Browsing by Subject "Comorbidity"

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  • Junkkari, A.; Sintonen, H.; Danner, N.; Jyrkkänen, H. K.; Rauramaa, T.; Luikku, A. J.; Koivisto, A. M.; Roine, R. P.; Viinamäki, H.; Soininen, H.; Jääskeläinen, J. E.; Leinonen, V. (2021)
    Background Health-related quality of life (HRQoL) is severely impaired in persons with idiopathic normal pressure hydrocephalus (iNPH). The HRQoL improves in a number of patients after the placement of a cerebrospinal fluid (CSF) shunt, but long-term follow-up of HRQoL is rare. Methods Extended follow-up (60 months) of a prospective cohort study involving 189 patients with iNPH who underwent shunt surgery. Preoperative variables were used to predict favorable HRQoL outcome (improvement or non-deterioration) measured by the 15D instrument 5 years after shunting. Results Out of the 189 initially enrolled study participants, 88 had completed 5-year HRQoL follow-up (46%), 64 had died (34%), and 37 (20%) failed to complete the HRQoL follow-up but were alive at the end of the study. After initial post-operative HRQoL improvement, HRQoL deteriorated so that 37/88 participants (42%) had a favorable HRQoL outcome 5 years after shunting. Multivariate binary logistic regression analysis indicated that younger age (adjusted OR 0.86, 95% CI 0.77-0.95; p <0.005), lower body mass index (adjusted OR 0.87, 95% CI 0.77-0.98; p <0.05) and better Mini-Mental State Examination performance (adjusted OR 1.16, 95% CI 1.01-1.32; p <0.05) before surgery predicted favorable 5-year outcome. Conclusions This extended follow-up showed that the self-evaluated HRQoL outcome is associated with iNPH patients' pre-operative cognitive status, overweight and age. The post-operative deterioration may reflect the natural progression of iNPH, but also derive from aging and comorbidities. It indicates a need for long-term follow-up.
  • Eriksson, Mia D.; Eriksson, Johan G.; Kautiainen, Hannu; Salonen, Minna K.; Mikkola, Tuija M.; Kajantie, Eero; Wasenius, Niko; von Bonsdorff, Mikaela; Laine, Merja K. (2021)
    Background: Millions of people live with depression and its burden of disease. Depression has an increased comorbidity and mortality that has remained unexplained. Studies have reported connections between advanced glycation end products (AGEs) and various disease processes, including mental health. The present study evaluated associations between AGEs, depressive symptoms, and types of depressive symptoms. Methods: From the Helsinki Birth Cohort Study, 815 participants with a mean age of 76 years were recruited for this cross-sectional study. Characteristics regarding self-reported lifestyle and medical history, as well as blood tests were obtained along with responses regarding depressive symptoms according to the Beck Depression Inventory (BDI) and Mental Health Inventory-5. Each participant had their AGE level measured non-invasively with skin autofluorescence (SAF). Statistical analyses looked at relationships between types of depressive symptoms and AGE levels by sex. Results: Of women, 27% scored >= 10 on the BDI and 18% of men, respectively. Men had higher crude AGE levels (mean [standard deviation], arbitrary units) (2.49 [0.51]) compared to women (2.33 [0.46]) (p < 0.001). The highest crude AGE levels were found in those with melancholic depressive symptoms (2.61 [0.57]), followed by those with non-melancholic depressive symptoms (2.45 [0.45]) and those with no depressive symptoms (2.38 [0.49]) (p = 0.013). These findings remained significant in the fully adjusted model. Conclusions: The current study shows an association between depressive symptoms and higher AGE levels. The association is likely part of a multi-factorial effect, and hence no directionality, causality, or effect can be inferred solely based on the results of this study.
  • Koskentausta, Terhi; Koski, Anniina; Tani, Pekka (2018)
  • Levola, Jonna; Aalto, Mauri (2019)
  • Rintala, Risto; Pakarinen, Mikko (2020)
    Anorektumin epämuodostumat ovat tavallisimpia suoliston synnynnäisiä epämuodostumia, jotka vaihtelevat peräaukon lievästä virhesijainnista vaikeisiin monianomalioihin. Niiden yleisyys Suomessa on 1/2 500 elävänä syntynyttä, ja 65 %:lla potilaista todetaan liitännäisanomalioita. Lievät anorektumin kehityshäiriöt hoidetaan ensisijaisesti laajentamalla tai yksinkertaisella anoplastialla, mutta vaikeimmissa epämuodostumissa potilaille joudutaan tekemään monimutkaisia rekonstruktioita avannesuojassa. Lievissä tapauksissa suolen toiminnallinen ennuste on erinomainen. Vaikeammissa tapauksissa merkittävälle osalle potilaista jää suolen pysyvä toimintahäiriö, johon voi liittyä virtsateiden ja sukuelinten toiminnallisia ongelmia sekä heikentynyt elämänlaatu. Potilaiden onnistunut hoito edellyttää asiantuntevaa seurantaa ja tukitoimia läpi koko lapsuusiän, ja niiden tulisi jatkua aikuislääketieteen piiriin siirtymisen jälkeenkin.
  • Karpov, B.; Joffe, G.; Aaltonen, K.; Suvisaari, J.; Baryshnikov, I.; Naatanen, P.; Koivisto, M.; Melartin, T.; Oksanen, J.; Suominen, K.; Heikkinen, M.; Paunio, T.; Isometsa, E. (2016)
    Background: Comorbid anxiety symptoms and disorders are present in many psychiatric disorders, but methodological variations render comparisons of their frequency and intensity difficult. Furthermore, whether risk factors for comorbid anxiety symptoms are similar in patients with mood disorders and schizophrenia spectrum disorders remains unclear. Methods: The Overall Anxiety Severity and Impairment Scale (OASIS) was used to measure anxiety symptoms in psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n = 113), bipolar disorder (BD, n = 99), or depressive disorder (DD, n = 188) in the Helsinki University Psychiatric Consortium Study. Bivariate correlations and multivariate linear regression models were used to examine associations of depressive symptoms, neuroticism, early psychological trauma and distress, self-efficacy, symptoms of borderline personality disorder, and attachment style with anxiety symptoms in the three diagnostic groups. Results: Frequent or constant anxiety was reported by 40.2% of SSA, 51.5% of BD, and 55.6% of DD patients; it was described as severe or extreme by 43.8%, 41.4%, and 41.2% of these patients, respectively. SSA patients were significantly less anxious (P = 0.010) and less often avoided anxiety-provoking situations (P = 0.009) than the other patients. In regression analyses, OASIS was associated with high neuroticism, symptoms of depression and borderline personality disorder and low self-efficacy in all patients, and with early trauma in patients with mood disorders. Conclusions: Comorbid anxiety symptoms are ubiquitous among psychiatric patients with mood or schizophrenia spectrum disorders, and in almost half of them, reportedly severe. Anxiety symptoms appear to be strongly related to both concurrent depressive symptoms and personality characteristics, regardless of principal diagnosis. (C) 2016 Elsevier Masson SAS. All rights reserved.
  • Sarparanta, Saana (Helsingin yliopisto, 2015)
    Objective: Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD) are serious psychiatric disorders highly prevalent in clinical settings, characterized by multiple forms of distress, functional decline, and increased risk of suicide. MDD and BPD often co-occur and the co-occurrence of the disorders is associated with the course of MDD. Early Maladaptive Schemas (EMSs) refer to maladaptive internalized representations of the self in relation to others that develop early in life. EMSs are associated with depressive and BPD symptomatology and symptom severity. However, the associations between EMSs and psychiatric comorbidity have rarely been studied. The aim of the present study was to provide new insight into the comorbidity of BPD and MDD by focusing on the associations between EMSs and BPD symptomatology among depressed inpatient population. Methods: The sample consisted of 43 adult inpatients (29 women and 14 men). BPD symptomatology was measured via Structured Clinical Interview for DSM-III-R Personality Disorders and EMSs via Young Schema Questionnaire-S2-Extended self-report questionnaires. A three-level linear regression model was created to predict self-reported BPD symptomatology: In level 1, linear regression analysis was conducted for each individual EMS separately, EMSs entered as predictors for BPD symptomatology. In level 2, gender, age, education level and employment status were added to the model as covariates. In level 3, also current level of depressive symptoms measured via Center for Epidemiological Studies Depression Scale was added to the model as a covariate. Results and conclusions: Higher scores on 10 of the 18 EMSs were significantly positively associated with elevated self-reported BPD symptomatology. However, only one EMS, Unrelenting Standards and Hypercriticalness, was independently positively associated with self-reported BPD symptomatology and explained variance over the effect of current depressive symptom state, gender, age, education level and employment status. According to the findings of the present study, Unrelenting Standards and Hypercriticalness may act a specific cognitive risk factor for elevated BPD symptomatology and symptom severity among depressed individuals.
  • Mäntylä, Jarkko; Mazur, Witold; Törölä, Tanja; Bergman, Paula; Saarinen, Tuomas; Kauppi, Paula (2019)
    Background: By definition bronchiectasis (BE) means destructed structure of normal bronchus as a consequence of frequent bacterial infections and inflammation. In many senses, BE is a neglected orphan disease. A recent pan-European registry study, EMBARC, has been set up in order to better understand its pathophysiology, better phenotype patients, and to individualize their management. Aim: To examine the aetiology and co-morbidity of BE in the capital area in Finland. Methods: Two hundred five patients with BE diagnosis and follow up visits between 2016 and 2017 in Helsinki University Hospital were invited to participate in the study. Baseline demographics, lung functions, imaging, microbiological, and therapeutic data, together with co-morbidities were entered into EMBARC database. Clinical characteristics, aetiologic factors, co-morbidities, and risk factors for extensive BE were explored. Results: To the study included 95 adult patients and seventy nine percent of the BE patients were women. The mean age was 69 years (SD +/- 13). Asthma was a comorbid condition in 68% of the patients but in 26% it was estimated to be the cause of BE. Asthma was aetiological factor for BE if it had been diagnosed earlier than BE. As 41% BE were idiopathic, in 11% the disorder was postinfectious and others were associated to rheumatic disease, Alpha-1-antitrypsin deficiency, IgG deficiency and Kartagener syndrome. The most common co-morbidities in addition to asthma were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (15%), and immunodeficiency (12%). Extensive BE was found in 68% of BE patients in whom four or more lobes were affected. Risk factors for extensive BE were asthma (OR 2.7), asthma as aetiology for BE (OR 4.3), and rhinosinusitis (OR 3.1). Conclusions: Asthma was associated to BE in 68% and it was estimated as aetiology in every fourth patient. However, retrospectively, it is difficult to exclude asthma as a background cause in patients with asthma-like symptoms and respiratory infections. We propose asthma as an aetiology factor for BE if it is diagnosed earlier than BE. Asthma and rhinosinusitis were predictive for extensive BE.
  • Salmela, Liisa; Kuula, Liisa; Merikanto, Ilona; Räikkönen, Katri; Pesonen, Anu-Katriina (2019)
    Objective: Diagnosed autism spectrum disorders have been associated with a high prevalence of sleep problems, other psychiatric disorders and social deficits in adolescence. However, little is known about the possible connection between subclinical autistic traits and sleep. This study explored whether adolescents with elevated levels of subclinical autistic traits are at heightened risk for sleep problems. Methods: This study used data from the community cohort born in 1998. The sample consisted of 157 (57% girls) 17-year-old adolescents. Autistic traits were assessed using the Autism Spectrum Quotient (AQ). The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the Adult ADHD Self-Report Scale were utilized to control for comorbid psychiatric symptoms. Sleep was measured with actigraphy and sleep quality was self-rated using the Pittsburgh Sleep Quality Index (PSQI). Associations between autistic traits and sleep were examined using logistic regression analysis. Results: Elevated levels of autistic traits were significantly associated with shorter weekday sleep duration. Moreover, autistic traits remained an independent predictor of short sleep duration when comorbid psychiatric symptoms were controlled for (OR 1.14; 95% CI: 1.03-1.26). Conclusions: The results suggest that subclinical autistic traits should be considered as a possible underlying mechanism affecting adolescent sleep. (c) 2018 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (
  • Jokinen, T. S.; Tiira, K.; Metsähonkala, L.; Seppala, E. H.; Hielm-Bjorkman, A.; Lohi, H.; Laitinen-Vapaavuori, O. (2015)
    BackgroundLagotto Romagnolo (LR) dogs with benign juvenile epilepsy syndrome often experience spontaneous remission of seizures. The long-term outcome in these dogs currently is unknown. In humans, behavioral and psychiatric comorbidities have been reported in pediatric and adult-onset epilepsies. Hypothesis/ObjectivesThe objectives of this study were to investigate possible neurobehavioral comorbidities in LR with a history of benign familial juvenile epilepsy (BFJE) and to assess the occurrence of seizures after the remission of seizures in puppyhood. AnimalsA total of 25 LR with a history of BFJE and 91 control dogs of the same breed. MethodsOwners of the LR dogs in the BFJE and control groups completed an online questionnaire about each dog's activity, impulsivity, and inattention. Principal component analysis (PCA) served to extract behavioral factors from the data. We then compared the scores of these factors between the 2 groups in a retrospective case-control study. We also interviewed all dog owners in the BFJE group by telephone to inquire specifically about possible seizures or other neurological problems after remission of seizures as a puppy. ResultsLagotto Romagnolo dogs with BFJE showed significantly higher scores on the factors Inattention and Excitability/Impulsivity than did the control group (P=.003; P=.021, respectively). Only 1 of the 25 BFJE LR exhibited seizures after remission of epilepsy in puppyhood. Conclusions and Clinical ImportanceAlthough the long-term seizure outcome in BFJE LR seems to be good, the dogs exhibit behavioral abnormalities resembling attention deficit hyperactivity disorder (ADHD) in humans, thus suggesting neurobehavioral comorbidities with epilepsy.
  • Bartels, Meike; Hendriks, Anne; Mauri, Matteo; Krapohl, Eva; Whipp, Alyce; Bolhuis, Koen; Conde, Lucia Colodro; Luningham, Justin; Ip, Hill Fung; Hagenbeek, Fiona; Roetman, Peter; Gatej, Raluca; Lamers, Audri; Nivard, Michel; van Dongen, Jenny; Lu, Yi; Middeldorp, Christel; van Beijsterveldt, Toos; Vermeiren, Robert; Hankemeijer, Thomas; Kluft, Cees; Medland, Sarah; Lundstrom, Sebastian; Rose, Richard; Pulkkinen, Lea; Vuoksimaa, Eero; Korhonen, Tellervo; Martin, Nicholas G.; Lubke, Gitta; Finkenauer, Catrin; Fanos, Vassilios; Tiemeier, Henning; Lichtenstein, Paul; Plomin, Robert; Kaprio, Jaakko; Boomsma, Dorret I. (2018)
    Childhood aggression and its resulting consequences inflict a huge burden on affected children, their relatives, teachers, peers and society as a whole. Aggression during childhood rarely occurs in isolation and is correlated with other symptoms of childhood psychopathology. In this paper, we aim to describe and improve the understanding of the co-occurrence of aggression with other forms of childhood psychopathology. We focus on the co-occurrence of aggression and other childhood behavioural and emotional problems, including other externalising problems, attention problems and anxiety-depression. The data were brought together within the EU-ACTION (Aggression in Children: unravelling gene-environment interplay to inform Treatment and InterventiON strategies) project. We analysed the co-occurrence of aggression and other childhood behavioural and emotional problems as a function of the child's age (ages 3 through 16years), gender, the person rating the behaviour (father, mother or self) and assessment instrument. The data came from six large population-based European cohort studies from the Netherlands (2x), the UK, Finland and Sweden (2x). Multiple assessment instruments, including the Child Behaviour Checklist (CBCL), the Strengths and Difficulties Questionnaire (SDQ) and Multidimensional Peer Nomination Inventory (MPNI), were used. There was a good representation of boys and girls in each age category, with data for 30,523 3- to 4-year-olds (49.5% boys), 20,958 5- to 6-year-olds (49.6% boys), 18,291 7- to 8-year-olds (49.0% boys), 27,218 9- to 10-year-olds (49.4% boys), 18,543 12- to 13-year-olds (48.9% boys) and 10,088 15- to 16-year-olds (46.6% boys). We replicated the well-established gender differences in average aggression scores at most ages for parental ratings. The gender differences decreased with age and were not present for self-reports. Aggression co-occurred with the majority of other behavioural and social problems, from both externalising and internalising domains. At each age, the co-occurrence was particularly prevalent for aggression and oppositional and ADHD-related problems, with correlations of around 0.5 in general. Aggression also showed substantial associations with anxiety-depression and other internalizing symptoms (correlations around 0.4). Co-occurrence for self-reported problems was somewhat higher than for parental reports, but we found neither rater differences, nor differences across assessment instruments in co-occurrence patterns. There were large similarities in co-occurrence patterns across the different European countries. Finally, co-occurrence was generally stable across age and sex, and if any change was observed, it indicated stronger correlations when children grew older. We present an online tool to visualise these associations as a function of rater, gender, instrument and cohort. In addition, we present a description of the full EU-ACTION projects, its first results and the future perspectives.
  • Laakso, Sini M.; Myllynen, Chris; Strbian, Daniel; Atula, Sari (2021)
    Background: The effect of comorbidities on the prognosis of myasthenia gravis (MG) remains unclear. In particular, the role of other autoimmune diseases (AD) is controversial. Methods: In this retrospective single-center cohort study, we investigated 154 consecutive generalized thymectomized MG patients, with a mean follow-up time of 8.6 (+/- 5.0) years post-thymectomy. Comorbidities diagnosed at any timepoint were retrieved from medical records and Charlson comorbidity index (CCI) scores were calculated. Patients were categorized into subgroups MG alone (n = 45) and MG with any comorbidity (n = 109); the latter was further categorized into MG with other ADs (n = 33) and MG with non-AD comorbidities (n = 76). The endpoints analyzed were complete stable remission (CSR), minimal need for medications, and need for inhospital treatments. Results: CSR was more frequent in MG alone than in MG with any comorbidity group (26.7% vs 8.3%, p = 0.004). Minimal need for medication was reached more often in the MG alone than in the MG with non-AD comorbidities group (p = 0.047). Need for in-hospital treatments was lower in the MG alone group than in MG patients with any comorbidity (p = 0.046). Logistic regression analysis revealed that lower CCI scores increased the likelihood of CSR (p = 0.033). Lower CCI scores were more prevalent both in patients with minimal need for medication and in patients who did not need in-hospital treatments (p < 0.001). Conclusions: Patients with generalized MG and comorbidities have a poorer prognosis than patients with MG alone during almost 9 years follow-up after thymectomy. AD comorbidities appeared not to translate into a higher risk compared to other comorbidities.
  • Ortiz, Rebekka M.; Scheperjans, Filip; Mertsalmi, Tuomas; Pekkonen, Eero (2019)
    Background Cervical dystonia (CD) is the most common form of dystonia. The onset of CD is usually before 60 years of age and it may cause severe functional and psychosocial impairment in everyday life. Recently non-motor symptoms have been reported to occur in CD substantially affecting the quality of life. Methods/patients We studied comorbidities of patients with primary focal CD in Finland based on ICD-10 codes obtained from the care registry and patient records of 937 confirmed adult isolated focal CD patients between the years 2007-2016. The retirement months and diagnosis of retirement were calculated from pension registry information. The results were compared with 3746 age and gender-matched controls. Results Most prominent comorbidities with primary focal CD were depression (14%), anxiety (7%), and back pain (11%). The retirement age was significantly younger in CD patients compared to control group controls (59.0 years, 95% CI 58.5-59.5 vs. 61.7 years, 95% CI 61.6-61.9) years, p <0.001). For dystonia patients the most common diagnoses for retirement due to sickness were dystonia (51%), depression (14%), and anxiety (8%). Patients with anxiety and depression retired earlier than other dystonia patients. Discussion Cervical dystonia considerably reduces working ability and leads to earlier retirement. Anxiety and depression are most notable comorbidities and their co-occurrence further reduces working ability. Our results suggest that more health care resources should be administered in treatment of CD to longer maintain working ability of CD patients. Further, psychiatric comorbidities should be taken into consideration in CD treatment.
  • Kieseppä, Valentina; Holm, Minna; Jokela, Markus; Suvisaari, Jaana; Gissler, Mika; Lehti, Venla (2021)
    Background: The aims of this study were to (1) compare differences in psychiatric comorbidity of depression and anxiety disorders between immigrants and native Finns and to (2) compare differences in the intensity of psychiatric care received by different immigrant groups and Finnish-born controls with depression and/or anxiety disorders. Methods: The study uses registered-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression and/or an anxiety disorder during the follow-up (2011?2015) (immigrants n = 6542, Finnish-born controls n = 9281). We compared differences in comorbidity between the immigrants and the Finnish-born controls using chi-squared tests. Multinomial logistic regression was used to predict psychiatric treatment intensity by immigrant status, region of origin, and other background factors. Results: In both diagnosis groups, Finnish-born participants exhibited greater comorbidity of other psychiatric disorders. Immigrants more often received lower intensity treatment and less often higher intensity treatment. These differences were most striking among those from Eastern Europe, the Middle East, and Africa. Limitations: We did not have the information on the perceived need for the services, which limits us from drawing further conclusions about the mechanisms behind the observed patterns. Conclusions: Immigrants in Finland receive less intensive treatment for depression and anxiety disorders compared to the Finnish-born population. Since lower symptom levels can unlikely alone explain these differences, they could reflect a need for improvement in the psychiatric services for immigrants.
  • Saavalainen, Liisu; Lassus, Heini; Härkki, Päivi; Tiitinen, Aila; Pukkala, Eero; Heikinheimo, Oskari (2021)
    Aiempien tutkimusten mukaan endometrioosia sairastavien naisten kokonaissyöpäriski ei poikkea muista samanikäisistä naisista. Munasarjasyöpää, kilpirauhassyöpää ja ihomelanoomaa on todettu hieman useammin ja kohdunkaulasyöpää esiastemuutoksineen hieman harvemmin kuin muilla naisilla. Uuden suomalaistutkimuksen perusteella näyttää siltä, että suurentunut munasarjasyöpäriski liittyy vain munasarjan endometrioosiin.
  • Kämppi, Leena; Rainesalo, Sirpa; Roivainen, Reina (2020)
    Epilepsiapotilaat ohjautuvat päivystykseen ensimmäisen, pitkittyneen, tiheästi toistuvan tai komplisoituneen kohtauksensa vuoksi. Nopea ja oikein kohdennettu hoito parhaassa tapauksessa estää kohtauksen vaikeutumisen status epilepticukseksi. Hoitoketjun eri vaiheiden saumaton eteneminen selkeän hoitoprotokollan mukaan on pitkittyneen epilepsiakohtauksen saaneen potilaan ennusteen kannalta keskeistä. Viiveettömän hoidon toteutuksen lisäksi lääkehoidon valinnassa tulisi huomioida epilepsian ja pitkittyneen kohtauksen tyyppi, etiologia ja niihin liittyvät epävarmuustekijät. Aikuispotilaiden osalta korostuvat liitännäissairaudet, niihin liittyvät hoidot ja kohtaustilanteen vaikeutumisen muut syyt. Vaikeassa kohtaustilanteessa epileptologisen yksikön konsultoiminen on tarpeen. Jos potilaan status epilepticus on vaikeahoitoinen, konsultaation tulisi toteutua kiireellisesti. Päivystyspisteiden osuus on merkittävä paitsi viiveettömässä kohtausten hoidossa myös jatkohoidon toteutuksessa ja ohjauksessa.
  • Rissanen, Antti; Herse, Fredrik; Rossi, Jari; Säävuori, Niina; Roine, Risto O.; Pakarinen, Sami (2021)
    Lähtökohdat : Suoria antikoagulantteja ja varfariinia käytetään ei-läppäperäiseen eteisvärinään liittyvän aivohalvauksen estossa, mutta toistaiseksi eri antikoagulaatiolääkityksellä olevista suomalaisista potilaista on rajallisesti tosielämän tietoon perustuvia tutkimuksia. Menetelmät : utkimme rekisteritiedolla antikoagulaatiohoitoa saavien eteisvärinäpotilaiden palvelukäyttöä, lääkitystä sekä potilasprofiilia. Tarkastelimme lääkesegmenteittäin sosiaali- ja terveyspalvelujen käyttöä ja kustannuksia sekä aivotapahtumista ja ruoansulatuskanavan vuodoista johtuvia erikoissairaanhoidon ja ¬perusterveydenhuollon käyntejä ja hoitopäiviä potilailla, jotka olivat käyttäneet vähintään vuoden ¬samaa antikoagulanttia. Tulokset : Varfariinia ja apiksabaania määrätään keskimäärin vanhemmille ja korkeamman riskin potilaille kuin muita antikoagulantteja. Eteisvärinäpotilaiden yhteenlasketut sote-palveluiden kustannukset olivat vuonna 2018 noin 2 miljardia euroa. Haittatapahtumista aivoinfarktit ja aivotapahtumien jälkitilat aiheuttivat eteisvärinä¬potilaille eniten palvelukäyttöä. Päätelmät : Eteisvärinäpotilaiden hoidosta kertyy yhteiskunnalle suuria kustannuksia. Suoria antikoagulantteja ja varfariinia käyttävien potilaiden välillä on eroja potilasprofiilissa sekä palvelukäytössä ja sen kustannuksissa.
  • Riihimaki, K.; Sintonen, H.; Vuorilehto, M.; Jylhä, P.; Saarni, S.; Isometsa, E. (2016)
    Background: Depressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear. Methods: In a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n = 3707) at five years. Results: Depression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory [BDI]) and HRQoL was very strong (r = -0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms. Conclusions: Among depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent. (C) 2016 Elsevier Masson SAS. All rights reserved.
  • Sutinen, Jussi; Leppä, Sirpa; Tarkkanen, Maija (2016)
  • Winell, Klas; Mikkola, Ilona; Kuronen, Risto; Liira, Helena (2019)
    Hoitosuunnitelma antaa potilaalle mahdollisuuden osallistua hoidon suunnitteluun. Se parantaa pitkäaikais¬sairauksien hoitotuloksia. Hoitosuunnitelmassa luodaan selkeä kuva siitä, mitä hoidoilla yhteisesti tavoitellaan ja miten. Se on oiva väline omahoidon tehostamiseen ja elämäntapamuutosten tukemiseen. Kaikille pitkäaikaissairaille suunnitelma ei ole välttämätön, mutta on tärkeää tunnistaa sitä eniten tarvitsevat. Heille tulee varata riittävästi aikaa hoitosuunnitelmakeskusteluihin.