring and automation of referral for early detection of growth disorders, which could trigger rapid evaluation and diagnosis. Patient support included the use of eHealth for enhanced patient and caregiver communication, better access to educational opportunities, and enhanced medical and psychological support during growth hormone therapy management. Given the potential availability of patient data from connected devices, artificial intelligence can be used to predict adherence and personalize patient support. Providing evidence to demonstrate the value and utility of eHealth tools will ensure that these tools are widely accepted, trusted, and used in clinical practice, but implementation issues (eg, adaptation to specific clinical settings) must be addressed. Conclusions: The use of eHealth in growth hormone therapy has major potential to improve the management of growth disorders along the patient journey. Combining objective clinical information and patient adherence data is vital in supporting decision-making and the development of new eHealth tools. Involvement of clinicians and patients in the process of integrating such technologies into clinical practice is essential for implementation and developing evidence that eHealth tools can provide value across the patient pathway.
  • Kiiski, A.; Airaksinen, M.; Mäntylä, A.; Desselle, S.; Kumpusalo-Vauhkonen, A.; Järvensivu, T.; Pohjanoksa-Mäntylä, M. (2019)
    Background Collaborative medication review (CMR) practices for older adults are evolving in many countries. Development has been under way in Finland for over a decade, but no inventory of evolved practices has been conducted. The aim of this study was to identify and describe CMR practices in Finland after 10 years of developement. Methods An inventory of CMR practices was conducted using a snowballing approach and an open call in the Finnish Medicines Agency's website in 2015. Data were quantitatively analysed using descriptive statistics and qualitatively by inductive thematic content analysis. Clyne et al's medication review typology was applied for evaluating comprehensiveness of the practices. Results In total, 43 practices were identified, of which 22 (51%) were designed for older adults in primary care. The majority (n = 30, 70%) of the practices were clinical CMRs, with 18 (42%) of them being in routine use. A checklist with criteria was used in 19 (44%) of the practices to identify patients with polypharmacy (n = 6), falls (n = 5), and renal dysfunction (n = 5) as the most common criteria for CMR. Patients were involved in 32 (74%) of the practices, mostly as a source of information via interview (n = 27, 63%). A medication care plan was discussed with the patient in 17 practices (40%), and it was established systematically as usual care to all or selected patient groups in 11 (26%) of the practices. All or selected patients' medication lists were reconciled in 15 practices (35%). Nearly half of the practices (n = 19, 44%) lacked explicit methods for following up effects of medication changes. When reported, the effects were followed up as a routine control (n = 9, 21%) or in a follow-up appointment (n = 6, 14%). Conclusions Different MRs in varying settings were available and in routine use, the majority being comprehensive CMRs designed for primary outpatient care and for older adults. Even though practices might benefit from national standardization, flexibility in their customization according to context, medical and patient needs, and available resources is important.
  • Tolvi, Morag; Mattila, Kimmo; Haukka, Jari; Aaltonen, Leena-Maija; Lehtonen, Lasse (2020)
    Background: The weekend effect, the phenomenon of patients admitted at the weekend having a higher mortality risk, has been widely investigated and documented in both elective and emergency patients. Research on the issue is scarce in Europe, with the exception of the United Kingdom. We examined the situation in Helsinki University Hospital over a 14-year period from a specialty-specific approach. Materials and methods: We collected the data for all patient visits for 2000-2013, selecting patients with in-hospital care in the university hospital and extracting patients that died during their hospital stay or within 30 days of discharge. These patients were categorized according to urgency of care and specialty. Results: A total of 1,542,230 in-patients (853,268 emergency patients) met the study criteria, with 47,122 deaths in-hospital or within 30 days of discharge. Of 12 specialties, we found a statistically significant weekend effect for in-hospital mortality in 7 specialties (emergency admissions) and 4 specialties (elective admissions); for 30-day post-discharge mortality in 1 specialty (emergency admissions) and 2 specialties (elective admissions). Surgery, internal medicine, neurology, and gynecology and obstetrics were most sensitive to the weekend effect. Conclusions: The study confirms a weekend effect for both elective and emergency admissions in most specialties. Reducing the number of weekend elective procedures may be necessary. More disease-specific research is needed to find the diagnoses most susceptible. (C) 2020 Elsevier B.V. All rights reserved.
  • Pätäri, Jyri-Oskari (Helsingin yliopisto, 2021)
    Tässä maisterintutkielmassa käsitellään suomalaisten lapsiperheiden kokemaa köyhyyttä ja puutetta toisen maailmansodan jälkeen vanhan Hämeen läänin alueella CARE-toiminnan näkökulmasta. Köyhillä lapsiperheillä oli mahdollisuus anoa Yhdysvalloissa asuneilta amerikansuomalaisilta avustuspaketteja, joita kutsuttiin niitä välittävän organisaation mukaisesti CARE-paketeiksi. Tämän kansainvälisen organisaation toimintaa johti Suomessa Suomen Huolto ry. Suomen Huolto toimi vuoteen 1953 asti Suomessa tapahtuneen vapaaehtoisuuteen perustuneen hyväntekeväisyyden keskusjärjestönä, jonka tehtävänä oli organisoida vapaaehtoinen Suomea avustava huoltotyö Suomen rajojen sisä- ja ulkopuolella. Suomen Huolto johti keskuselimenä toimintaa alaisinaan lääninkeskukset ja lääninkeskusten alaiset vapaan huollon keskukset. Vapaan huollon keskukset toimivat kunnan tai kaupungin vapaaehtoisen avustustoiminnan koordinoijina. Tutkimuksessa selvitetään miten suomalaisen köyhän lapsiperheen avustusprosessi eteni yksittäisestä anomuskirjeestä aina avustuksen saamiseen saakka. Tutkimuksessa vastataan tutkimuskysymykseen: ”Millainen oli CARE-avustuksen saanut lapsiperhe?” ja alatutkimuskysymyksiin: ”Millainen oli avustuksen saaneen lapsiperheen rakenne?”, ”Mitkä olivat avustuksen myöntämisen perusteet?”, ”Mikä oli vapaaehtoisen huoltotyön merkitys avustuksen saaneille perheille?”, ”Mikä oli siirtoväen määrä ja merkitys avustusten saaneiden perheiden joukossa?” ja ”Miten avustusorganisaatio toimi?”. Tutkimuskysymykseen vastataan kuvaamalla suomalaisen köyhän lapsiperheen rakenne vanhempien ammatin, lasten lukumäärän, mahdollisten perhettä kohdanneiden sairauksien ja siirtolaisstatuksen tarkkuudella. Tutkimuksen pääasiallisena aineistona on käytetty lähes 800 kotitalouden tietoja vuosien 1946–1948 väliseltä ajalta, joita vertaillaan maaseudun ja kaupunkien välillä. Materiaali koostuu erilaisista yksityisten perheiden kirjoittamista kirjeistä ja vapaan huollon keskusten tekemistä luetteloista, joiden perusteella Suomen Huolto on myöntänyt CARE-paketteja. Kyseisen avustuksen tärkein peruste on ollut suuri alaikäisten lasten lukumäärä. Tutkimuksen tärkeimpänä johtopäätöksenä on lapsiperheiden tukemisen ja avustamisen tärkeys niin yksittäisen perheen subjektiivisen köyhyyden tunteen lievittämisessä kuin valtakunnallisen sosiaalipolitiikan pitkäjänteisessä kehittämisessä. Suomalainen sosiaalipolitiikka painottui sotien jälkeisenä aikana nimenomaan perhepolitiikkaan pyrkien vähentämään köyhyyden ylisukupolvisuutta. Sotatilan aiheuttama valtakunnallinen köyhyys loi toimintakentän vapaaehtoiselle huoltotyölle, joka konkretisoitui myöhemmin 1950-luvun jälkeen tapahtuneessa hyvinvointivaltiokehityksessä.
  • FIDELITY Finnish Degenerative Meni; Sihvonen, Raine; Paavola, Mika; Malmivaara, Antti; Itälä, Ari; Joukainen, Antti; Kalske, Juha; Nurmi, Heikki; Kumm, Jaanika; Sillanpää, Niko; Kiekara, Tommi; Turkiewicz, Aleksandra; Toivonen, Pirjo; Englund, Martin; Taimela, Simo; Järvinen, Teppo L. N. (2020)
    Objectives To assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up. Design Multicentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial. Setting Orthopaedic departments in five public hospitals in Finland. Participants 146 adults, mean age 52 years (range 35-65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised. Interventions APM or placebo surgery (diagnostic knee arthroscopy). Main outcome measures We used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade >= 1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function ( Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale). Results There was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade >= 1 of 13%, 95% CI -2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), -1.7 (95% CI -7.7 to 4.3) in WOMET, -2.1 (95% CI -6.8 to 2.6) in Lysholm knee score, and -0.04 (95% CI -0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar. Conclusions APM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.
  • Hirvonen, Outi M.; Leskelä, Riikka-Leena; Gronholm, Lotta; Haltia, Olli; Rissanen, Antti; Tyynela-Korhonen, Kristiina; Rahko, Eeva K.; Lehto, Juho T.; Saarto, Tiina (2019)
    Background: To avoid aggressive treatments at the end-of-life and to provide palliative care (PC), physicians need to terminate futile anti-cancer treatments and define the palliative goal of the treatment in time. This single center study assesses the practices used to make the decision that leads to treatment with a palliative goal, i.e., the PC decision and its effect on anti-cancer treatments at the end of life. Material and methods: Patients with a cancer diagnosis treated in tertiary hospital during 1st January 2013 - 31st December 2014 and deceased by the end of 2014 were identified in the hospital database (N = 2737). Of these patients, 992 were randomly selected for this study. The PC decision was screened from patient records, i.e., termination of cancer-specific treatments and a focus on symptom-centered PC. Results: The PC decision was defined in 82% of the patients during the last year of life (49% >30 days and 33%
  • Janssen, Niels; Handels, Ron L.; Wimo, Anders; Antikainen, Riitta; Laatikainen, Tiina; Soininen, Hilkka; Strandberg, Timo; Tuomilehto, Jaakko; Kivipelto, Miia; Evers, Silvia M. A. A.; Verhey, Frans R. J.; Ngandu, Tiia (2022)
    Background: The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition. Objective: In this exploratory data analysis we investigated the association between cognition, HRQoL utilities and costs in a well-functioning population at risk for cognitive decline. Methods: An exploratory data analysis was conducted using longitudinal 2-year data from the FINGER study (n= 1,120). A change score analysis was applied using HRQoL utilities and total medical care costs as outcome. HRQoL utilities were derived from the Short Form Health Survey-36 (SF-36). Total care costs comprised visits to a general practitioner, medical specialist, nurse, and days at hospital. Analyses were adjusted for activities of daily living (ADL) and depressive symptoms. Results: Although univariable analysis showed an association between cognition and HRQoL utilities, multivariable analysis showed no association between cognition, HRQoL utilities and total care costs. A one-unit increase in ADL limitations was associated with a -0.006 (p Conclusion: The level of cognition in people at-risk for cognitive decline does not seem to be associated with HRQoL utilities. Future research should examine the level at which cognitive decline starts to affect HRQoL and care costs. Ideally, this would be done by means of cross-validation in populations with various stages of cognitive functioning and decline.
  • Ahola, Aila J.; Radzeviciene, Lina; Zaharenko, Linda; Bulum, Tomislav; Skrebinska, Sabine; Prakapiene, Edita; Blaslov, Kristina; Roso, Vinko; Rovite, Vita; Pirags, Valdis; Duvnjak, Lea; Sokolovska, Jelizaveta; Verkauskiene, Rasa; Forsblom, Carol (2020)
    Aims: To investigate the association between depressive symptomatology and health markers in type 1 diabetes. Methods: Four countries from the InterDiane Consortium had adopted the Finnish Diabetic Nephropathy Study protocol, including the Beck Depression Inventory (BDI). Associations between depression symptomatology, diabetes complications (diabetic nephropathy, proliferative retinopathy, major adverse cardiovascular events [MACE]) and vascular risk factors (metabolic syndrome, body mass index, glycaemic control) were investigated. Results: In a sample of 1046 participants (Croatia n = 99; Finland n = 314; Latvia n = 315; Lithuania n = 318), 13.4% displayed symptoms of depression (BDI score 16) with no statistically significant difference in the prevalence of depression among the cohorts. The highest rates of diabetic nephropathy (37.1%) and proliferative retinopathy (36.3%) were observed in Lithuania. The rates of MACE and metabolic syndrome were highest in Finland. In joint analyses, individuals exhibiting depression symptomatology had higher HbA(1c) (79 vs. 72 mmol/mol, p <0.001) and higher triglyceride concentration (1.67 vs. 1.28 mmol/l, p <0.001), than those without. In the multivariable model, BDI score was positively associated with the presence of diabetic nephropathy, proliferative retinopathy, MACE, and metabolic syndrome and its triglyceride component. Moreover, BDI score was positively associated with the number of metabolic syndrome components, triglyceride concentration, and HbA(1c). Conclusions: Comorbid depression should be considered a relevant factor explaining metabolic problems and vascular outcomes. Causality cannot be inferred from this crosssectional study. (c) 2020 Elsevier B.V. All rights reserved.
  • Helanterä, Ilkka; Isola, Timo; Lehtonen, Taru K.; Åberg, Fredrik; Lempinen, Marko; Isoniemi, Helena (2019)
    Background: Kidney transplantation is reported to save costs compared to maintenance dialysis. We analyzed the current actual costs of kidney transplantation compared to dialysis, and analyzed risk factors for higher costs after transplantation. Material/Methods: Altogether, 338 kidney transplant recipients between 2009 and 2014 were included in this study. All individual-level cost data from specialized health care and data from all reimbursed medication and travel costs were acquired from official records. Cost data were compared before and after transplantation within the same patients starting from dialysis initiation and continued until the end of follow-up at the end of 2015. Results: Total annual costs were median 53 275 EUR per patient in dialysis, 59 583 EUR for the first post-transplantation year (P Conclusions: After the first posttransplant year the costs of a kidney transplant patient for the health care system are