Browsing by Subject "Middle Aged"

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  • Pietarinen, Petra; Suomela, Jarkko (2021)
    Juuri koronaepidemian alkaessa 58-vuotias nainen otti yhteyttä terveysasemalle. Hän kertoi, että ääni särkyy lyhyenkin puhumisen aikana ja samalla alkaa yskittää.
  • Heikinheimo, Terttu; Aarnio, Karoliina; Koivunen, Riku-Jaakko; Tatlisumak, Turgut; Putaala, Jukka (2017)
    Aivoverenkiertohäiriöt ovat yleistymässä alle 50-vuotiailla. Nuoret ja keski-ikäiset aivoverenkiertohäiriöpotilaat toipuvat yleensä paremmin kuin iäkkäät. Akuuttivaiheen hoito, kuten aivoinfarktin liuotushoito, mekaaninen aivovaltimon veritulpan poisto ja hoito aivohalvausyksikössä, parantavat ennustetta. Toipumiseen ja kuolleisuuteen vaikuttavat mm. häiriön syy, akuuttivaiheen oirekuva, diabetes, tupakointi ja infektiot. Noin puolet aivoverenkiertohäiriön sairastaneista palaa työelämään. Tavalliset riskitekijät ovat nuorillakin potilailla tavallisia, ja ne vaativat seurantaa ja sitoutumista pitkäaikaiseen lääkehoitoon. Pitkäaikaisseurannassa joka kymmenennelle iskeemisen aivoverenkiertohäiriön sairastaneista ja jopa joka neljännelle aivoverenvuotopotilaista kehittyy epilepsia.
  • Kurko, Terhi; Saastamoinen, Leena; Tuulio-Henriksson, Annamari; Taiminen, Tero; Tiihonen, Jari; Airaksinen, Marja; Hietala, Jarmo (2018)
    Lähtökohdat Rekisteritutkimuksessa selvitettiin bentsodiatsepiinien pitkäaikaiskäytön yleisyyttä lääkeaineittain, ikäryhmittäin ja sukupuolittain koko väestössä. Menetelmät Kelan reseptitiedostosta tarkasteltiin sairausvakuutuksesta korvattuja bentsodiatsepiinien lääkeostoja vuosina 2006–2014. Pitkäaikaiskäytöksi määriteltiin vähintään 180 vuorokausiannoksen lääkeosto kalenterivuoden aikana. Tulokset Bentsodiatsepiinien pitkäaikaiskäyttö väheni kaikissa ikäryhmissä merkittävästi. Eniten se väheni75 vuotta täyttäneillä, mutta silti heistä 9,7 % oli pitkäaikaiskäyttäjiä vuonna 2014. Unilääkkeiden pitkäaikaiskäyttö oli yleisintä vanhimmissa ikäryhmissä ja rauhoittavien lääkkeiden 50–64-vuotiailla. Tsopikloni oli käytetyin lääkeaine ja myös sen pitkäaikaiskäyttö oli yleisintä. Tsolpideemin pitkäaikaiskäyttö lisääntyi kaikissa ja klonatsepaamin muissa paitsi 75 vuotta täyttäneiden ikäryhmässä. Päätelmät Vaikka bentsodiatsepiinien pitkäaikaiskäyttö on kokonaisuutena vähentynyt, käytön pitkittymiseen tulee edelleen kiinnittää huomiota.
  • Gaily, Eija; Roivainen, Reina (2018)
    Dravet’n oireyhtymä on harvinainen, mutta todennäköisesti alidiagnosoitu sairaus. Sen tavallisin syy on hermosolujen natriumkanavien toimintaa säätelevän SCN1A-geenin virhe. Sairaus alkaa infektioon, rokotukseen tai muuhun lämmönnousuun liittyvillä pitkittyneillä kuumekouristuksilla ensimmäisen ikävuoden aikana. Vaikea epilepsia on tunnetuin oire, mutta useimmilla on myös vaikeita kognitiivisia ja motorisia häiriöitä. Diagnoosilla on merkitystä, koska epilepsialääkkeiden oikealla valinnalla voidaan estää sarjakohtaukset ja lievittää oireita. Lapset tulee rokottaa normaalisti diagnoosista huolimatta.
  • Kuchenbaecker, K.B.; McGuffog, L.; Barrowdale, D.; Lee, Andrew; Soucy, P.; Dennis, J.; Domchek, S.M.; Robson, M.; Spurdle, A.B.; Ramus, S.J.; Mavaddat, N.; Terry, M.B.; Neuhausen, S.L.; Schmutzler, R.K.; Simard, J.; Pharoah, P.D.P.; Offit, K.; Couch, F.J.; Chenevix-Trench, G.; Easton, D.F.; Antoniou, A.C.; Healey, S.; Lush, M.; Hamann, U.; Southey, M.; John, E.M.; Chung, W.K.; Daly, M. B.; Buys, S.S.; Goldgar, D.E.; Dorfling, C.M.; van Rensburg, E.J.; Ding, Y.C.; Ejlertsen, B.; Gerdes, A.-M.; Hansen, T.V.O.; Slager, S.; Hallberg, E.; Benitez, J.; Osorio, A.; Cohen, N.; Lawler, W.; Weitzel, J.N.; Peterlongo, P.; Pensotti, V.; Dolcetti, R.; Barile, M.; Aittomäki, K.; Nevanlinna, H.; Rantala, J. (2017)
    Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 × 10-53). InBRCA2 carriers, the strongest association with BC risk was seen for the overall BCPRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 × 10-20). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management. © The Author 2017.
  • Paavola, Mika; Malmivaara, Antti; Taimela, Simo; Kanto, Kari; Järvinen, Teppo L. N. (2017)
    Introduction: Arthroscopic subacromial decompression (ASD) is the most commonly performed surgical intervention for shoulder pain, yet evidence on its efficacy is limited. The rationale for the surgery rests on the tenet that symptom relief is achieved through decompression of the rotator cuff tendon passage. The primary objective of this superiority trial is to compare the efficacy of ASD versus diagnostic arthroscopy (DA) in patients with shoulder impingement syndrome (SIS), where DA differs only by the lack of subacromial decompression. A third group of supervised progressive exercise therapy (ET) will allow for pragmatic assessment of the relative benefits of surgical versus non-operative treatment strategies. Methods and Analysis: Finnish Subacromial Impingement Arthroscopy Controlled Trial is an ongoing multicentre, three-group randomised controlled study. We performed two-fold concealed allocation, first by randomising patients to surgical (ASD or DA) or conservative (ET) treatment in 2:1 ratio and then those allocated to surgery further to ASD or DA in 1:1 ratio. Our two primary outcomes are pain at rest and at arm activity, assessed using visual analogue scale (VAS). We will quantify the treatment effect as the difference between the groups in the change in the VAS scales with the associated 95% CI at 24 months. Our secondary outcomes are functional assessment (Constant score and Simple shoulder test), quality of life (15D and SF-36), patient satisfaction, proportions of responders and non-responders, reoperations/treatment conversions, all at 2 years post-randomisation, as well as adverse effects and complications. We recruited a total of 210 patients from three tertiary referral centres. We will conduct the primary analysis on the intention-to-treat basis. Ethics and Dissemination: The study was approved by the Institutional Review Board of the Pirkanmaa Hospital District and duly registered at ClinicalTrials.gov. The findings of this study will be disseminated widely through peer-reviewed publications and conference presentations. © 2017 Article author(s).
  • Kaarne, Markku; Tarkkanen, Maija (2018)
  • Suomela, Jarkko (2018)
    50-vuotias mies hakeutui yksityislääkärin vastaanotolle puolison vaatimuksesta. Paino oli pudonnut lyhyessä ajassa niin, että lähipiirikin siitä huomautteli. Lisäksi hänellä oli kuumetta iltaisin.
  • Suomela, Jarkko (2018)
    50-vuotias mies hakeutui puolison vaatimuksesta yksityislääkärin vastaanotolle. Paino oli pudonnut lyhyessä ajassa 5 kg. Muutamia viikkoja aiemmin oli alkanut olla kuumetta iltapainotteisesti, ylimmillään 38,4 astetta, ja lisäksi yöhikoilua ilman muita merkittäviä infektion oireita.
  • Laitinen, Mika; Suomela, Jarkko (2018)
    Anamneesin kertaus 50-vuotias mies hakeutui puolison vaatimuksesta yksityislääkärin vastaanotolle painon putoamisen ja kuumeilun takia. Lääkäri kirjoitti lähetteen sisätautipoliklinikalle, mutta näköoireet ajoivat potilaanneurologian päivystykseen.
  • Suomela, Jarkko (2017)
    Lähtötilanne 59-vuotias mies huomasi yhtenä aamuna näkevänsä ilman laseja, jotka olivat olleet 20 vuotta käytössä. Hän hakeutui optikolle, ja tämän tutkima näöntarkkuus oli parantunut 4,5 dioptrian verran. Optikko ohjasi miehen kiireellisesti työterveyslääkärille.
  • Laitinen, Mika; Suomela, Jarkko (2017)
    59-vuotias mies huomasi yhtenä aamuna näkevänsä ilman laseja, jotka olivat olleet 20 vuotta käytössä. Hän hakeutui optikolle, ja tämän tutkima näöntarkkuus oli parantunut 4,5 dioptrian verran. Optikko ohjasi miehen kiireellisesti työterveyslääkärille, joka totesi verensokeritason olevan huomattavan koholla ja ohjasi miehen saman tien yhteispäivystykseen.
  • Nummela, Mari; Haaramo, Anu; Numminen, Jussi (2020)
  • Kanerva, Mari; Laitinen, Mika (2021)
    Perhosharrastaja hakeutui päivystykseen selkävaivojen pahennuttua ja oikean suupielen alettua roikkua.
  • Arkkila, Perttu; Anttila, Veli-Jukka; Koistinen, Heikki; Pikkarainen, Sampsa (2020)
  • Saukkonen, K.; Hagström, J.; Mustonen, H.; Lehtinen, Laura; Carpen, O.; Andersson, L.C.; Seppänen, H.; Haglund, C. (2018)
    Expression of regenerating islet-derived protein 4 (REG4), a secretory protein involved in cell differentiation and proliferation, is upregulated in inflammatory bowel diseases and in many gastrointestinal malignancies. The prognostic significance of its expression in pancreatic ductal adenocarcinoma is unknown. Our aim was to investigate tumor tissue and serum REG4 expression in pancreatic ductal adenocarcinoma patients. We also evaluated as a control the diagnostic value of serum REG4 level in patients with chronic pancreatitis. Immunohistochemical expression of REG4 was evaluated in 154 surgical specimens and serum REG4 level in 130 samples from pancreatic ductal adenocarcinoma patients treated at Helsinki University Hospital, Finland, in 2000–2011. REG4 tissue and serum expression was assessed in relation to clinicopathological parameters and patient survival. A chronic pancreatitis control group comprised 34 patients who underwent pancreatic resection because of suspicion of malignancy. Significant survival differences were detectable in subgroups: in tumor stages IA–IIA, high serum REG4 level predicted worse survival (p=0.046). In patients with grade I tumor, positive tissue REG4 expression predicted better survival (p=0.006). In multivariate analysis, neither tissue nor serum REG4 expression was independent prognostic factors. Serum REG4 levels were higher in pancreatic ductal adenocarcinoma than in chronic pancreatitis (p=0.002), with diagnostic sensitivity of 45% and specificity of 91%. In logistic regression analysis, a multivariate model with REG4, CA19-9, and age provided sensitivity of 82% and specificity of 79%. REG4 tissue expression is a prognostic marker in subgroups of pancreatic ductal adenocarcinoma patients. Serum REG4 level might be useful in differential diagnosis between pancreatic ductal adenocarcinoma and chronic pancreatitis. © 2018, © The Author(s) 2018.
  • Fizazi, Karim; Massard, Christophe; Bono, P.; Kataja, Vesa; James, Nicholas; Tammela, T.L.; Joensuu, H.; Aspegren, John; Mustonen, M. (2017)
    Background: Patients with castration-resistant prostate cancer (CRPC) had extended responses to the androgen receptor antagonist ODM-201, in phase 1/2 studies. Objective: To evaluate the safety and antitumour activity of prolonged ODM-201 treatment in patients with CRPC. Design, setting, and participants: The ARADES trial was a multicentre phase 1 (dose escalation) and phase 2 (dose expansion) trial; 134 patients with CRPC were stratified by previous chemotherapy to receive ODM-201. This paper reports extended follow-up in CYP17 inhibitor (CYP17i)-naïve patients. Intervention: Patients (n = 77) received oral ODM-201 twice daily at daily doses of 200–1800 mg. Outcome measurements and statistical analysis: Safety, measured as the occurrence of adverse events (AEs), prostate-specific antigen (PSA), and radiographic progression. Results and limitations: The safety profile of extended ODM-201 treatment (median treatment duration 8.2 mo, 95% confidence interval [CI] 5.6–11.0) was consistent with that reported at the time of the original data cutoff in the main ARADES trial, with no unexpected safety concerns over time. The majority of AEs (61.1%) were mild (grade 1); the most common AE was fatigue/asthenia (35.1% of patients), with no clear relationship to ODM-201. Median time to PSA progression was 25.2 mo (95% CI 11.3–25.2) for chemotherapy-naïve men and not reached (NR; 95% CI 5.5–NR) for chemotherapy-pretreated patients; a trend for improved antitumour response was observed for chemotherapy-naïve patients. The median time to radiographic progression was longer for chemotherapy-naïve (14.0 mo, 95% CI 8.1–33.3) than for chemotherapy-pretreated (7.2 mo, 95% CI 2.7–11.0) patients. Conclusions: Prolonged exposure to ODM-201 was well tolerated, with no additional safety concerns; disease suppression was sustained, especially in chemotherapy-naïve patients. These data support further development of ODM-201 in men with CYP17i-naïve CRPC. Patient summary: Extended ODM-201 therapy was well tolerated, with beneficial antitumour activity in men with advanced prostate cancer, indicating that ODM-201 may represent a new active treatment for men with CRPC. This extension trial is registered at ClinicalTrials.gov (www.clinicaltrials.gov) under identification number NCT01429064. Extended ODM-201 therapy showed encouraging antitumour activity in both chemotherapy-naïve and chemotherapy-treated men with metastatic castration-resistant prostate cancer (CRPC). Continued treatment with ODM-201 was well tolerated, with no unexpected safety concerns, and may represent a new, effective treatment option for men with CRPC. © 2017 European Association of Urology
  • Pihlajamäki, Minna; Uitti, J.; Arola, H.; Ollikainen, J.; Korhonen, M.; Nummi, T.; Taimela, S. (2019)
    Objectives To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries. Methods The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ' work disability (WD) risk factors' in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA. Results The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with ' WD risk factors' and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, ' WD risk factors', SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups. Conclusion Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
  • Laitinen, A.; Hagström, J.; Mustonen, H.; Kokkola, A.; Tervahartiala, T.; Sorsa, T.; Böckelman, C.; Haglund, C. (2018)
    Despite gastric cancer being rare nowadays in Western countries, it remains one of the leading causes of cancer death worldwide. The course of the disease varies, so the individual gastric cancer patient’s prognosis is difficult to determine. The need for new biomarkers is crucial. The aim of this study was to evaluate the prognostic value of serum matrix metalloproteinase-8, serum tissue inhibitor of metalloproteinase-1, and tissue matrix metalloproteinase-8 in patients with gastric cancer. Preoperative serum samples from 233 patients with gastric cancer were retrospectively analyzed. Serum levels of matrix metalloproteinase-8 were analyzed with immunofluorometric assay, and tissue inhibitor of metalloproteinase-1 levels were determined by enzyme-linked immunosorbent assay. We also determined the tissue expression of matrix metalloproteinase-8 in 276 gastric cancer samples by immunohistochemistry. Survival data and death causes came from patient records, the Population Register Center of Finland, and Statistics Finland. Patients with a low (131 ng/mL) serum matrix metalloproteinase-8 level had a considerably unfavorable prognosis (p = 0.002). Those patients with a high (≥170 ng/mL) serum tissue inhibitor of metalloproteinase-1 level also had a poor prognosis (p <0.001), and the latter remained significant in multivariable analysis (hazard ratio = 1.85; 95% confidence interval: 1.26–2.72; p = 0.002). The molar ratio of serum matrix metalloproteinase-8 and tissue inhibitor of metalloproteinase-1 levels with low (0.30) molar ratios predicted a worse prognosis (p = 0.020). Tissue matrix metalloproteinase-8 did not influence prognosis. These results suggest that serum matrix metalloproteinase-8, tissue inhibitor of metalloproteinase-1, and the ratio of matrix metalloproteinase-8/ tissue inhibitor of metalloproteinase-1 may prove useful biomarkers for prediction of prognosis in patients with gastric cancer. © The Author(s) 2018.