Browsing by Subject "MEDICATION"

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  • Rautamo, Maria M; Kvarnström, Kirsi; Siven, Mia; Airaksinen, Marja; Lahdenne, Pekka Olavi; Sandler, Niklas (2020)
    Oral drug administration to pediatric patients is characterized by a lack of age-appropriate drug products and the off-label use of medicines. However, drug administration practices at hospital wards is a scarcely studied subject. The aim of this study was to explore the oral drug administration practices at pediatric hospital wards, with a focus on experiences and challenges faced, methods used to mitigate existing problems, drug manipulation habits, perceptions about oral dosage forms and future needs of oral dosage forms for children. This was a qualitative study consisting of focus group discussions with physicians, nurses and clinical pharmacists in a tertiary university hospital with the objective of bringing forward a holistic view on this research topic. These healthcare professionals recognized different administration challenges that were classified as either dosage form-related or patient-related ones. A lack of depot formulations developed especially for children as well as oral pediatric dosage forms of drug substances currently available as intravenous dosage forms was recognized. The preferred oral dosage forms were oral liquids and orodispersible tablets. Patient-centered drug administration practices including factors facilitating drug administration both at hospital wards and at home after patient discharge were identified. Among all healthcare professionals, the efficient cooperation in drug prescribing and administration as well as in educating the child's caregivers in correct administration techniques before discharge and improving the overall discharge process of patients was emphasized. This study complements the prevalent understanding that new dosage forms for children of varying ages and stages of development are still needed. It also brings a holistic view on different aspects of oral drug administration to pediatric patients and overall patient-centered drug administration practices.
  • Tiili, Paula; Leventis, Ioannis; Kinnunen, Janne; Svedjebäck, Ida; Lehto, Mika; Karagkiozi, Efstathia; Sagris, Dimitrios; Ntaios, George; Putaala, Jukka (2021)
    Background Non-vitamin K antagonist oral anticoagulants (NOAC) have superior safety and comparable efficacy profile compared to vitamin-K antagonists (VKAs), with more convenient dosing schemes. However, issues with adherence to the NOACs remain unsolved. Aims We sought to investigate the adherence to oral anticoagulation (OAC) and baseline factors associated with poor adherence after ischaemic stroke in patients with atrial fibrillation (AF). Methods We recruited hospitalised patients (2013-2019) from two prospective stroke registries in Larissa and Helsinki University Hospitals and invited survived patients to participate in a telephone interview. We assessed adherence with the Adherence to Refills and Medications Scale (ARMS) and defined poor adherence as a score of over 17. In addition to demographics, individual comorbidities, and stroke features, we assessed the association of CHA(2)DS(2)-VASc and SAMe-TT2R2 scores with poor adherence. Results Among 396 patients (median age 75.0 years, interquartile range [IQR] 70-80; 57% men; median time from ischaemic stroke to interview 21 months [IQR 12-33]; median ARMS score 17 [IQR 17-19]), 56% of warfarin users and 44% of NOAC users reported poor adherence. In the multivariable regression model adjusted for site, sex, and age, poor adherence was independently associated with tertiary education, absence of heart failure, smoking history, use of VKA prior to index stroke, and prior ischaemic stroke. CHA(2)DS(2)-VASc and SAMe-TT2R2 scores were not associated with poor adherence. Conclusions Adherence was poor in half of AF patients who survived an ischaemic stroke. Independent patient-related factors, rather than composite scores, were associated with poor adherence in these patients. KEY MESSAGES Adherence was poor in half of the atrial fibrillation patients who survived an ischaemic stroke. Independent patient-related factors rather than composite scores were associated with poor adherence. The findings support the importance of recognising adherence support as a crucial part of holistic patient care recommended by recent AF guideline.
  • Celikkayalar, Ercan; Airaksinen, Marja; Kivelä, Sirkka-Liisa; Nieminen, Jenni; Kleme, Jenni; Puustinen, Juha (2021)
    Purpose: The use of benzodiazepines and related drugs (BZD) is common among older adults although there is growing evidence of their harmful effects. This study investigated how well older people are aware of the potential risks related to the BZD they are taking and whether the risk awareness has changed in the years between 2004 and 2015. Patients and Methods: The data were collected by interviewing BZD using home-dwelling patients aged >= 65 years with normal cognitive function (MMSE >= 20) who were admitted to the hospital within a 1 month study period in the years 2004 and 2015. Patients were asked whether they were aware of the ten main potential risks related to BZD use. A risk awareness score (range 0-10) was assessed for each patient, each known potential risk yielding one point. Results: The study included 37 patients in 2004 and 31 patients in 2015. In 2004,6/37 patients (16%), while 16/31 patients (52%) in 2015 had risk awareness scores between 6 and 10. Awareness of dependence (p=0.047), interaction with alcohol (p=0.001), dizziness (p=0.002) and developing tolerance (p=0.002) had improved, while awareness of the other potential risks remained unchanged, muscle weakness being the least known (3/37 in 2004 and 4/31 in 2015 were aware of it as a potential risk). Regular BZD use had declined (p=0.043) but pro re nata (PRN; when required) BZD use had increased (p=0.003) between the years 2004 and 2015. Conclusion: Older BZD users' awareness of some potential risks related to BZD use (dependence, interaction with alcohol, dizziness and developing tolerance) had improved between 2004 and 2015, while awareness of other potential risks remained unchanged.
  • Teppo, Konsta; Jaakkola, Jussi; Biancari, Fausto; Halminen, Olli; Linna, Miika; Haukka, Jari; Putaala, Jukka; Tiili, Paula; Lehtonen, Ossi; Niemi, Mikko; Mustonen, Pirjo; Kinnunen, Janne; Hartikainen, Juha; Airaksinen, K. E. Juhani; Lehto, Mika (2022)
    Low socioeconomic status has been associated with poor outcomes in patients with atrial fibrillation (AF). However, little is known about socioeconomic disparities in adherence to stroke prevention with direct oral anticoagulants (DOACs). We assessed the hypothesis that AF patients with higher income or educational levels have better adherence to DOACs in terms of treatment implementation and persistence. The used nationwide registry-based FinACAF cohort covers all patients with incident AF starting DOACs in Finland during 2011-2018. The implementation analyses included 74 222 (mean age 72.7 +/- 10.5 years, 50.8% female) patients, and persistence analyses included 67 503 (mean age 75.3 +/- 8.9 years, 53.6% female) patients with indication for permanent anticoagulation (CHA(2)DS(2)-VASc score >1 in men and >2 in women). Patients were divided into income quartiles and into three categories based on their educational attainment. Therapy implementation was measured using the medication possession ratio (MPR), and patients with MPR >= 0.90 were defined adherent. Persistence was measured as the incidence of therapy discontinuation, defined as the first 135-day period without DOAC purchases after drug initiation. Patients with higher income or education were consistently more likely adherent to DOACs in the implementation phase (comparing the highest income or educational category to the lowest adjusted odds ratios 1.18 (1.12-1.25) and 1.21(1.15-1.27), respectively). No association with income or educational levels was observed on the incidence of therapy discontinuation. In conclusion, we observed that income and educational levels both have independent positive association on the implementation of DOAC therapy but no association on therapy persistence in patients with AF.
  • Ruonala, Verneri; Pekkonen, Eero; Airaksinen, Olavi; Kankaanpää, Markku; Karjalainen, Pasi A.; Rissanen, Saara M. (2022)
    Objective Deep brain stimulation (DBS) is an effective treatment for motor symptoms of advanced Parkinson's disease (PD). Currently, DBS programming outcome is based on a clinical assessment. In an optimal situation, an objectively measurable feature would assist the operator to select the appropriate settings for DBS. Surface electromyographic (EMG) measurements have been used to characterise the motor symptoms of PD with good results; with proper methodology, these measurements could be used as an aid to program DBS. Methods Muscle activation measurements were performed for 13 patients who had advanced PD and were treated with DBS. The DBS pulse voltage, frequency, and width were changed during the measurements. The measured EMG signals were analysed with parameters that characterise the EMG signal morphology, and the results were compared to the clinical outcome of the adjustment. Results The EMG signal correlation dimension, recurrence rate, and kurtosis changed significantly when the DBS settings were changed. DBS adjustment affected the signal recurrence rate the most. Relative to the optimal settings, increased recurrence rates (median ± IQR) 1.1 ± 0.5 (-0.3 V), 1.3 ± 1.1 (+0.3 V), 1.7 ± 0.4 (-30 Hz), 1.7 ± 0.8 (+30 Hz), 2.0 ± 1.7 (+30 μs), and 1.5 ± 1.1 (DBS off) were observed. With optimal stimulation settings, the patients' Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) score decreased by 35% on average compared to turning the device off. However, the changes in UPRDS-III arm tremor and rigidity scores did not differ significantly in any settings compared to the optimal stimulation settings. Conclusion Adjustment of DBS treatment alters the muscle activation patterns in PD patients. The changes in the muscle activation patterns can be observed with EMG, and the parameters calculated from the signals differ between optimal and non-optimal settings of DBS. This provides a possibility for using the EMG-based measurement to aid the clinicians to adjust the DBS.
  • Tähkäpää, Sanna-Mari; Saastamoinen, Leena; Airaksinen, Marja; Tuulio-Henriksson, Annamari; Aalto-Setälä, Terhi; Kurko, Terhi (2018)
    Objective: Patterns of benzodiazepine (BZD) use and long-term use among young adults are not well known. Our aim was to study trends in BZD use and long-term use among 18-25-year-old young adults by gender and active substance in a nationwide retrospective longitudinal register-based setting. Methods: All Finns aged 18-25 years with reimbursed purchases of BZDs in 2006-2014 recorded to the Finnish Prescription Register were included. Annual prevalence rates of BZD use and long-term use among young adults were reported overall, according to gender, drug group (anxiolytic or hypnotic), and active substance. Long-term use of BZDs was defined as purchasing 180 Defined Daily Doses (DDDs) in at least two drug purchases during a calendar year. Results: Overall prevalence of BZD use among young adults decreased from 24.0 to 18.8 users per 1000 inhabitants in 2006-2014. Prevalence of long-term use decreased from 5.5 to 3.3 users per 1000 inhabitants. Overall BZD use was higher among females, whereas long-term use was more common among males. Use of anxiolytics was more common than use of hypnotics. Oxazepam, alprazolam, zopiclone, and zolpidem were the most used BZDs, whereas alprazolam and clonazepam were the substances with most long-term use. The use and long-term use of BZDs have decreased annually since 2008 among Finnish young adults. Further research is needed to investigate the reasons behind the decline.
  • Weiste, Elina; Stevanovic, Melisa; Valkeapää, Taina; Valkiaranta, Kaisa; Lindholm, Camilla (2021)
    Being identified as “mentally ill” is a complicated social process that may be stigmatizing and socially problematic, as a mental illness diagnosis determines the criteria for what is considered normal. This has given rise to a number of anti-stigma campaigns designed to create awareness of the way stigmas affect people with mental health difficulties and to normalize those difficulties in society. One such campaign is the “diagnosis-free zone”, which declares that those with mental health difficulties should not be categorized on the basis of their diagnosis; rather, they should be encountered as full individuals. In this paper, we investigate how mental health difficulties are discussed in Clubhouse communities, which adhere to the “diagnosis free zone” programme. The findings are based on conversation analysis of 29 video-recorded rehabilitation group meetings, in one Finnish Clubhouse, intended to advance clients' return to the labour market. The analysis demonstrated that members referred to their mental health difficulties to explain the misfortunes in their lives, especially interruptions and stoppages in their careers. By contrast, staff members disattended members’ explanations and normalized their situations as typical of all humans and thus unrelated to their mental health difficulties as such. In this way, the discussion of mental health difficulties at the Clubhouse meetings was implicitly discouraged. We propose that the standards of normality expected of a person not suffering from a mental health difficulty may well be different from the expectations levelled at participants with a history of mental problems. Therefore, instead of considering cultural expectations of normality to be a unified domain, effective anti-stigma work might sometimes benefit from referring to mental-health diagnoses as a means of explicitly tailoring expectations of normality.
  • Rossi, Vilma; Salimäki, Johanna; Sandler, Charlotta; Airaksinen, Marja; Kauppi, Paula (2021)
    Objectives: The objective of this study was to examine how Inhalation Technique Assessment Service (ITAS) by community pharmacies affect patients' inhalation techniques when using the Respimat (R) soft mist inhaler. The inhaler was simultaneously updated into a reusable inhaler. The study focused on the Respimat (R) inhaler because its use is known to be challenging for patients. Methods: The study was performed as a pre-post design in 33 community pharmacies (CPs) in Finland. Patients' inhalation technique was assessed before ITAS (baseline) and immediately after ITAS (follow-up 1). Follow-up 2 was performed when the patient came to the pharmacy for a refill (1-3 months after the baseline and the followup 1). A Respimat specific twenty item checklist was used to assess inhalation technique. The checklist included 1) preparation steps before the first use of the Respimat (R) inhaler (8 items) and 2) daily use steps of the Respimat (R) inhaler (12 items). After ITAS, the patients received a brief questionnaire to assess their asthma/ COPD history. Results: A total of 228 patients were enrolled at the first visit (mean age 67.8 years, 61.0% female, 85.5% had previous Respimat (R) use experience) and 42 of them attended the follow-up 2, 1-3 months later (mean age 70.1 years, 69.0% female, 92.9% had previous Respimat (R) use experience. The median number of the steps performed correctly increased from 17/20 at the baseline to all the 20 steps at the follow-up 1 (p < 0.001). At the baseline, 27.6% of the patients (n = 228) performed all preparation steps correctly, while 87.3% at the follow-up 1 and 71.4% at the follow-up 2. The percentage of the patients with acceptable inhalation technique (all critical daily use steps correct) increased from 69.7% at the baseline to 93.0% at the follow-up 1 (p < 0.001). The corresponding figure at the follow-up 2 was 69.0%. At the baseline, 30.3% of patients had optimal inhalation technique (all daily use steps correct). At the follow-up 1 corresponding figure was 85.1%, and 54.8% at the followup 2. Conclusions: A pharmacist-led intervention significantly improved asthma and COPD patients' inhalation technique with the Respimat (R) inhaler. Significant improvements were found in the daily use steps and the preparation steps before the first use.
  • Taipale, Heidi; Särkilä, Hanna; Tanskanen, Antti; Kurko, Terhi; Taiminen, Tero; Tiihonen, Jari; Sund, Reijo; Tuulio-Henriksson, Annamari; Saastamoinen, Leena; Hietala, Jarmo (2020)
    This cohort study uses national longitudinal data from the Social Insurance Institution of Finland to investigate the incidence of long-term use of benzodiazepines and related drugs among new users and factors associated with development of long-term use. Importance The proportion of patients who develop long-term benzodiazepine use remains controversial, as do the length of time before long-term use develops and the factors associated with long-term use. Objective To investigate the incidence of long-term benzodiazepine and related drug (BZDR) use and factors associated with the development of long-term use implementing a follow-up design with new BZDR users. Design, Setting, and Participants This population-based cohort study used a nationwide cohort of 129x202f;732 new BZDR users in Finland. New users of BZDRs aged 18 years or older were identified from the prescription register maintained by the Social Insurance Institution of Finland as individuals who initiated BZDR use during 2006 and had not used BZDRs from 2004 to 2005. The follow-up continued until death, long-term hospitalization, a gap of 2 years in BZDR use, or December 31, 2015. The population was analyzed according to age at treatment initiation, categorized into younger (= 65 years) subcohorts. Analyses were conducted from May 2019 to February 2020. Exposures Use of BZDRs, modeled from register-based data using the PRE2DUP (from prescriptions to drug use periods) method. Main Outcomes and Measures Long-term BZDR use, defined as continuous use of 180 days or longer, and factors associated with long-term vs short-term use, compared using Cox proportional hazards models. Results Among the 129x202f;732 incident BZDR users, the mean (SD) age was 52.6 (17.7) years, and 78x202f;017 (60.1%) individuals were women. During the follow-up period, 51x202f;099 BZDR users (39.4%) became long-term users. Long-term treatment was more common in the older subcohort (19x202f;103 individuals [54.5%]) than the younger subcohort (31x202f;996 individuals [33.8%]). At 6 months, 28x202f;586 individuals (22.0%) had become long-term users: 11x202f;805 (33.7%) in the older subcohort and 16x202f;781 (17.7%) in the younger subcohort. The largest proportions of initiators who became long-term users were those persons who initiated treatment with nitrazepam (76.4%; 95% CI, 73.6%-79.1%), temazepam (63.9%; 95% CI, 62.9%-65.0%), lorazepam (62.4%; 95% CI, 59.7%-65.1%), or clonazepam (57.5%; 95% CI, 55.9%-59.2%). Factors associated with the development of long-term use included male sex, older age, receipt of social benefits, psychiatric comorbidities, and substance abuse. Conclusions and Relevance The findings of this population-based cohort study conducted in Finland suggest that the incidence of subsequent long-term BZDR use in individuals who initiate use of BZDRs is high, especially among older persons, and that the specific BZDR used initially is associated with the development of long-term BZDR use and should be carefully considered when prescribing BZDRs. The observed factors that appear to be associated with development of long-term BZDR use also should be considered in clinical decision-making when starting and monitoring BZDR treatment. Questions What is the incidence of long-term use of benzodiazepines and related drugs (BZDRs) in persons who start new BZDR treatment, and what factors are associated with the development of long-term use? Findings In a cohort study of 129x202f;732 new BZDR users in Finland, 34% of working-aged persons and 55% of older persons developed long-term use. Higher rates of long-term use were associated with specific drugs, namely, nitrazepam, temazepam, lorazepam, and clonazepam. Meaning Despite guidelines and recommendations, BZDRs are still prescribed frequently for long-term treatment, especially in older persons, and the initial choice of a specific BZDR is associated with development of long-term BZDR use.
  • Noda, Toshie; Sugiyama, Naoya; Sato, Makiko; Ito, Hiroto; Sailas, Eila; Putkonen, Hanna; Kontio, Raija; Joffe, Grigori (2013)
  • Ruonala, Verneri; Pekkonen, Eero; Airaksinen, Olavi; Kankaanpää, Markku; Karjalainen, Pasi A.; Rissanen, Saara M. (2018)
    Levodopa medication is the most efficient treatment for motor symptoms of Parkinson's disease (PD). Levodopa significantly alleviates rigidity, rest tremor, and bradykinesia in PD. The severity of motor symptoms can be graded with UPDRS-III scale. Levodopa challenge test is routinely used to assess patients' eligibility to deep-brain stimulation (DBS) in PD. Feasible and objective measurements to assess motor symptoms of PD during levodopa challenge test would be helpful in unifying the treatment. Twelve patients with advanced PD who were candidates for DBS treatment were recruited to the study. Measurements were done in four phases before and after levodopa challenge test. Rest tremor and rigidity were evaluated using UPDRS-III score. Electromyographic (EMG) signals from biceps brachii and kinematic signals from forearm were recorded with wireless measurement setup. The patients performed two different tasks: arm isometric tension and arm passive flexion-extension. The electromyographic and the kinematic signals were analyzed with parametric, principal component, and spectrum-based approaches. The principal component approach for isometric tension EMG signals showed significant decline in characteristics related to PD during levodopa challenge test. The spectral approach on passive flexion-extension EMG signals showed a significant decrease on involuntary muscle activity during the levodopa challenge test. Both effects were stronger during the levodopa challenge test compared to that of patients' personal medication. There were no significant changes in the parametric approach for EMG and kinematic signals during the measurement. The results show that a wireless and wearable measurement and analysis can be used to study the effect of levodopa medication in advanced Parkinson's disease.
  • Huhtaniska, Sanna; Jaaskelainen, Erika; Heikka, Tuomas; Moilanen, Jani S.; Lehtiniemi, Heli; Tohka, Jussi; Manjon, Jose V.; Coupe, Pierrick; Bjornholm, Lassi; Koponen, Hannu; Veijola, Juha; Isohanni, Matti; Kiviniemi, Vesa; Murray, Graham K.; Miettunen, Jouko (2017)
    High doses of antipsychotics have been associated with loss in cortical and total gray matter in schizophrenia. However, previous imaging studies have not taken benzodiazepine use into account, in spite of evidence suggesting adverse effects such as cognitive impairment and increased mortality. In this Northern Finland Birth Cohort 1966 study, 69 controls and 38 individuals with schizophrenia underwent brain MRI at the ages of 34 and 43 years. At baseline, the average illness duration was over 10 years. Brain structures were delineated using an automated volumetry system, volBrain, and medication data on cumulative antipsychotic and benzodiazepine doses were collected using medical records and interviews. We used linear regression with intracranial volume and sex as covariates; illness severity was also taken into account. Though both medication doses associated to volumetric changes in subcortical structures, after adjusting for each other and the average PANSS total score, higher scan-interval antipsychotic dose associated only to volume increase in lateral ventricles and higher benzodiazepine dose associated with volume decrease in the caudate nucleus. To our knowledge, there are no previous studies reporting associations between benzodiazepine dose and brain structural changes. Further studies should focus on how these observations correspond to cognition and functioning.
  • Robinson, Rachel; Lahti-Pulkkinen, Marius; Schnitzlein, Daniel; Voit, Falk; Girchenko, Polina; Wolke, Dieter; Lemola, Sakari; Kajantie, Eero; Heinonen, Kati; Räikkönen, Katri (2020)
    Preterm birth research is poised to explore the mental health of adults born very preterm(VP;1970) included VP/VLBW individuals with controls born at term(≥37+0 weeks) or with normal birth weight(NBW; ≥2500g). Thirteen studies were included. Studies consistently showed an increased risk for psychotropic medication use for VP/VLBW adults in comparison to NBW/term controls, but whether VP/VLBW adults have an increased risk for mental health disorders or symptoms appearing in adulthood remains uncertain. The quality of the evidence was moderate (65.8%) to high (34.2%). Further research in larger samples is needed.
  • Herttua, Kimmo; Martikainen, Pekka; Batty, G. David; Kivimäki, Mika (2016)
    BACKGROUND Poor adherence to medication regimens is common, potentially contributing to the occurrence of related disease. OBJECTIVES The authors sought to assess the risk of fatal stroke associated with nonadherence to statin and/ or antihypertensive therapy. METHODS We conducted a population-based study using electronic medical and prescription records from Finnish national registers in 1995 to 2007. Of the 58,266 hypercholesterolemia patients age 30+ years without pre-existing stroke or cardiovascular disease, 532 patients died of stroke (cases), and 57,734 remained free of incident stroke (controls) during the mean follow-up of 5.5 years. We captured year-by-year adherence to statin and antihypertensive therapy in both study groups and estimated the excess risk of stroke death associated with nonadherence. RESULTS In all hypercholesterolemia patients, the adjusted odds ratio for stroke death for nonadherent compared with adherent statin users was 1.35 (95% confidence interval [CI] 1.04 to 1.74) 4 years before and 2.04 (95% CI: 1.72 to 2.43) at the year of stroke death or the end of the follow-up. In hypercholesterolemia patients with hypertension, relative to those who adhered to statins and antihypertensive therapy, the odds ratio at the year of stroke death was 7.43 (95% CI: 5.22 to 10.59) for those nonadherent both to statin and antihypertensive therapy, 1.82 (95% CI: 1.43 to 2.33) for those non-adherent to statin but adherent to antihypertensive therapy, and 1.30 (95% CI: 0.53 to 3.20) for those adherent to statin, but nonadherent to antihypertensive, therapy. CONCLUSIONS Individuals with hypercholesterolemia and hypertension who fail to take their prescribed statin and antihypertensive medication experience a substantially increased risk of fatal stroke. The risk is lower if the patient is adherent to either one of these therapies. (C) 2016 by the American College of Cardiology Foundation.
  • Ranjit, Anu; Buchwald, Jadwiga; Latvala, Antti; Heikkila, Kauko; Tuulio-Henriksson, Annamari; Rose, Richard J.; Kaprio, Jaakko; Korhonen, Tellervo (2019)
    Longitudinal, genetically informative studies of the association between cigarette smoking and depressive symptoms among adolescents are limited. We examined the longitudinal association of cigarette smoking with subsequent depressive symptoms during adolescence in a Finnish twin cohort. We used prospective data from the population-based FinnTwin12 study (maximum N = 4152 individuals, 1910 twin pairs). Current smoking status and a number of lifetime cigarettes smoked were assessed at the age of 14 and depressive symptoms at the age of 17. Negative binomial regression was conducted to model the association between smoking behavior and subsequent depressive symptoms among individuals, and within-pair analyses were conducted to control for unmeasured familial confounding. Analyses were adjusted for age, sex, school grades, drinking alcohol to intoxication, health status, family structure, parental education, and smoking, as well as for pre-existing depressiveness. The results of the individual-level analyses showed that cigarette smoking at the age of 14 predicted depressive symptoms at the age of 17. Compared to never smokers, those who had smoked over 50 cigarettes (incidence rate ratio, IRR = 1.43, 95% CI 1.28-1.60) and regular smokers (IRR = 1.46, 95% CI 1.32-1.62) had higher depression scores. The associations were attenuated when adjusted for measured covariates and further reduced in within-pair analyses. In the within-pair results, the estimates were lower within monozygotic (MZ) pairs compared to dizygotic (DZ) pairs, suggesting that shared genetic factors contribute to the associations observed in individual-based analyses. Thus, we conclude that cigarette smoking is associated with subsequent depressive symptoms during adolescence, but the association is not independent of measured confounding factors and shared genetic influences.
  • Hendriksen, L. C.; van der Linden, P. D.; Lagro-Janssen, A. L. M.; van den Bemt, P. M. L. A.; Siiskonen, S. J.; Teichert, M.; Kuiper, J. G.; Herings, R. M. C.; Stricker, B. H.; Visser, L. E. (2021)
    Background Adverse drug events, including adverse drug reactions (ADRs), are responsible for approximately 5% of unplanned hospital admissions: a major health concern. Women are 1.5-1.7 times more likely to develop ADRs. The main objective was to identify sex differences in the types and number of ADRs leading to hospital admission. Methods ADR-related hospital admissions between 2005 and 2017 were identified from the PHARMO Database Network using hospital discharge diagnoses. Patients aged >= 16 years with a drug possibly responsible for the ADR and dispensed within 3 months before admission were included. Age-adjusted odds ratios (OR) with 95% CIs for drug-ADR combinations for women versus men were calculated. Results A total of 18,469 ADR-related hospital admissions involving women (0.35% of all women admitted) and 14,678 admissions involving men (0.35% of all men admitted) were included. Most substantial differences were seen in ADRs due to anticoagulants and diuretics. Anticoagulants showed a lower risk of admission with persistent haematuria (ORadj 0.31; 95%CI 0.21, 0.45) haemoptysis (ORadj 0.47, 95%CI 0.30,0.74) and subdural haemorrhage (ORadj 0.61; 95%CI 0.42,0.88) in women than in men and a higher risk of rectal bleeding in women (ORadj 1.48; 95%CI 1.04,2.11). Also, there was a higher risk of admission in women using thiazide diuretics causing hypokalaemia (ORadj 3.03; 95%CI 1.58, 5.79) and hyponatraemia (ORadj 3.33, 95%CI 2.31, 4.81) than in men. Conclusions There are sex-related differences in the risk of hospital admission in specific drug-ADR combinations. The most substantial differences were due to anticoagulants and diuretics.
  • Rissanen, Saara M.; Ruonala, Verneri; Pekkonen, Eero; Kankaanpaa, Markku; Airaksinen, Olavi; Karjalainen, Pasi A. (2015)
    Objective: Electromyography (EMG) and acceleration (ACC) measurements are potential methods for quantifying efficacy of deep brain stimulation (DBS) treatment in Parkinson's disease (PD). The treatment efficacy depends on the settings of DBS parameters (pulse amplitude, frequency and width). This study quantified, if EMG and ACC signal features differ between different DBS settings and if DBS effect is unequal between different muscles. Methods: EMGs were measured from biceps brachii (BB) and tibialis anterior (TA) muscles of 13 PD patients. ACCs were measured from wrists. Measurements were performed during seven different settings of DBS and analyzed using methods based on spectral analysis, signal morphology and nonlinear dynamics. Results: The results showed significant within-subject differences in the EMG signal kurtosis, correlation dimension, recurrence rate and EMG-ACC coherence between different DBS settings for BB but not for TA muscles. Correlations between EMG feature values and clinical rest tremor and rigidity scores were weak but significant. Conclusions: Surface EMG features differed between different DBS settings and DBS effect was unequal between upper and lower limb muscles. Significance: EMG changes pointed to previously defined optimal settings in most of patients, which should be quantified even more deeply in the upcoming studies. (C) 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
  • Lähteenmäki, Ritva; Neuvonen, Pertti J.; Puustinen, Juha; Vahlberg, Tero; Partinen, Markku; Räihä, Ismo; Kivelä, Sirkka-Liisa (2019)
    Long-term use of benzodiazepines or benzodiazepine receptor agonists is widespread, although guidelines recommend short-term use. Only few controlled studies have characterized the effect of discontinuation of their chronic use on sleep and quality of life. We studied perceived sleep and quality of life in 92 older (age 55-91 years) outpatients with primary insomnia before and after withdrawal from long-term use of zopiclone, zolpidem or temazepam (BZDA). BZDA was withdrawn during 1 month, during which the participants received psychosocial support and blindly melatonin or placebo. A questionnaire was used to study perceived sleep and quality of life before withdrawal, and 1 month and 6 months later. 89 participants completed the 6-month follow-up. As melatonin did not improve withdrawal, all participants were pooled and then separated based solely on the withdrawal results at 6 months (34 Withdrawers. 55 Nonwithdrawers) for this secondary analysis. At 6 months, the Withdrawers had significantly (P <0.05) shorter sleep-onset latency and less difficulty in initiating sleep than at baseline and when compared to Nonwithdrawers. Compared to baseline, both Withdrawers and Nonwithdrawers had at 6 months significantly (P <0.05) less fatigue during the morning and daytime. Stress was alleviated more in Withdrawers than in Nonwithdrawers (P <0.05). Satisfaction with life and expected health 1 year later improved (P <0.05) in Withdrawers. In conclusion, sleep disturbances, daytime fatigue and impaired quality of life may resolve within 6 months of BZDA withdrawal. These results encourage withdrawal from chronic use of benzodiazepine-type hypnotics, particularly in older subjects.