Browsing by Subject "ILLNESS"

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  • Siikamäki, Heli; Kivela, Pia; Fotopoulos, Mikael; Kantele, Anu (2017)
    Background: Although infections represent the most common health problem of travellers abroad, data on morbidity and incidences of various infections are scarce. Method: Data on infections of Finnish travellers during 2010-2012 were retrieved from the database of SOS International, an assistance organization covering 95% of Finns requiring aid abroad. The study included 30,086 cases. For incidence calculation, the data were linked to the numbers of Finns visiting these regions during the same period as recorded by the Official Statistics of Finland. Results: The incidence of infections was particularly high in Africa, southern Europe plus the eastern Mediterranean, and Asia plus Oceania. The most frequent diagnoses were acute gastroenteritis (38.0%) and respiratory-tract infections (RTI) (34.5%), followed by infections of the ear (12.6%), skin or subcutaneous tissue (5.1%), urogenital tract (4.2%), eye (3.1%), and systemic febrile infections (2.2%). Vaccinepreventable diseases (VPD) accounted for 0.8% of cases, with varicella as most (49%) and influenza as second-most (27%) common. Conclusions: Incidence of infections was higher in southern than in eastern and western Europe. Gastroenteritis and RTI proved the most frequent diagnoses, whereas systemic febrile infections were uncommon. Despite pre-travel immunizations, VPDs still occurred; pre-travel consultation should cover both varicella and influenza. (C) 2016 Elsevier Ltd. All rights reserved.
  • Ojansuu, Ilkka; Putkonen, Hanna; Tiihonen, Jari (2018)
    Purpose: To analyze the causes of mortality among patients committed to compulsory forensic psychiatric hospital treatment in Finland during 1980-2009 by categorizing the causes of mortality into somatic diseases, suicides and other unnatural deaths.Materials and methods: The causes of mortality were analyzed among 351 patients who died during the follow-up. Standardized mortality ratio (SMR) was calculated as the ratio of observed and expected number of deaths by using the subject-years methods with 95% confidence intervals, assuming a Poisson distribution. The expected number of deaths was calculated on the basis of sex-, age- and calendar-period-specific mortality rates for the Finnish population.Results: The vast majority (249/351) of deaths were due to a somatic disease with SMR of 2.6 (mean age at death 61 years). Fifty nine patients committed suicide with a SMR of 7.1 (mean age at death 40 years). Four patients were homicide victims (mean age at death 40 years) and 32 deaths were accidental (mean age at death 52 years). The combined homicides and accidental deaths resulted in a SMR of 1.7.Conclusions: The results of this study point out that the high risk for suicide should receive attention when the hospital treatment and the outpatient care is being organized for forensic psychiatric patients. In addition, the risk of accidents should be evaluated and it should be assured that the patients receive proper somatic healthcare during the forensic psychiatric treatment and that it continues also in the outpatient setting.
  • SICS Study Grp; Hiemstra, Bart; Eck, Ruben J.; Wiersema, Renske; Pettilä, Ville; van der Horst, Iwan C. C. (2019)
    Objectives: Caregivers use clinical examination to timely recognize deterioration of a patient, yet data on the prognostic value of clinical examination are inconsistent. In the Simple Intensive Care Studies-I, we evaluated the association of clinical examination findings with 90-day mortality in critically ill patients. Design: Prospective single-center cohort study. Setting: ICU of a single tertiary care level hospital between March 27, 2015, and July 22, 2017. Patients: All consecutive adults acutely admitted to the ICU and expected to stay for at least 24 hours. Interventions: A protocolized clinical examination of 19 clinical signs conducted within 24 hours of admission. Measurements Main Results: Independent predictors of 90-day mortality were identified using multivariable logistic regression analyses. Model performance was compared with established prognostic risk scores using area under the receiver operating characteristic curves. Robustness of our findings was tested by internal bootstrap validation and adjustment of the threshold for statistical significance. A total of 1,075 patients were included, of whom 298 patients (28%) had died at 90-day follow-up. Multivariable analyses adjusted for age and norepinephrine infusion rate demonstrated that the combination of higher respiratory rate, higher systolic blood pressure, lower central temperature, altered consciousness, and decreased urine output was independently associated with 90-day mortality (area under the receiver operating characteristic curves = 0.74; 95% CI, 0.71-0.78). Clinical examination had a similar discriminative value as compared with the Simplified Acute Physiology Score-II (area under the receiver operating characteristic curves = 0.76; 95% CI, 0.73-0.79; p = 0.29) and Acute Physiology and Chronic Health Evaluation-IV (using area under the receiver operating characteristic curves = 0.77; 95% CI, 0.74-0.80; p = 0.16) and was significantly better than the Sequential Organ Failure Assessment (using area under the receiver operating characteristic curves = 0.67; 95% CI, 0.64-0.71; p <0.001). Conclusions: Clinical examination has reasonable discriminative value for assessing 90-day mortality in acutely admitted ICU patients. In our study population, a single, protocolized clinical examination had similar prognostic abilities compared with the Simplified Acute Physiology Score-II and Acute Physiology and Chronic Health Evaluation-IV and outperformed the Sequential Organ Failure Assessment score.
  • Fallenius, Marika; Skrifvars, Markus B.; Reinikainen, Matti; Bendel, Stepani; Raj, Rahul (2017)
    Background: Intensive care scoring systems are widely used in intensive care units (ICU) around the world for case-mix adjustment in research and benchmarking. The aim of our study was to investigate the usefulness of common intensive care scoring systems in predicting mid-term mortality in patients with spontaneous intracerebral hemorrhage (ICH) treated in intensive care units (ICU). Methods: We performed a retrospective observational study including adult patients with spontaneous ICH treated in Finnish ICUs during 2003-2012. We used six-month mortality as the primary outcome of interest. We used logistic regression to customize Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) for six-month mortality prediction. To assess the usefulness of the scoring systems, we compared their discrimination and calibration with two simpler models consisting of age, Glasgow Coma Scale (GCS) score, and premorbid functional status. Results: Totally 3218 patients were included. Overall six-month mortality was 48%. APACHE II and SAPS II outperformed SOFA (area under the receiver operator curve [AUC] 0.83 and 0.84, respectively, vs. 0.73) but did not show any benefit over the simpler models in terms of discrimination (AUC 0.84, p > 0.05 for all models). SAPS II showed satisfactory calibration (p = 0.058 in the Hosmer-Lemeshow test), whereas all other models showed poor calibration (p <0.05). Discussion: In this retrospective multi-center study, we found that SAPS II and APACHE II were of no additional prognostic value to a simple model based on only age and GCS score for patients with ICH treated in the ICU. In fact, the major predictive ability of APACHE II and SAPS II comes from their age and GCS score components. SOFA performed significantly poorer than the other models and is not applicable as a prognostic model for ICH patients. All models displayed poor calibration, highlighting the need for improved prognostic models for ICH patients. Conclusion: The common intensive care scoring systems did not outperform a simpler model based on only age and GCS score. Thus, the use of previous intensive care scoring systems is not warranted in ICH patients.
  • Oristo, Satu; Rönnqvist, Maria; Aho, Mika; Sovijärvi, Ava; Hannila-Handelberg, Tuula; Horman, Ari; Nikkari, Simo; Kinnunen, Paula M.; Maunula, Leena (2017)
    This study investigated the presence of norovirus and adenovirus, especially enteric adenovirus, on the environmental surfaces (n = 481) and military conscripts' hands (n = 109) in two Finnish garrisons (A and B) in 2013 and 2014. A questionnaire study was conducted to reveal possible correlations between viral findings on the conscripts' hands and their acute gastroenteritis symptoms. In addition to the swab samples, 14 fecal samples were obtained for viral analysis. In total, norovirus was present in 9.0 % of the surface swabs in 2013, whereas enteric adenovirus was present in 0.0 % and non-enteric adenovirus in 9.4 %. In the same year, 2.6 % of the hand swabs contained norovirus, 2.6 % enteric adenovirus, and 40.3 % non-enteric adenovirus. Norovirus GI.6 was continually detected on the surfaces of garrison A, and identical virus was detected in some of the fecal samples. In garrison B, two slightly different norovirus GII.4 strains were present on the surfaces. The questionnaires revealed no recent acute gastroenteritis cases in garrison A, but in garrison B, where the norovirus-positive hand swabs were collected, 30.6 % of the conscripts reported of recent symptoms. In 2014, norovirus was rarely detected, but adenovirus was again frequently present, both on the surfaces and hands. Taken together, our results suggest that gastroenteritis outbreaks occurred in 2013, but not in 2014. Due to the low number of hand swabs positive for enteric viruses, no conclusions about associations between viral findings and gastroenteritis symptoms could be drawn. This study increased our understanding of the possible transmission of viruses via contaminated environment and hands.
  • Hakulinen, Christian; Elovainio, Marko; Arffman, Martti; Lumme, Sonja; Suokas, Kimmo; Pirkola, Sami; Keskimäki, Ilmo; Manderbacka, Kristiina; Böckerman, Petri (2020)
    Objective: Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of employment and personal income before and after a first hospitalization for a serious mental disorder. Methods: All individuals (N=50,551) who had been hospitalized for schizophrenia, other nonaffective psychosis, or bipolar disorder in Finland between 1988 and 2015 were identified and matched with five randomly selected participants who were the same sex and who had the same birth year and month. Employment status and earnings, income transfer payments, and total income in euros were measured annually from 1988 to 2015. Results: Individuals with serious mental disorders had notably low levels of employment before, and especially after, the diagnosis of a severe mental disorder. Their total income was mostly constituted of transfer payments, and this was especially true for those diagnosed as having schizophrenia. More than half of all individuals with a serious mental disorder did not have any employment earnings after they received the diagnosis. Conclusions: The current study shows how most individuals in Finland depend solely on income transfer payments after an onset of a severe mental disorder.
  • Jones, Marjaana; Pietilä, Ilkka (2020)
    Peer support workers are now working with patients in a variety of settings, coming into close contact and even work alongside health professionals. Despite the potentially influential position peer support workers hold in relation to those engaged in support activities, their role, duties and their relationship to peers and health professionals lack clarity and is often defined by other actors. This study explores how peer support workers interpret and define the activities, responsibilities and knowledge associated with their work. Using methods of membership categorisation analysis, we analysed interview materials generated by conducting individual semi-structured interviews during the autumn of 2016 with prostate cancer peer support workers (n = 11) who currently volunteer as support workers in Finland. Although the peer support workers acknowledged the psychosocial aspects of the work, we argue that their interpretations extend far beyond this and encompass expertise, advocacy and activism as central features of their work. These can be used to strengthen their position as credible commentators and educators on issues relating to cancer and men's health; raise awareness and represent the 'patient's voice' and attempt to influence both policy and clinical practice. These findings suggest that by categorising their work activities in different ways, voluntary sector actors such as peer support workers can attempt to portray themselves as legitimate authorities on a range of issues and influence decision-making ranging from individual level treatment decisions all the way to health policy.
  • Smits, Dins; Brigis, Girts; Pavare, Jana; Urtane, Inga; Kovalovs, Sandis; Barengo, Noel Christopher (2020)
    Background The problem of nonadherence to therapy is a key reason of insufficient asthma control. Evaluating the beliefs about asthma medication, cognitive and emotional perceptions may help to identify patients with poor adherence to treatment in clinical practice which need additional attention in order to increase the likelihood of them taking their asthma medication according to the prescribed treatment protocol. The purpose of this study is to assess whether beliefs about asthma medication, cognitive and emotional factors are related to poor treatment adherence of asthma medication in a sample of asthma patients in Latvia. Methods Study subjects were asthma patients attending outpatient pulmonologist consultations in Latvia during September 2013 to December 2015. Beliefs about asthma medicine, cognitive and emotional factors related to asthma were determined in a cross-sectional, self-administered survey. The validated Beliefs about Medicines Questionnaire (BMQ) and the Brief Illness Perception Questionnaire (brief IPQ) were used. Treatment adherence was assessed using 5-item version of the Medication Adherence Reporting Scale (MARS). The total sample size was 352 patients. Logistic regression models were used to predict poor adherence to asthma treatment. The validity of each logistic regression model was assessed by the Hosmer/Lemeshow test. The main outcome measure was self-reported adherence to treatment. Results The more the patients agreed with the statement "My future health depends on my asthma medication" the lower the possibility of poor adherence to asthma treatment (OR 0.42; 95% CI 0.24-0.74). The more concerned the patients were in regard to long-term effects of their medication (OR 2; 95% CI 1.22-3.27), the higher the probability of poor treatment adherence. Conclusions Screening asthma patients using the BMQ may help to identify those to benefit from interventions targeting their concerns and medication beliefs in order to improve adherence to asthma medication.
  • Elfving, Pia; Puolakka, Kari; Rantalaiho, Vappu; Kautiainen, Hannu; Virta, Lauri J.; Kaipiainen-Seppänen, Oili (2018)
    Objectives of this study were to examine work disability (WD) and its leading causes in incident SLE patients. Data were derived from the Finnish nationwide registries to identify all non-retired, 18 to 64-year-old incident SLE patients between 2000 and 2007. Sick benefits and WD pensions and the causes for them were monitored until the end of 2008. A total of 446 working-aged, incident SLE patients available for work force (mean age 42 +/- 13 years, 89% females) were found. During the follow-up (median 5.3 years), WD pension was granted to 27 patients. The most common cause was SLE itself (14 patients, 52%), with cumulative incidence of 3.4% (95% CI 1.9 to 5.8) in 5 years and 5.0% (95% CI 3.0 to 8.5) in 8 years, followed by musculoskeletal and psychiatric causes. The age- and sex- adjusted incidence ratio for WD pension in SLE patients due to any cause was 5.4 (95% CI 3.7 to 7.9) compared to the Finnish population. The mean number of WD days was 32 (95% CI 28 to 35) per patient-year among all SLE patients during the follow-up. The study concludes that SLE patients have an increased risk for WD already in early course of the disease.
  • Biddle, Daniel J.; Hermens, Daniel F.; Lallukka, Tea; Aji, Melissa; Glozier, Nick (2019)
    Objectives: We evaluated whether insomnia symptoms and short or long sleep duration, alone or in combination, are robustly associated with subsequent trajectory of mental health symptoms. Methods: Participants were 2598 individuals (15 to 94 years of age) with elevated mental health symptoms at baseline (2013-14). Associations of baseline insomnia symptoms and sleep duration with two-year trajectory of mental health were estimated and adjusted for multiple potential confounders. Outcomes included recovery (well at both follow-up timepoints), intermittent symptoms (unwell at one follow-up timepoint), and chronic symptoms (unwell at each follow-up timepoint). Results: Adjusted for age and sex, baseline insomnia symptoms predicted intermittent (OR 1.43, 95% CI 1.15-1.80) and chronic (OR 2.16, 95% CI 1.77-2.68) trajectories of mental health symptoms. Short sleep duration (= 6 to Conclusion: A focus on just sleep duration or insomnia symptoms in those with elevated mental health symptoms will not be adequate to address chronicity. Both components of sleep disturbance, and in particular their co-occurrence, should be addressed. (c) 2018 Elsevier B.V. All rights reserved.
  • Pelkonen, Tuula; Sarajuuri, Anne; Rautanen, Tarja; Sinkkonen, Saku T.; Jero, Jussi (2017)
    We report on a previously healthy 11-year-old male presenting with meningoencephalitis and otitis media. Computed tomography demonstrated opacification of the right middle ear and mastoid ear cells, but no destructive changes. Anti-Mycoplasma pneumoniae IgG and IgM were positive in serum and at high concentrations in cerebrospinal fluid (CSF), and its nucleic acid was detected in the middle ear fluid and in a throat swab, but not in CSF. EEG showed generalized slowing and right temporal sharp waves. Brain MRI imaging remained normal. After a 3-week treatment with doxycycline and a tympanostomy tube, the patient recovered, and no long-term neurological sequelae have appeared. Diagnostics and pathogenetic mechanisms in meningoencephalitis caused by M. pneumoniae are discussed.
  • Keinänen, Jaakko; Mantere, Outi; Markkula, Niina; Partti, Krista; Perälä, Jonna; Saarni, Samuli I.; Härkänen, Tommi; Suvisaari, Jaana (2018)
    Objectives: We conducted a population based study aiming at finding predictors of mortality in psychotic disorders and evaluating the extent to which sociodemographic, lifestyle and health-related factors explain the excess mortality. Methods: In a nationally representative sample of Finns aged 30-70 years (n = 5642), psychotic disorders were diagnosed using structured interviews and medical records in 2000-2001. Information on mortality and causes of death was obtained of those who died by the end of year 2013. Cox proportional hazards models were used to investigate the mortality risk. Results: No people with affective psychoses (n = 36) died during the follow-up, thus the analysis was restricted to non-affective psychotic disorders (NAP) (n = 106). Adjusting for age and sex, NAP was statistically significantly associated with all-cause mortality (hazard ratio (HR) 2.99, 95% CI 2.03-441) and natural-cause mortality (HR 2.81, 95% CI 1.85-4.28). After adjusting for sociodemographic factors, health status, inflammation and smoking, the HR dropped to 2.11 (95%CI 1.10-4.05) for all-cause and to 1.98 (95% CI 0.94-4.16) for natural-cause mortality. Within the NAP group, antipsychotic use at baseline was associated with reduced HR for natural-cause mortality (HR 0.25, 95% CI 0.07-0.96), and smoking with increased HR (HR 3.54, 95% CI 1.07-11.69). Conclusions: The elevated mortality risk in people with NAP is only partly explained by socioeconomic factors, lifestyle, cardio-metabolic comorbidities and inflammation. Smoking cessation should be prioritized in treatment of psychotic disorders. More research is needed on the quality of treatment of somatic diseases in people with psychotic disorders. (C) 2017 Elsevier B.V. All rights reserved.
  • Mars, NJ; Kerola, AM; Kauppi, MJ; Pirinen, M; Elonheimo, O; Sokka-Isler, T (2019)
    Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA).Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization.Results: Cost distributions were similar between rheumatic diseases (p=0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs.Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.
  • Halonen, Jaana I.; Mänty, Minna; Pietiläinen, Olli; Kujanpää, Tero; Kanerva, Noora; Lahti, Jouni; Lahelma, Eero; Rahkonen, Ossi; Lallukka, Tea (2020)
    Purpose Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. Methods The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. Results Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. Conclusions Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.
  • Airaksinen, Jaakko; Jokela, Markus; Virtanen, Marianna; Oksanen, Tuula; Koskenvuo, Markku; Pentti, Jaana; Vahtera, Jussi; Kivimaki, Mika (2018)
    Objectives This study aimed to develop and validate a risk prediction model for long-term sickness absence. Methods Survey responses on work-and lifestyle-related questions from 65 775 public-sector employees were linked to sickness absence records to develop a prediction score for medically-certified sickness absence lasting > 9 days and >= 90 days. The score was externally validated using data from an independent population-based cohort of 13 527 employees. For both sickness absence outcomes, a full model including 46 candidate predictors was reduced to a parsimonious model using least-absolute-shrinkage-and-selection-operator (LASSO) regression. Predictive performance of the model was evaluated using C-index and calibration plots. Results Variance explained in >= 90-day sickness absence by the full model was 12.5%. In the parsimonious model, the predictors included self-rated health (linear and quadratic term), depression, sex, age (linear and quadratic), socioeconomic position, previous sickness absences, number of chronic diseases, smoking, shift work, working night shift, and quadratic terms for body mass index and Jenkins sleep scale. The discriminative ability of the score was good (C-index 0.74 in internal and 0.73 in external validation). Calibration plots confirmed high correspondence between the predicted and observed risk. In > 9-day sickness absence, the full model explained 15.2% of the variance explained, but the C-index of the parsimonious model was poor ( Conclusions Individuals' risk of a long-term sickness absence that lasts >= 90 days can be estimated using a brief risk score. The predictive performance of this score is comparable to those for established multifactorial risk algorithms for cardiovascular disease, such as the Framingham risk score.
  • Aronen, Matti; Viikari, Laura; Kohonen, Ia; Vuorinen, Tytti; Hämeenaho, Mira; Wuorela, Maarit; Sadeghi, Mohammadreza; Söderlund-Venermo, Maria; Viitanen, Matti; Jartti, Tuomas (2019)
    Background: In children suffering from severe lower airway illnesses, respiratory virus detection has given good prognostic information, but such reports in the elderly are scarce. Therefore, our aim was to study whether the detection of nasopharyngeal viral pathogens and conventional inflammatory markers in the frail elderly correlate to the presence, signs and symptoms or prognosis of radiographically-verified pneumonia. Methods: Consecutive episodes of hospital care of patients 65years and older with respiratory symptoms (N = 382) were prospectively studied as a cohort. Standard clinical questionnaire was filled by the study physician. Laboratory analyses included PCR diagnostics of nasopharyngeal swab samples for 14 respiratory viruses, C-reactive protein (CRP) and white blood cell count (WBC). Chest radiographs were systematically analysed by a study radiologist. The length of hospital stay, hospital revisit and death at ward were used as clinical endpoints. Results: Median age of the patients was 83years (range 76-90). Pneumonia was diagnosed in 112/382 (29%) of the studied episodes. One or more respiratory viruses were detected in 141/382 (37%) episodes and in 34/112 (30%) episodes also diagnosed with pneumonia. Pneumonia was associated with a WBC over 15 x 10(9)/L (P = .006) and a CRP value over 80 mg/l (P <.05). A virus was detected in 30% of pneumonia episodes and in 40% of non-pneumonia episodes, but this difference was not significant (P = 0.09). The presence of a respiratory virus was associated with fewer revisits to the hospital (P <.05), whereas a CRP value over 100 mg/l was associated with death during hospital stay (P <.05). Respiratory virus detections did not correlate to WBC or CRP values, signs and symptoms or prognosis of radiographically-verified pneumonia episodes. Conclusion: Among the elderly with respiratory symptoms, respiratory virus detection was not associated with an increased risk of pneumonia or with a more severe clinical course of the illness. CRP and WBC remain important indicators of pneumonia, and according to our findings, pneumonia should be treated as a bacterial disease regardless of the virus findings. Our data does not support routine virus diagnostics for the elderly patients with pneumonia outside the epidemic seasons.
  • Mikola, Emilia; Palomares, Oscar; Turunen, Riitta; Waris, Matti; Ivaska, Lotta E.; Silvoniemi, Antti; Puhakka, Tuomo; Rückert, Beate; Vuorinen, Tytti; Akdis, Mübeccel; Akdis, Cezmi A.; Jartti, Tuomas (2019)
    Background Rhinovirus A and C infections are important contributors to asthma induction and exacerbations. No data exist on the interaction of local immune responses in rhinovirus infection. Therefore, we aimed to determine the tonsillar immune responses according to rhinovirus A, B and C infections. Methods We collected tonsillar samples, nasopharyngeal aspirates and peripheral blood from 42 rhinovirus positive tonsillectomy patients. Fifteen respiratory viruses or their types were investigated from nasopharynx and tonsil tissue, and rhinovirus species were typed. The expression of 10 cytokines and 4 transcription factors (IFN-alpha, IFN-beta, IFN-gamma, IL-10, IL-13, IL-17, IL-28, IL-29, IL-37, TGF-beta, FOXP3, GATA3, RORC2 and Tbet) were studied from tonsil tissue by quantitative PCR. A standard questionnaire of respiratory symptoms and health was filled by the patient or his/her guardian. The patients were divided into three groups by the determination of rhinovirus species. Results Overall, 16 patients had rhinovirus A, 12 rhinovirus B and 14 rhinovirus C infection. In rhinovirus B positive group there were significantly less men (P = 0.0072), less operated in spring (P = 0.0096) and more operated in fall (P = 0.030) than in rhinovirus A or C groups. Rhinovirus A positive patients had more respiratory symptoms (P = 0.0074) and particularly rhinitis (P = 0.036) on the operation day. There were no significant differences between the groups in virus codetection. In adjusted analysis, rhinovirus C infections were associated with increased IFN-alpha (P = 0.045) and decreased RORC2 expression (P = 0.025). Conclusions Rhinovirus species associated differently with clinical characteristics and tonsillar cytokine responses.
  • Paananen, Jenny; Lindholm, Camilla; Stevanovic, Melisa; Weiste, Elina (2020)
    Mental illness remains as one of the most stigmatizing conditions in contemporary western societies. This study sheds light on how mental health professionals and rehabilitants perceive stigmatization. The qualitative study is based on stimulated focus group interviews conducted in five Finnish mental health rehabilitation centers that follow the Clubhouse model. The findings were analyzed through inductive content analysis. Both the mental health rehabilitants and the professionals perceived stigmatization as a phenomenon that concerns the majority of rehabilitants. However, whereas the professionals viewed stigma as something that is inflicted upon the mentally ill from the outside, the rehabilitants perceived stigma as something that the mentally ill themselves can influence by advancing their own confidence, shame management, and recovery. Improvements in treatment, along with media coverage, were seen as the factors that reduce stigmatization, but the same conceptualization did not hold for serious mental illnesses. As the average Clubhouse client was thought to be a person with serious mental illness, the rehabilitation context designed to normalize attitudes toward mental health problems was paradoxically perceived to enforce the concept of inevitable stigma. Therefore, it is important for professionals in rehabilitation communities to be reflexively aware of these tensions when supporting the rehabilitants.
  • Finell, Eerika; Vainio, Annukka (2020)
    It has been well documented that both risk perception and group identification are related to psychosocial well-being. However, their combined effect has rarely been analyzed. We examined the combined effect of perceived risk associated with COVID-19 infection at work and work community identification on psychosocial well-being (i.e., frequency of stress symptoms) among health care and social sector workers in Finland (N = 1279). Data were collected via an online questionnaire in June 2020 and analyses of covariance were conducted. Perceived COVID-19 infection risk at work was classified into high, medium and low risk. In total, 41% of participants reported a high risk. After all background variables were included, participants who reported high perceived infection risk and low work community identification reported stress symptoms more often than those who reported high perceived risk and high identification (p = 0.010). Similarly, the former differed significantly from all other comparison groups (medium and low risk, p <0.001), being the most stressed. We found that perceived infection risk and work community identification were not related to each other. Our conclusion is that high work community identification can buffer employee stress when faced with a high perceived health risk. In the context of the COVID-19 pandemic, work organizations with a high infection risk should advance the possibility of employees' identification with their work community.
  • Mildh, Henriikka; Pettilä, Ville; Korhonen, Anna-Maija; Karlsson, Sari; Ala-Kokko, Tero; Reinikainen, Matti; Vaara, Suvi; FINNAKI Study Grp (2016)
    Background: The role of an episode of acute kidney injury (AKI) in long-term mortality among initial survivors of critical illness is controversial. We aimed to determine whether AKI is independently associated with decreased survival at 3 years among 30-day survivors of intensive care. Results: We included 2336 30-day survivors of intensive care enrolled in the FINNAKI study conducted in seventeen medical-surgical ICUs in Finland during a 5-month period in 2011-2012. The incidence of AKI, defined by the Kidney Disease: Improving Global Outcomes criteria, was 34.6%, and 192 (8.3%) commenced RRT. The 3-year mortality among AKI patients was 23.5% (95% CI 20.6-26.4%) compared to 18.9% (17.0-20.9%) of patients without AKI, p = 0.01. However, after adjustments using Cox proportional hazards regression, AKI was not associated with decreased 3-year survival (HR 1.05; CI 95% 0.86-1.27), whereas advanced age, poor pre-morbid functional performance, and presence of several comorbidities were. Additionally, we matched AKI patients to non-AKI patients 1: 1 according to age, gender, presence of severe sepsis, and a propensity score to develop AKI. In the well-balanced matched cohort, 3-year mortality among AKI patients was 136 of 662 (20.5%; 17.5-23.6%) and among matched non-AKI patients 143 of 662 (21.6%; 18.5-24.7%), p = 0.687. Neither AKI nor RRT was associated with decreased survival at 3 years in the sensitivity analyses that excluded patients (1) with chronic kidney disease, (2) with AKI not commenced renal replacement therapy (RRT), and (3) with estimated pre-admission creatinine, chronic kidney disease, or AKI stage 1. Conclusion: AKI was not an independent risk factor for 3-year mortality among 30-day survivors. Increased 3-year mortality among patients with AKI who survive critical illness may not be related to AKI per se, but rather to advanced age and pre-existing comorbidities.