Browsing by Subject "HIGH-RISK"

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  • Takala, Riikka S. K.; Kiviranta, Riku; Olkkola, Klaus T.; Vahlberg, Tero; Laukka, Dan; Kotkansalo, Anna; Rahi, Melissa; Sankinen, Matti; Posti, Jussi; Katila, Ari; Rinne, Jaakko (2017)
    Purpose: The aim was to assess anterior pituitary hormone levels during the acute phase of aneurysmal subarachnoid hemorrhage (aSAH) and analyze the possible association with the clinical condition and outcome. Material and methods: Forty patients with aSAH whose aneurysm was secured by endovascular coiling were enrolled. Basal secretions of cortisol, testosterone, luteinizing hormone (LH), prolactin (PRL), and sex hormone binding globulin (SHBG) levels were measured up to 14 days after the incident. Results: The main finding was that hypocortisolism was rare whereas testosterone deficiency was common in male patients. Furthermore, various other hormone deviations were frequent and there was wide interindividual variability. We found no association between delayed cerebral ischemia (DCI), outcome of the patients or aneurysm location, and hormone abnormalities, while both Hunt & Hess and Fisher grade were associated with low PRL levels. Hunt & Hess 5 was associated with low PRL concentration when compared to grades 1 (OR = 4.81, 95% CI 1.15-20.14, p = 0.03), 3 (OR 7.73, 95% CI 1.33-45.01, p = 0.02), and 4 (OR = 6.86 95% CI 1.28-26.83, p = 0.02). Fisher grade 4 was associated with low PRL concentration when compared to grades 3 (OR 3.37, 95% CI 1.06-10.73, p = 0.03) and 2 (OR 9.71, 95% CI 1.22-77.10, p = 0.04). Conclusion: Deviations from normal and huge interindividual differences are common in hormone levels during the acute phase of aSAH. Routine assessment of anterior pituitary function in the acute phase of aSAH is not warranted. During the follow-up in the outpatient clinic, hormone concentrations were not measured, which would have brought a more long-term perspective into our findings.
  • Heliste, Maria; Pettilä, Ville; Berger, David; Jakob, Stephan M.; Wilkman, Erika (2022)
    Background Critical illness may lead to activation of the sympathetic system. The sympathetic stimulation may be further increased by exogenous catecholamines, such as vasopressors and inotropes. Excessive adrenergic stress has been associated with organ dysfunction and higher mortality. beta-Blockers may reduce the adrenergic burden, but they may also compromise perfusion to vital organs thus worsening organ dysfunction. To assess the effect of treatment with beta-blockers in critically ill adults, we conducted a systematic review and meta-analysis of randomized controlled trials. Materials and methods We conducted a search from three major databases: Ovid Medline, the Cochrane Central Register for Controlled Trials and Scopus database. Two independent reviewers screened, selected, and assessed the included articles according to prespecified eligibility criteria. We assessed risk of bias of eligible articles according to the Cochrane guidelines. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Sixteen randomized controlled trials comprising 2410 critically ill patients were included in the final review. A meta-analysis of 11 trials including 2103 patients showed a significant reduction in mortality in patients treated with beta-blockers compared to control (risk ratio 0.65, 95%CI 0.53-0.79; p < .0001). There was no significant difference in mean arterial pressure or vasopressor load. Quality of life, biventricular ejection fraction, blood lactate levels, cardiac biomarkers and mitochondrial function could not be included in meta-analysis due to heterogenous reporting of outcomes. Conclusions In this systematic review we found that beta-blocker treatment reduced mortality in critical illness. Use of beta-blockers in critical illness thus appears safe after initial hemodynamic stabilization. High-quality RCT's are needed to answer the questions concerning optimal target group of patients, timing of beta-blocker treatment, choice of beta-blocker, and choice of physiological and hemodynamic parameters to target during beta-blocker treatment in critical illness. KEY MESSAGES A potential outcome benefit of beta-blocker treatment in critical illness exists according to the current review and meta-analysis. Administration of beta-blockers to resuscitated patients in the ICU seems safe in terms of hemodynamic stability and outcome, even during concomitant vasopressor administration. However, further studies, preferably large RCTs on beta-blocker treatment in the critically ill are needed to answer the questions concerning timing and choice of beta-blocker, patient selection, and optimal hemodynamic targets.
  • Mustelin, Linda; Kaprio, Jaakko; Keski-Rahkonen, Anna (2018)
    Objective: Binge eating disorder (BED) is a clinical eating disorder that is strongly and bidirectionally related to overweight and obesity. Little is known about how subclinical features of BED relate to weight development in adolescence and young adulthood. Method: Women (n=2825) and men (n=2423) from the community-based longitudinal FinnTwin16 cohort participated. Seven eating-related cognitions and behaviors similar to the defining features of BED were extracted from the Eating Disorder Inventory-2 and were assessed at a mean age of 24. We used linear mixed models to assess the association of features of BED with BMI trajectories across four waves of data collection (mean ages 16, 17, 18, and 24). Results: The number of features of BED at wave 4 (age 24) was significantly associated with BMI from age 16 years onwards. Those reporting more features of BED had gained more weight throughout adolescence and into their twenties. Conclusions: Features of BED in young adulthood were preceded by steeper BMI trajectories in adolescence. A higher number of features were consistently associated with higher BMI and more weight gain.
  • Niinikoski, Laura; Hukkinen, Katja; Leidenius, Marjut H. K.; Ståhls, Anders; Meretoja, Tuomo J. (2018)
    Objectives: This study aims to evaluate the feasibility of Breast Lesion Excision System (BLES) in the treatment of intraductal papillomas. Material and methods: All patients with a needle biopsy-based suspicion of an intraductal papilloma who consequently underwent a BLES procedure at Helsinki University Hospital between 2011 and 2016 were included in this retrospective study. The purpose of the BLES procedure was either to excise the entire lesion or in few cases to achieve better sampling. Results: In total, 74 patients underwent 80 BLES procedures. Pathological diagnosis after the BLES biopsy confirmed an intraductal papilloma without atypia in 43 lesions, whereas 10 lesions were upgraded to high-risk lesions (HRL) with either atypical ductal hyperplasia or lobular carcinoma in situ. Five cases were upgraded to malignancy, two were invasive ductal carcinomas and three were ductal carcinoma in situ. Additionally, 18 lesions were diagnosed as other benign lesions. Four procedures failed. Complete excision with BLES was achieved in 19 out of 43 intraductal papillomas, 6 out of 10 HRL and two out of five malignant lesions. No major complications occurred. The BLES procedure was adequate in the management of the 71 breast lesions. Conclusion: The BLES procedure is an acceptable method for the management of small benign and high-risk breast lesions such as intraductal papillomas in selected patients. Thus, a great amount of diagnostic surgical biopsies can be avoided. (C) 2017 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
  • Baumgartner, Ana; Drame, Katarina; Geutjens, Stijn; Airaksinen, Marja (2020)
    Many patients, especially those with a high pill burden and multiple chronic illnesses, are less adherent to medication. In medication treatments utilizing polypills, this problem might be diminished since multiple drugs are fused into one formulation and, therefore, the therapy regimen is simplified. This systematic review summarized evidence to assess the effect of polypills on medication adherence. The following databases were searched for articles published between 1 January 2000, and 14 May 2019: PubMed, Web of Science, Cochrane Library, and Scopus. Medication adherence was the only outcome assessed, regardless of the method of measuring it. Sixty-seven original peer-reviewed articles were selected. Adherence to polypill regimens was significantly higher in 56 articles (84%) compared to multiple pill regimens. This finding was also supported by the results of 13 out of 17 selected previously published systematic reviews and meta-analyses dealing with this topic. Adherence can be improved through the formulation of polypills, which is probably why the interest in researching them is growing. There are many polypills on the market, but the adherence studies so far focused mainly on a small range of medical conditions.
  • Closed Open Laparotomy COOL Sou; Doig, Christopher J.; Page, Stacey A.; McKee, Jessica L.; Tolonen, Matti; Kirkpatrick, Andrew W. (2019)
    Background Severe complicated intra-abdominal sepsis (SCIAS) has high mortality, thought due in part to progressive bio-mediator generation, systemic inflammation, and multiple organ failure. Treatment includes early antibiotics and operative source control. At surgery, open abdomen management with negative-peritoneal-pressure therapy (NPPT) has been hypothesized to mitigate MOF and death, although clinical equipoise for this operative approach exists. The Closed or Open after Laparotomy (COOL) study () will prospectively randomize eligible patients intra-operatively to formal abdominal closure or OA with NPTT. We review the ethical basis for conducting research in SCIAS. Main body Research in critically ill incapacitated patients is important to advance care. Conducting research among SCIAS is complicated due to the severity of illness including delirium, need for emergent interventions, diagnostic criteria confirmed only at laparotomy, and obtundation from anaesthesia. In other circumstances involving critically ill patients, clinical experts have worked closely with ethicists to apply principles that balance the rights of patients whilst simultaneously permitting inclusion in research. In Canada, the Tri-Council Policy Statement-2 (TCPS-2) describes six criteria that permit study enrollment and randomization in such situations: (a) serious threat to the prospective participant requires immediate intervention; (b) either no standard efficacious care exists or the research offers realistic possibility of direct benefit; (c) risks are not greater than that involved in standard care or are clearly justified by prospect for direct benefits; (d) prospective participant is unconscious or lacks capacity to understand the complexities of the research; (e) third-party authorization cannot be secured in sufficient time; and (f) no relevant prior directives are known to exist that preclude participation. TCPS-2 criteria are in principle not dissimilar to other (inter)national criteria. The COOL study will use waiver of consent to initiate enrollment and randomization, followed by surrogate or proxy consent, and finally delayed informed consent in subjects that survive and regain capacity. Conclusions A delayed consent mechanism is a practical and ethical solution to challenges in research in SCIAS. The ultimate goal of consent is to balance respect for patient participants and to permit participation in new trials with a reasonable opportunity for improved outcome and minimal risk of harm.
  • Åström, Max J.; von Bonsdorff, Mikaela B.; Haanpää, Maija; Salonen, Minna K.; Kautiainen, Hannu; Eriksson, Johan G. (2021)
    Aims: To assess if individuals with diabetes or prediabetes report more pain or have increased use of pain medication compared to normoglycaemic individuals. Methods: Using cross-sectional data, we studied 928 men and 1075 women from the Helsinki Birth Cohort Study in 2001-2004 at a mean age of 61.5 years. Glucose regulation was assessed with a 2-h 75 g oral glucose tolerance test, and applying World Health Organization criteria, participants were defined as having normoglycaemia, prediabetes (impaired fasting glucose or impaired glucose tolerance), newly diagnosed diabetes or previously diagnosed diabetes. Self-reported pain intensity and interference during the previous 4 weeks was estimated using the RAND 36-Item Health Survey 1.0. Information on use of pain medication during the past 12 months was obtained from the Social Insurance Institution of Finland. Results: There was no difference in pain intensity or interference between glucose regulation groups for neither men nor women after adjusting for covariates (age, body mass index, education years, Beck Depression Inventory and physical activity). In addition, use of pain medication was similar between glucose regulation groups. Conclusions: Although pain is a common symptom in the general population, impairments in glucose regulation alone does not seem to increase pain among older individuals. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
  • Åström, Max J.; von Bonsdorff, Mikaela B.; Perälä, Mia M.; Salonen, Minna K.; Rantanen, Taina; Kajantie, Eero; Simonen, Mika; Pohjolainen, Pertti; Osmond, Clive; Eriksson, Johan G. (2018)
    Aims To assess whether disturbances in glucose regulation are associated with impairment in physical performance during a 10-year follow-up. Methods 475 Men and 603 women from the Helsinki Birth Cohort Study were studied. Glucose regulation was evaluated with a 2-h 75-g oral glucose tolerance test (OGTT) in 2001-2004. Subjects were categorised as having either impaired fasting glucose (IFG), impaired glucose tolerance (IGT), newly diagnosed diabetes or previously known diabetes. Physical performance was assessed approximately 10 years later using the validated senior fitness test (SFT). The relationship between glucose regulation and the overall SFT score was estimated using multiple linear regression models. Results The mean age was 70.8 years for men and 71.0 years for women when physical performance was assessed. The mean SFT score for the whole population was 45.0 (SD 17.5) points. The SFT score decreased gradually with increased impairment in glucose regulation. Individuals with previously known diabetes had the lowest overall SFT score in the fully adjusted model (mean difference compared to normoglycaemic individuals -11.56 points, 95% CI - 16.15 to - 6.98, p <0.001). Both individuals with newly diagnosed diabetes and individuals with IGT had significantly poorer physical performance compared to those with normoglycaemia. No significant difference in physical performance was found between those with IFG and those with normoglycaemia. Conclusions Among older people, impaired glucose regulation is strongly related with poor physical performance. More severe disturbances in glucose regulation are associated with a greater decrease in physical function, indicating the importance of diagnosing these disturbances at an early stage.
  • Laine, Riku; Myrskylä, Mikko; Kaskela, Teemu; Pitkänen, Tuuli (2022)
    Background The first few weeks’ post-imprisonment are associated with high mortality, particularly among individuals with a history of substance use. Excess risk may vary by societal context due to a range of penal systems and substance use patterns. Using data on Finnish individuals who had sought treatment for substance use, we studied the association between criminal sanctions with cause-specific mortality. Methods The database contained 10887 individuals who had sought treatment between 1990 and 2009. Their treatment data were combined with register data on imprisonments and community sanctions and weekly mortality between 1992 and 2015. Mortality was analysed using discrete-time survival models. We controlled for age and sociodemographic factors, and analysed whether education, type of substance used and the type of latest sentence modified the associations. Findings Mortality was high in the first two weeks after sanctions (all-cause odds ratio [OR] 2.61, 95% confidence interval [CI] 1.67-4.07; drug-related deaths OR 8.52, 95% CI 4.64-15.7). Excess risk declined over time (OR after 12 weeks: 1.19, 95% CI 1.07-1.31). Most of the excess risk was attributable to external causes. Mortality was low during imprisonment, but not during community sanctions. The patterns were similar by level of education, substance use and the type of latest sentence. Conclusions Community sanctions were not associated with mortality among people with substance use disorders. Mortality was low during imprisonment, but high post-release. Criminal sanctions should be better utilised as intervention touchpoints and follow-up resources should target prisoners with substance use treatment history to reduce post-release mortality.
  • Ollila, Laura; Heliö, Tiina; Sovijärvi, Anssi; Jalanko, Mikko; Kaartinen, Maija; Kuusisto, Johanna; Kärkkäinen, Satu; Jurkko, Raija; Reissell, Eeva; Palojoki, Eeva; Piirilä, Päivi (2017)
    BackgroundLMNA mutations are an important cause of cardiomyopathy often leading to cardiac arrhythmias, heart failure and even heart transplantation. An increasing number of asymptomatic mutation carriers are identified, as family members of the index patients are screened. Our aim was to study the disease progression in asymptomatic LMNA mutation carriers and in patients with symptomatic cardiolaminopathy by repeated spiroergometric testing in a prospective clinical follow-up study. Methods and ResultsWe studied 26 LMNA mutation carriers once a year during 5years up to 6 times by spiroergometry, clinical assessment, laboratory tests and echocardiography. The 23 control subjects underwent clinical assessment and spiroergometry once. Twelve of the mutation carriers were asymptomatic, and 14 had some clinical manifestations of the mutation ranging from clinically relevant rhythm disturbances to DCM and heart failure. Compared to controls, the symptomatic carriers showed a higher slope of the ventilatory equivalent for CO2 (VE/VCO2 slope) and a lower fraction of end-tidal CO2 (FetCO(2)). The asymptomatic mutation carriers also showed an increased ventilatory response to exercise during the follow-up as indicated by increased VE/VCO2 slope and decreased FetCO(2). ConclusionsThe study suggests that an increased ventilatory response during exercise might reveal a preclinical manifestation of DCM in LMNA mutation carriers.
  • Kerola, Anne M.; Semb, Anne Grete; Juonala, Markus; Palomäki, Antti; Rautava, Päivi; Kytö, Ville (2022)
    Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005-2018 were retrospectively studied using multiple national registries. The primary outcome of interest was a combined major adverse cardiovascular event (MACE; cardiovascular death, recurrent MI, ischemic stroke, or heart failure hospitalization) studied with a competing risk Fine-Gray analyses. Median follow-up was 3.9 years (maximum 12 years). Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 1401 patient pairs). Results Cumulative incidence of MACE after MI was higher in patients with type 1 diabetes (67.6%) compared to propensity score-matched patients without diabetes (46.0%) (sub-distribution hazard ratio [sHR]: 1.94; 95% confidence interval [CI]: 1.74-2.17; p < 0.0001). Probabilities of cardiovascular death (sHR 1.81; p < 0.0001), recurrent MI (sHR 1.91; p < 0.0001), ischemic stroke (sHR 1.50; p = 0.0003), and heart failure hospitalization (sHR 1.98; p < 0.0001) were higher in patients with type 1 diabetes. Incidence of MACE was higher in diabetes patients than in controls in subgroups of men and women, patients aged < 60 and >= 60 years, revascularized and non-revascularized patients, and patients with and without atrial fibrillation, heart failure, or malignancy. Conclusions Patients with type 1 diabetes have notably poorer long-term cardiovascular prognosis after an MI compared to patients without diabetes. These results underline the importance of effective secondary prevention after MI in patients with type 1 diabetes.
  • Blauw, Lisanne L.; Noordam, Raymond; Soidinsalo, Sebastian; Blauw, C. Alexander; Li-Gao, Ruifang; de Mutsert, Renee; Berbee, Jimmy F. P.; Wang, Yanan; van Heemst, Diana; Rosendaal, Frits R.; Jukema, J. Wouter; Mook-Kanamori, Dennis O.; Wurtz, Peter; van Dijk, Ko Willems; Rensen, Patrick C. N. (2019)
    According to the current dogma, cholesteryl ester transfer protein (CETP) decreases high-density lipoprotein (HDL)-cholesterol (C) and increases low-density lipoprotein (LDL)-C. However, detailed insight into the effects of CETP on lipoprotein subclasses is lacking. Therefore, we used a Mendelian randomization approach based on a genetic score for serum CETP concentration (rs247616, rs12720922 and rs1968905) to estimate causal effects per unit (mu g/mL) increase in CETP on 159 standardized metabolic biomarkers, primarily lipoprotein subclasses. Metabolic biomarkers were measured by nuclear magnetic resonance (NMR) in 5672 participants of the Netherlands Epidemiology of Obesity (NEO) study. Higher CETP concentrations were associated with less large HDL (largest effect XL-HDL-C, P = 6 x 10(-22)) and more small VLDL components (largest effect S-VLDL cholesteryl esters, P = 6 x 10(-6)). No causal effects were observed with LDL subclasses. All these effects were replicated in an independent cohort from European ancestry (MAGNETIC NMR GWAS; n similar to 20,000). Additionally, we assessed observational associations between ELISA-measured CETP concentration and metabolic measures. In contrast to results from Mendelian randomization, observationally, CETP concentration predominantly associated with more VLDL, IDL and LDL components. Our results show that CETP is an important causal determinant of HDL and VLDL concentration and composition, which may imply that the CETP inhibitor anacetrapib decreased cardiovascular disease risk through specific reduction of small VLDL rather than LDL. The contrast between genetic and observational associations might be explained by a high capacity of VLDL, IDL and LDL subclasses to carry CETP, thereby concealing causal effects on HDL.
  • Siljander, Heli; Honkanen, Jarno; Knip, Mikael (2019)
    The steep increase in the incidence of type 1 diabetes (T1D), in the Western world after World War II, cannot be explained solely by genetic factors but implies that this rise must be due to crucial interactions between predisposing genes and environmental changes. Three parallel phenomena in early childhood – the dynamic development of the immune system, maturation of the gut microbiome, and the appearance of the first T1D-associated autoantibodies – raise the question whether these phenomena might reflect causative relationships. Plenty of novel data on the role of the microbiome in the development of T1D has been published over recent years and this review summarizes recent findings regarding the associations between islet autoimmunity, T1D, and the intestinal microbiota.
  • Ylonen, Venla; Lindfors, Katri; Repo, Marleena; Huhtala, Heini; Fuchs, Valma; Saavalainen, Päivi; Musikka, Alex; Laurila, Kaija; Kaukinen, Katri; Kurppa, Kalle (2020)
    Non-biopsy diagnosis of celiac disease is possible in children with anti-transglutaminase 2 antibodies (TGA) > 10x the upper limit of normal (ULN) and positive anti-endomysial antibodies (EMA). Similar criteria have been suggested for adults, but evidence with different TGA assays is scarce. We compared the performance of four TGA tests in the diagnosis of celiac disease in cohorts with diverse pre-test probabilities. Serum samples from 836 adults with either clinical suspicion or family risk of celiac disease were tested with four commercial TGA assays, EmA and celiac disease-associated genetics. The diagnosis was set based on duodenal lesion or, in some cases, using special methods. 137 (57%) patients with clinical suspicion and 85 (14%) of those with family risk had celiac disease. Positive predictive value (PPV) for 10xULN was 100% in each TGA test. The first non-diagnostic investigations were encountered with ULN 1.0x-5.1x in the clinical cohort and 1.3x-4.9x in the family cohort, respectively. Using the assays' own cut-offs (1xULN) the PPVs ranged 84-100%. Serology-based diagnosis of celiac disease was accurate in adults using different commercial kits and pre-test probabilities using 10xULN. The results also suggest that the ULN threshold for biopsy-omitting approach could be lower.
  • Drews, Teemu E. I.; Laukkanen, Jari; Nieminen, Tuomo (2021)
    We planned this systematic review and meta-analysis to study an estimate of the effect of non-invasive home telemonitoring (TM) in the treatment of patients with recently decompensated heart failure (HF). A systematic literature search was conducted in the Medline, Cinahl, and Scopus databases to look for randomized controlled studies comparing TM with standard care in the treatment of patients with recently decompensated HF. The main outcomes of interest were all-cause hospitalizations and mortality. Eleven original articles met our eligibility criteria. The pooled estimate of the relative risk of all-cause hospitalization in the TM group compared with standard care was 0.95 (95% CI 0.84-1.08, P = 0.43) and the relative risk of all-cause death was 0.83 (95% CI 0.63-1.09, P = 0.17). There was significant clinical heterogeneity among primary studies. HF medication could be directly altered in three study interventions, and two of these had a statistically significant effect on all-cause hospitalizations. The pooled effect estimate of TM interventions on all-cause hospitalizations and all-cause death in patients with recently decompensated heart failure was neutral.
  • Brick, Tabea; Schober, Yvonne; Boecking, Christian; Pekkanen, Juha; Genuneit, Jon; Loss, Georg; Dalphin, Jean-Charles; Riedler, Josef; Lauener, Roger; Nockher, Wolfgang Andreas; Renz, Harald; Vaarala, Outi; Braun-Fahrlander, Charlotte; von Mutius, Erika; Ege, Markus Johannes; Pfefferle, Petra Ina; PASTURE Study Grp (2016)
    Background: Living on a farm has repeatedly been shown to protect children from asthma and allergies. A major factor involved in this effect is consumption of unprocessed cow's milk obtained directly from a farm. However, this phenomenon has never been shown in a longitudinal design, and the responsible milk components are still unknown. Objectives: We sought to assess the asthma-protective effect of unprocessed cow's milk consumption in a birth cohort and to determine whether the differences in the fatty acid (FA) composition of unprocessed farm milk and industrially processed milk contributed to this effect. Methods: The Protection Against Allergy-Study in Rural Environments (PASTURE) study followed 1133 children living in rural areas in 5 European countries from birth to age 6 years. In 934 children milk consumption was assessed by using yearly questionnaires, and samples of the ``usually'' consumed milk and serum samples of the children were collected at age 4 years. Doctor-diagnosed asthma was parent reported at age 6 years. In a nested case-control study of 35 asthmatic and 49 nonasthmatic children, 42 FAs were quantified in milk samples. Results: The risk of asthma at 6 years of age was reduced by previous consumption of unprocessed farm milk compared with shop milk (adjusted odds ratio for consumption at 4 years, 0.26; 95% CI,0.10-0.67). Part of the effect was explained by the higher fat content of farm milk, particularly the higher levels of omega-3 polyunsaturated FAs (adjusted odds ratio, 0.29; 95% CI,0.11-0.81). Conclusion: Continuous farm milk consumption in childhood protects against asthma at school age partially by means of higher intake of omega-3 polyunsaturated FAs, which are precursors of anti-inflammatory mediators.
  • Tuomala, Henni; Verkola, Marie; Meller, Anna; Van der Auwera, Jasper; Patpatia, Sheetal; Järvinen, Asko; Skurnik, Mikael; Heikinheimo, Annamari; Kiljunen, Saija (2021)
    The increase of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) causes a threat to human health. LA-MRSA can be transmitted from animals to animal caretakers, which may further spread MRSA to communities and health care facilities. The objective of this work was to study the efficacy of phage treatment in the eradication of LA-MRSA from healthy carrier pigs. A total of 19 MRSA -positive weanling pigs were assigned to a test (n = 10) and a control group (n = 9). A phage cocktail containing three Staphylococcus phages, or a control buffer was administered to the nares and skin of the pigs three times every two days, after which the phage and MRSA levels in nasal and skin swab samples were monitored for a three-week period. The sensitivity of the strains isolated during the follow-up period to the phage cocktail and each phage individually was analyzed and the pig sera were tested for antibodies against the phages used in the cocktail. The phage treatment did not cause any side effects to the pigs. Phages were found in the skin and nasal samples on the days following the phage applications, but there was no reduction in the MRSA levels in the sampled animals. Phage-resistant strains or phage-specific antibodies were not detected during the experiment. The MRSA load in these healthy carrier animals was only 10–100 CFU/swab or nasal sample, which was likely below the replication threshold of phages. The effectiveness of phage treatment to eradicate MRSA from the pigs could thus not be (reliably) determined.
  • Mustelin, Linda; Bulik, Cynthia M.; Kaprio, Jaakko; Keski-Rahkonen, Anna (2017)
    Binge eating disorder (BED) is associated with high levels of obesity and psychological suffering, but little is known about 1) the distribution of features of BED in the general population and 2) their consequences for weight development and psychological distress in young adulthood. We investigated the prevalence of features of BED and their association with body mass index (BMI) and psychological distress among men (n = 2423) and women (n = 2825) from the longitudinal community-based FinnTwin16 cohort (born 1975-1979). Seven eating-related cognitions and behaviors similar to the defining features of BED were extracted from the Eating Disorder Inventory-2 and were assessed at a mean age of 24. BMI and psychological distress, measured with the General Health Questionnaire, were assessed at ages 24 and 34. We assessed prevalence of the features and their association with BMI and psychological distress cross-sectionally and prospectively. More than half of our participants reported at least one feature of BED; clustering of several features in one individual was less common, particularly among men. The most frequently reported feature was 'stuffing oneself with food', whereas the least common was 'eating or drinking in secrecy'. All individual features of BED and their clustering particularly were associated with higher BMI and more psychological distress cross-sectionally. Prospectively, the clustering of features of BED predicted increase in psychological distress but not additional weight gain when baseline BMI was accounted for. In summary, although some features of BED were common, the clustering of several features in one individual was not. The features were cumulatively associated with BMI and psychological distress and predicted further increase in psychological distress over ten years of follow-up. (C) 2016 Published by Elsevier Ltd.
  • Gergov, Vera; Milic, Branka; Löffler-Stastka, Henriette; Ulberg, Randi; Vousoura, Eleni; Poulsen, Stig (2022)
    Background: Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12–30) with psychotic disorders. Methods: A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. Results: Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. Conclusion: There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment. Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].
  • Lindgren, Maija; Numminen, Linda; Holm, Minna; Therman, Sebastian; Tuulio-Henriksson, Annamari (2022)
    Psychotic-like experiences (PLEs) have been identified as risk markers for psychotic disorders and may indicate an individual's susceptibility to mental disorders in general. We examined whether 23 PLEs (assessed with MCIDI questionnaire) reported in young adulthood (n = 1313) predict subsequent psychotic or any mental disorders in the general population. We also investigated whether these possible associations are explained by general psychological distress assessed with the General Health Questionnaire-12 (GHQ-12). The register follow-up period spanned 10-12 years. In Cox regression models, PLEs predicted subsequent psychotic disorders (n = 12) when the effects of age, sex, education, and marital status were adjusted for, but not when general psychological distress was added to the model. Having any mental disorders during follow-up (n = 91) was predicted by PLEs reported at a younger age, when controlling for age, sex, education, marital status, and general psychological distress. In line with earlier results in other age groups, PLEs can be seen as a sign of vulnerability to not just psychotic but all mental disorders during the following years also among young adults in the general population. PLEs were a predictive marker of general psychopathology independently from general psychological distress.