Browsing by Subject "DEFINITIONS"

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  • Möller, Vidar; Östholm-Balkhed, Åse; Berild, Dag; Fredriksson, Mats; Gottfredsson, Magnus; Holmbom, Martin; Järvinen, Asko; Kristjansson, Mar; Rydell, Ulf; Sonksen, Ute Wolff; Kolmos, Hans Joern; Hanberger, Håkan (2021)
    Background The Nordic countries have comparable nationwide antibiotic resistance surveillance systems and individual antibiotic stewardship programmes. The aim of this study was to assess antibiotic resistance among major pathogens in relation to practice guidelines for hospital antibiotic treatment and antibiotic use in Nordic countries 2010-2018. Methods Antibiotic resistance among invasive isolates from 2010-2018 and aggregated antibiotic use were obtained from the European Centre for Disease Prevention and Control. Hospital practice guidelines were obtained from national or regional guidelines. Results Antibiotic resistance levels among Escherichia coli and Klebsiella pneumoniae were similar in all Nordic countries in 2018 and low compared to the European mean. Guidelines for acute pyelonephritis varied; 2nd generation cephalosporin (Finland), 3rd generation cephalosporins (Sweden, Norway), ampicillin with an aminoglycoside or aminoglycoside monotherapy (Denmark, Iceland and Norway). Corresponding guidelines for sepsis of unknown origin were 2nd (Finland) or 3rd (Sweden, Norway, Iceland) generation cephalosporins, carbapenems, (Sweden) combinations of penicillin with an aminoglycoside (Norway, Denmark), or piperacillin-tazobactam (all Nordic countries). Methicillin-resistant Staphylococcus aureus rates were 0-2% and empirical treatment with anti-MRSA antibiotics was not recommended in any country. Rates of penicillin non-susceptibility among Streptococcus pneumoniae were low (
  • Rank, Cecilie U.; Wolthers, Benjamin O.; Grell, Kathrine; Albertsen, Birgitte K.; Frandsen, Thomas L.; Overgaard, Ulrik M.; Toft, Nina; Nielsen, Ove J.; Wehner, Peder S.; Harila-Saari, Arja; Heyman, Mats M.; Malmros, Johan; Abrahamsson, Jonas; Noren-Nystrom, Ulrika; Tomaszewska-Toporska, Beata; Lund, Bendik; Jarvis, Kirsten B.; Quist-Paulsen, Petter; Vaitkeviciene, Goda E.; Griskevicius, Laimonas; Taskinen, Mervi; Wartiovaara-Kautto, Ulla; Lepik, Kristi; Punab, Mari; Jonsson, Olafur G.; Schmiegelow, Kjeld (2020)
    PURPOSE Asparaginase-associated pancreatitis (AAP) is common in patients with acute lymphoblastic leukemia (ALL), but risk differences across age groups both in relation to first-time AAP and after asparaginase re-exposure have not been explored. PATIENTS AND METHODS We prospectively registered AAP (n = 168) during treatment of 2,448 consecutive ALL patients aged 1.0-45.9 years diagnosed from July 2008 to October 2018 and treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol. RESULTS Compared with patients aged 1.0-9.9 years, adjusted AAP hazard ratios (HRa) were associated with higher age with almost identical HRa (1.6; 95% CI, 1.1 to 2.3; P = .02) for adolescents (10.0-17.9 years) and adults (18.0-45.9 years). The day 280 cumulative incidences of AAP were 7.0% for children (1.0-9.9 years: 95% CI, 5.4 to 8.6), 10.1% for adolescents (10.0 to 17.9 years: 95% CI, 7.0 to 13.3), and 11.0% for adults (18.0-45.9 years: 95% CI, 7.1 to 14.9; P = .03). Adolescents had increased odds of both acute (odds ratio [OR], 5.2; 95% CI, 2.1 to 13.2; P = .0005) and persisting complications (OR, 6.7; 95% CI, 2.4 to 18.4; P = .0002) compared with children (1.0-9.9 years), whereas adults had increased odds of only persisting complications (OR, 4.1; 95% CI, 1.4 to 11.8; P = .01). Fifteen of 34 asparaginase-rechallenged patients developed a second AAP. Asparaginase was truncated in 17/21 patients with AAP who subsequently developed leukemic relapse, but neither AAP nor the asparaginase truncation was associated with increased risk of relapse. CONCLUSION Older children and adults had similar AAP risk, whereas morbidity was most pronounced among adolescents. Asparaginase re-exposure should be considered only for patients with an anticipated high risk of leukemic relapse, because multiple studies strongly indicate that reduction of asparaginase treatment intensity increases the risk of relapse. (C) 2019 by American Society of Clinical Oncology
  • Kuusela, Pentti I; Saraswat, Mayank; Joenväärä, Sakari; Kaartinen, Johanna; Järvinen, Asko; Renkonen, Risto (2017)
    Blood culture is the primary diagnostic test performed in a suspicion of bloodstream infection to detect the presence of microorganisms and direct the treatment. However, blood culture is slow and time consuming method to detect blood stream infections or separate septic and/or bacteremic patients from others with less serious febrile disease. Plasma proteomics, despite its challenges, remains an important source for early biomarkers for systemic diseases and might show changes before direct evidence from bacteria can be obtained. We have performed a plasma proteomic analysis, simultaneously at the time of blood culture sampling from ten blood culture positive and ten blood culture negative patients, and quantified 172 proteins with two or more unique peptides. Principal components analysis, Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) and ROC curve analysis were performed to select protein(s) features which can classify the two groups of samples. We propose a number of candidates which qualify as potential biomarkers to select the blood culture positive cases from negative ones. Pathway analysis by two methods revealed complement activation, phagocytosis pathway and alterations in lipid metabolism as enriched pathways which are relevant for the condition. Data are available via ProteomeXchange with identifier PXD005022.
  • Marola, Niko; Miranda, Michele; Shanmugalingam, Nageswari (2016)
    The overarching goal of this paper is to link the notion of sets of finite perimeter (a concept associated with N (1,1)-spaces) and the theory of heat semigroups (a concept related to N (1,2)-spaces) in the setting of metric measure spaces whose measure is doubling and supports a 1-Poincar, inequality. We prove a characterization of sets of finite perimeter in terms of a short time behavior of the heat semigroup in such metric spaces. We also give a new characterization of BV functions in terms of a near-diagonal energy in this general setting.
  • Räsänen, Aleksi; Lein, Haakon; Bird, Deanne; Setten, Gunhild (2020)
    Community resilience is often assessed in disaster risk management (DRM) research and it has been argued that it should be strengthened for more robust DRM. However, the term community is seldom precisely defined and it can be understood in many ways. We argue that it is crucial to explore the concept of community within the context of DRM in more detail. We identify three dominating views of conceptualizing community (place-based community, interaction-based community, community of practice and interest), and discuss the relevance of these conceptualizations. We base this discussion on quantitative and qualitative empirical and policy document data regarding flood and storm risk management in Finland, wildfire risk management in Norway and volcanic risk management Iceland. According to our results, all three conceptualizations of community are visible but in differing situations. Our results emphasize the strong role of public sector in DRM in the studied countries. In disaster preparedness and response, a professionalized community of practice and interest appear to be the most prominent within all three countries. The interaction-based community of informal social networks is of less relevance, although its role is more visible in disaster response and recovery. The place-based (local) community is visible in some of the policy documents, but otherwise its role is rather limited. Finally, we argue that the measured resilience of a community depends on how the community is conceptualized and operationalized, and that the measures to strengthen resilience of a particular community should be different depending on what the focal community is.
  • Lankelma, Jacqueline M.; van Vught, Lonneke A.; Belzer, Clara; Schultz, Marcus J.; van der Poll, Tom; de Vos, Willem M.; Wiersinga, W. Joost (2017)
    The intestinal microbiota has emerged as a virtual organ with essential functions in human physiology. Antibiotic-induced disruption of the microbiota in critically ill patients may have a negative influence on key energy resources and immunity. We set out to characterize the fecal microbiota composition in critically ill patients both with and without sepsis and to explore the use of microbiota-derived markers for clinical outcome measurements in this setting. In this prospective observational cohort study we analyzed the fecal microbiota of 34 patients admitted to the intensive care unit. Fifteen healthy subjects served as controls. The fecal microbiota was phylogenetically characterized by 16S rRNA gene sequencing, and associations with clinical outcome parameters were evaluated. A marked shift in fecal bacterial composition was seen in all septic and non-septic critically ill patients compared with controls, with extreme interindividual differences. In 13 of the 34 patients, a single bacterial genus made up > 50% of the gut microbiota; in 4 patients this was even > 75%. A significant decrease in bacterial diversity was observed in half of the patients. No associations were found between microbiota diversity, Firmicutes/Bacteroidetes ratio, or Gram-positive/Gram-negative ratio and outcome measurements such as complications and survival. We observed highly heterogeneous patterns of intestinal microbiota in both septic and non-septic critically ill patients. Nevertheless, some general patterns were observed, including disappearance of bacterial genera with important functions in host metabolism. More detailed knowledge of the short- and long-term health consequences of these major shifts in intestinal bacterial communities is needed.
  • Wikstrom, Miia; Anttila, Heidi; Savinainen, Minna; Kouvonen, Anne; Joensuu, Matti (2020)
    BackgroundThe unemployed have lower work ability and poorer health than the employed. This situation deteriorates when unemployment continues. The long-term unemployed often have co-morbidities and face many other challenges. This increases the need for a multidimensional assessment of work ability and functioning in different service settings. In this study, we describe the development and analyse the content validity of the Abilitator, a self-report questionnaire on work ability and functioning for those in a weak labour market position.MethodsThe Abilitator was developed in 2014-2017. Its construct was assessed by members of academic expert panels (n=30), practical expert panels of professionals (n=700) and target group clients (n=28). The structure and the content of the questionnaire was co-developed in 29 workshops and adjusted twice based on the expert panels' feedback. The Abilitator was also implemented among target group clients (n=3360) in different services and projects. During its development the Abilitator was linked to the International Classification of Functioning, Disability and Health (ICF). The content validation process followed the guidelines recommended by the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel.ResultsThe construct of the Abilitator combines the multidimensional and biopsychosocial models of work ability and functioning. It also includes aspects of social inclusion and employability. It evaluates social, psychological, cognitive and physical functioning, and the ability to cope with everyday life. The content of these concepts was validated by the academic and practical expert panels. The Abilitator's 79 ICF codes covered 57% of the Generic, 77% of the Brief Vocational Rehabilitation, and 8% of the Minimal Environmental ICF Core Sets. When compared with the Work Ability Index (WAI) and the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the direct equivalences of the ICF codes were 36 and 44%, respectively.ConclusionThe Abilitator sufficiently comprehensively covers the relevant aspects to enable the assessment of the overall work ability and functioning of the population in a weak labour market position.
  • Makkonen, Taina; Tirri, Kirsi; Lavonen, Jari (2021)
    Research on the advantages and disadvantages of project-based learning (PBL) among gifted pupils studying physics is scarce. This mixed-methods study investigates engagement, experiences, and learning outcomes among gifted Finnish uppersecondary-level students learning physics through PBL. A six-lesson PBL module on basic Newtonian mechanics was designed and implemented for a group of gifted students (N = 38), whereas a traditional teacher-driven approach was used among a control group (N = 38) of gifted students. Data were collected by means of a questionnaire, interviews and a physics test. According to the results, PBL met the preconditions (challenge, skill, interest) for engaging the students in learning physics. It generated interest in learning among the vast majority, but not as many found it challenging. The findings also highlight the impact of autonomy when learning through PBL. No differences in overall learning outcomes were found between the groups.
  • Coccolini, Federico; Catena, Fausto; Montori, Giulia; Ceresoli, Marco; Manfredi, Roberto; Nita, Gabriela Elisa; Moore, Ernest E.; Biffl, Walter; Ivatury, Rao; Whelan, James; Fraga, Gustavo; Leppaniemi, Ari; Sartelli, Massimo; Di Saverio, Salomone; Ansaloni, Luca (2015)
    Actually the most common indications for Open Abdomen (OA) are trauma, abdominal sepsis, severe acute pancreatitis and more in general all those situations in which an intra-abdominal hypertension condition is present, in order to prevent the development of an abdominal compartment syndrome. The mortality and morbidity rate in patients undergone to OA procedures is still high. At present many studies have been published about the OA management and the progresses in survival rate of critically ill trauma and septic surgical patients. However several issues are still unclear and need more extensive studies. The definitions of indications, applications and methods to close the OA are still matter of debate. To overcome this lack of high level of evidence data about the OA indications, management, definitive closure and follow-up, the World Society of Emergency Surgery (WSES) promoted the International Register of Open Abdomen (IROA). The register will be held on a web platform (Clinical Registers (R)) through a dedicated web site: www. clinicalregisters. org. This will allow to all surgeons and physicians to participate from all around the world only by having a computer and a web connection. The IROA protocol has been approved by the coordinating center Ethical Committee (Papa Giovanni XXIII hospital, Bergamo, Italy).
  • Vepsalainen, K.; Riikonen, P.; Lassila, R.; Arola, M.; Huttunen, P.; Lähteenmäki, P.; Mottonen, M.; Selander, T.; Martikainen, J. (2018)
    AimFor previously untreated patients (PUPs) with severe haemophilia A in Finland for the past 2 decades, the standard practice has been to start early primary prophylaxis. We evaluated the long-term clinical outcomes and costs of treatment with high-dose prophylaxis in PUPs from birth to adolescence, including immune tolerance induction (ITI). MethodsFrom the medical records of all PUPs born between June 1994 and May 2013 in Finland, we retrospectively extracted data on clinical outcomes and healthcare use. Using linear mixed models, we analysed longitudinal clinical outcome data. To analyse skewed cost data, including zero costs, we applied hurdle regression. ResultsAll 62 patients received early regular prophylaxis; totally, they have had treatment for nearly 700 patient-years. The median age of starting home treatment was 1.1years. The mean (SD) annual treatment costs (Europerkg) were 4391Euro (3852). For ages 1-3, ITI comprised over half of the costs; in other groups, prophylactic FVIII treatment dominated. With these high costs, however, clinical outcomes were desirable; median (IQR) ABR was low at 0.19 (0.07-0.46) and so was AJBR at 0.06 (0-0.24). Thirteen (21%) patients developed a clinically significant inhibitor, 10 (16%) with a high titre. All ITIs were successful. The mean costs for ITI were 383448Euro (259085). The expected ITI payback period was 1.81 (95% CI 0.62-12.12) years. ConclusionsEarly high-dose prophylaxis leads to excellent long-term clinical outcomes, and early childhood ITI therapy seems to turn cost-neutral generally already in 2years.
  • Urtamo, Annele; Jyväkorpi, Satu K.; Kautiainen, Hannu; Pitkälä, Kaisu H.; Strandberg, Timo E. (2020)
    Background The studies on the association of various midlife risk factors with reaching 90 years or more are scarce. We studied this association in a socioeconomically homogenous cohort of businessmen. Methods The study consists of men (n = 970) from the Helsinki Businessmen Study cohort (born 1919-1928). Five major cardiovascular disease (CVD) risk factors (smoking, BMI, blood pressure, serum lipids, fasting glucose), consumption of alcohol and coffee, self-rated health and self-rated fitness, were assessed in 1974, at an average age of 50 years. The number of major risk factors was tested as a risk burden. The Charlson Comorbidity Index and the RAND-36 (SF-36) Physical and Mental health summary scores were calculated from surveys in year 2000, at age of 73 years. Mortality dates were retrieved through 31 March 2018 from the Population Information System of Finland. Results 244 men survived to the age of 90 representing 25.2% of the study cohort. The survivors had less risk factor burden in midlife, and less morbidity and higher physical health summary score in 2000. Of those with five major risk factors only 7% survived up to 90 years, whereas 51% of those without any risk factors reached that age. Single risk factors reducing odds of reaching 90 years were smoking (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.34-0.67), glucose (0.66, 0.49-0.88), BMI (0.63, 0.46-0.86), and cholesterol (0.71, 0.53-0.96). Conclusion Lack of five major CVD risk factors in midlife strongly increased odds of reaching 90 years of age and also predicted factors related to successful ageing in late life.
  • Leahy, J. P.; Bersanelli, M.; D'Arcangelo, O.; Ganga, K.; Leach, S. M.; Moss, A.; Keihänen, E.; Keskitalo, R.; Kurki-Suonio, H.; Poutanen, T.; Sandri, M.; Scott, D.; Tauber, J.; Valenziano, L.; Villa, F.; Wilkinson, A.; Zonca, A.; Baccigalupi, C.; Borrill, J.; Butler, R. C.; Cuttaia, F.; Davis, R. J.; Frailis, M.; Francheschi, E.; Galeotta, S.; Gregorio, A.; Leonardi, R.; Mandolesi, N.; Maris, M.; Meinhold, P.; Mendes, L.; Mennella, A.; Morgante, G.; Prezeau, G.; Rocha, G.; Stringhetti, L.; Terenzi, L.; Tomasi, M. (2010)
  • Carrara, Arnaud; Kolari, Pasi; de Beeck, Maarten Op; Arriga, Nicola; Berveiller, Daniel; Dengel, Sigrid; Ibrom, Andreas; Merbold, Lutz; Rebmann, Corinna; Sabbatini, Simone; Serrano-Ortiz, Penelope; Biraud, Sebastien C. (2018)
    Solar radiation is a key driver of energy and carbon fluxes in natural ecosystems. Radiation measurements are essential for interpreting ecosystem scale greenhouse gases and energy fluxes as well as many other observations performed at ecosystem stations of the Integrated Carbon Observation System (ICOS). We describe and explain the relevance of the radiation variables that arc monitored continuously at ICOS ecosystems stations and define recommendations to perform these measurements with consistent and comparable accuracy. The measurement methodology and instruments are described including detailed technical specifications. Guidelines for instrumental set up as well as for operation, maintenance and data collection arc defined considering both ICOS scientific objectives and practical operational constraints. For measurements of short-wave (solar) and long wave (infrared) radiation components, requirements for the ICOS network are based on available well-defined state-of-the art standards (World Meteorological Organization, International Organization for Standardization). For photosynthetically active radiation measurements, some basic instrumental requirements are based on the performance of commercially available sensors. Since site specific conditions and practical constraints at individual ICOS ecosystem stations may hamper the applicability of standard requirements, we recommend that ICOS develops mid-tern coordinated actions to assess the effective level of uncertainties in radiation measurements at the network scale.
  • LITMUS Consortium; Hardy, Timothy; Wonders, Kristy; Younes, Ramy; Aithal, Guruprasad P.; Yki-Järvinen, Hannele (2020)
    Non-Alcoholic Fatty Liver Disease (NAFLD), a progressive liver disease that is closely associated with obesity, type 2 diabetes, hypertension and dyslipidaemia, represents an increasing global public health challenge. There is significant variability in the disease course: the majority exhibit only fat accumulation in the liver but a significant minority develop a necroinflammatory form of the disease (non-alcoholic steatohepatitis, NASH) that may progress to cirrhosis and hepatocellular carcinoma. At present our understanding of pathogenesis, disease natural history and long-term outcomes remain incomplete. There is a need for large, well characterised patient cohorts that may be used to address these knowledge gaps and to support the development of better biomarkers and novel therapies. The European NAFLD Registry is an international, prospectively recruited observational cohort study that aims to establish a large, highly-phenotyped patient cohort and linked bioresource. Here we describe the infrastructure, data management and monitoring plans, and the standard operating procedures implemented to ensure the timely and systematic collection of high-quality data and samples. Already recruiting subjects at secondary/tertiary care centres across Europe, the Registry is supporting the European Union IMI2-funded LITMUS 'Liver Investigation: Testing Marker Utility in Steatohepatitis' consortium, which is a major international effort to robustly validate biomarkers that diagnose, risk stratify and/or monitor NAFLD progression and liver fibrosis stage. The European NAFLD Registry has the demonstrable capacity to support research and biomarker development at scale and pace.
  • Turunen, Antti; Kuuliala, Antti; Penttilä, Anne; Kaukonen, Kirsi-Maija; Mustonen, Harri; Pettilä, Ville; Puolakkainen, Pauli; Kylänpää, Leena; Kuuliala, Krista (2020)
    Activation of intracellular signaling pathways in circulating leukocytes represents an early step in systemic immune-inflammatory response occurring e.g. in acute pancreatitis (AP) and sepsis. Previously, we found aberrations in the phosphorylation of leukocyte signaling proteins in patients with sepsis or AP (measured
  • FINNAKI Study Grp; Törnblom, Sanna; Nisula, Sara; Petäjä, Liisa; Vaara, Suvi T.; Haapio, Mikko; Pesonen, Eero; Pettilä, Ville (2020)
    Background: Neutrophil gelatinase-associated lipocalin (NGAL) is released from kidney tubular cells under stress as well as from neutrophils during inflammation. It has been suggested as a biomarker for acute kidney injury (AKI) in critically ill patients with sepsis. To evaluate clinical usefulness of urine NGAL (uNGAL), we post-hoc applied recently introduced statistical methods to a sub-cohort of septic patients from the prospective observational Finnish Acute Kidney Injury (FINNAKI) study. Accordingly, in 484 adult intensive care unit patients with sepsis by Sepsis-3 criteria, we calculated areas under the receiver operating characteristic curves (AUCs) for the first available uNGAL to assess discrimination for four outcomes: AKI defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria, severe (KDIGO 2-3) AKI, and renal replacement therapy (RRT) during the first 3 days of intensive care, and mortality at day 90. We constructed clinical prediction models for the outcomes and used risk assessment plots and decision curve analysis with predefined threshold probabilities to test whether adding uNGAL to the models improved reclassification or decision making in clinical practice. Results: Incidences of AKI, severe AKI, RRT, and mortality were 44.8% (217/484), 27.7% (134/484), 9.5% (46/484), and 28.1% (136/484). Corresponding AUCs for uNGAL were 0.690, 0.728, 0.769, and 0.600. Adding uNGAL to the clinical prediction models improved discrimination of AKI, severe AKI, and RRT. However, the net benefits for the new models were only 1.4% (severe AKI and RRT) to 2.5% (AKI), and the number of patients needed to be tested per one extra true-positive varied from 40 (AKI) to 74 (RRT) at the predefined threshold probabilities. Conclusions: The results of the recommended new statistical methods do not support the use of uNGAL in critically ill septic patients to predict AKI or clinical outcomes.