Browsing by Subject "Morbidity"

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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.
  • Alyodawi, Khalid; Vermeij, Wilbert P.; Omairi, Saleh; Kretz, Oliver; Hopkinson, Mark; Solagna, Francesca; Joch, Barbara; Brandt, Renata M. C.; Barnhoorn, Sander; van Vliet, Nicole; Ridwan, Yanto; Essers, Jeroen; Mitchell, Robert; Morash, Taryn; Pasternack, Arja; Ritvos, Olli; Matsakas, Antonios; Collins-Hooper, Henry; Huber, Tobias B.; Hoeijmakers, Jan H. J.; Patel, Ketan (2019)
    Background One of the principles underpinning our understanding of ageing is that DNA damage induces a stress response that shifts cellular resources from growth towards maintenance. A contrasting and seemingly irreconcilable view is that prompting growth of, for example, skeletal muscle confers systemic benefit. Methods To investigate the robustness of these axioms, we induced muscle growth in a murine progeroid model through the use of activin receptor IIB ligand trap that dampens myostatin/activin signalling. Progeric mice were then investigated for neurological and muscle function as well as cellular profiling of the muscle, kidney, liver, and bone. Results We show that muscle of Ercc1(Delta/-) progeroid mice undergoes severe wasting (decreases in hind limb muscle mass of 40-60% compared with normal mass), which is largely protected by attenuating myostatin/activin signalling using soluble activin receptor type IIB (sActRIIB) (increase of 30-62% compared with untreated progeric). sActRIIB-treated progeroid mice maintained muscle activity (distance travel per hour: 5.6 m in untreated mice vs. 13.7 m in treated) and increased specific force (19.3 mN/mg in untreated vs. 24.0 mN/mg in treated). sActRIIb treatment of progeroid mice also improved satellite cell function especially their ability to proliferate on their native substrate (2.5 cells per fibre in untreated progeroids vs. 5.4 in sActRIIB-treated progeroids after 72 h in culture). Besides direct protective effects on muscle, we show systemic improvements to other organs including the structure and function of the kidneys; there was a major decrease in the protein content in urine (albumin/creatinine of 4.9 sActRIIB treated vs. 15.7 in untreated), which is likely to be a result in the normalization of podocyte foot processes, which constitute the filtration apparatus (glomerular basement membrane thickness reduced from 224 to 177 nm following sActRIIB treatment). Treatment of the progeric mice with the activin ligand trap protected against the development of liver abnormalities including polyploidy (18.3% untreated vs. 8.1% treated) and osteoporosis (trabecular bone volume; 0.30 mm(3) in treated progeroid mice vs. 0.14 mm(3) in untreated mice, cortical bone volume; 0.30 mm(3) in treated progeroid mice vs. 0.22 mm(3) in untreated mice). The onset of neurological abnormalities was delayed (by similar to 5 weeks) and their severity reduced, overall sustaining health without affecting lifespan. Conclusions This study questions the notion that tissue growth and maintaining tissue function during ageing are incompatible mechanisms. It highlights the need for future investigations to assess the potential of therapies based on myostatin/activin blockade to compress morbidity and promote healthy ageing.
  • Sandelin, Atte; Härtel, Heidi; Seppä-Lassila, Leena; Kaartinen, Liisa; Rautala, Helena; Soveri, Timo; Simojoki, Heli (BioMed Central, 2020)
    Abstract Background Bovine respiratory disease (BRD) continues to be great challenge in calf rearing units. The urgent need to decrease the use of antibiotics and increase animal welfare in beef production has forced us to introduce new preventive methods. Vaccinations could contribute to the solution, but the high incidence of BRD already at an early age has made it difficult to introduce suitable vaccination programs. Challenge studies have shown promising results in 3–14 day old calves vaccinated with intranasal BRD vaccine, but very few field trials are available to assess the efficacy of the intranasal vaccines in field conditions. We evaluated the effect of one dose of commercial intranasal vaccination on calf mortality, daily gain, and treatment incidence for BRD in one calf rearing unit. In total, 497 calves (mean age 19 days) were included in our study, 247 of which were vaccinated at the time of arrival to the unit and 250 served as negative controls (unvaccinated). Vaccinated and unvaccinated calves were situated in separate compartments until weaning. Daily gain, treatment incidence, and mortality were recorded until the calves were transported to the finishing unit, which averaged 154.5 days from arrival. Results Average daily gain over the complete study period was 1151.9 g/day (SD 137.9) for the vaccinated calves and 1139.5 g/day (SD 135.9) for the unvaccinated calves. Intranasal vaccination combined with older arrival age (17 days or older) resulted in a higher daily gain (47.8 g/day) compared with unvaccinated calves (coef. 0.0478, p = 0.003). This association was not recorded in calves that were younger than 17 days upon arrival. Intranasal vaccination was not significantly associated either with mortality (OR 0.976, p = 0.968) or treatment incidence for BRD (OR 1.341, p = 0.120). In total, six vaccinated calves (2.43%) and six unvaccinated calves (2.40%) died during the study period. Conclusions Vaccinating arriving calves with intranasal vaccine in the calf rearing unit did not decrease the mortality or treatment incidence for BRD, but it significantly improved the weight gain in calves transported to the unit at the age of 17 days or older.
  • Sandelin, Atte; Härtel, Heidi; Seppä-Lassila, Leena; Kaartinen, Liisa; Rautala, Helena; Soveri, Timo; Simojoki, Heli (2020)
    BackgroundBovine respiratory disease (BRD) continues to be great challenge in calf rearing units. The urgent need to decrease the use of antibiotics and increase animal welfare in beef production has forced us to introduce new preventive methods. Vaccinations could contribute to the solution, but the high incidence of BRD already at an early age has made it difficult to introduce suitable vaccination programs. Challenge studies have shown promising results in 3-14day old calves vaccinated with intranasal BRD vaccine, but very few field trials are available to assess the efficacy of the intranasal vaccines in field conditions. We evaluated the effect of one dose of commercial intranasal vaccination on calf mortality, daily gain, and treatment incidence for BRD in one calf rearing unit. In total, 497 calves (mean age 19days) were included in our study, 247 of which were vaccinated at the time of arrival to the unit and 250 served as negative controls (unvaccinated). Vaccinated and unvaccinated calves were situated in separate compartments until weaning. Daily gain, treatment incidence, and mortality were recorded until the calves were transported to the finishing unit, which averaged 154.5days from arrival.ResultsAverage daily gain over the complete study period was 1151.9g/day (SD 137.9) for the vaccinated calves and 1139.5g/day (SD 135.9) for the unvaccinated calves. Intranasal vaccination combined with older arrival age (17days or older) resulted in a higher daily gain (47.8g/day) compared with unvaccinated calves (coef. 0.0478, p=0.003). This association was not recorded in calves that were younger than 17days upon arrival. Intranasal vaccination was not significantly associated either with mortality (OR 0.976, p=0.968) or treatment incidence for BRD (OR 1.341, p=0.120). In total, six vaccinated calves (2.43%) and six unvaccinated calves (2.40%) died during the study period.ConclusionsVaccinating arriving calves with intranasal vaccine in the calf rearing unit did not decrease the mortality or treatment incidence for BRD, but it significantly improved the weight gain in calves transported to the unit at the age of 17days or older.
  • Macharey, Georg; Ulander, Veli-Matti; Heinonen, Seppo; Kostev, Karel; Nuutila, Mika; Vaisanen-Tommiska, Mervi (2016)
    Objective The aim of this study is to evaluate whether induction of breech delivery at term is feasible and safe for mother and child compared with spontaneous vaginal breech delivery. Study design A total of 268 singleton term breech deliveries with an attempted vaginal delivery were identified in a single-center retrospective observational study. Out of these, 73 cases had an induction of labor for various medical and obstetric reasons and were compared to 195 spontaneous singleton breech deliveries. The main outcome measure was the mode of delivery. Secondary outcomes included maternal and neonatal morbidity and mortality. Results The vaginal delivery rate in the induction group was 64.4 % compared with 80 % in the spontaneous delivery group. No statistical differences were observed between the two delivery groups regarding neonatal and maternal morbidity and mortality. Conclusions The vaginal delivery rate was significantly lower in induced than in spontaneous breech deliveries. The neonatal and maternal morbidity and mortality rates were similar implying that induction in breech delivery is an option and it is time for clinical reappraisal.
  • Nicoli, Taija K.; Sinkkonen, Saku T.; Anttila, Turkka; Makitie, Antti; Jero, Jussi (2017)
    Treatment of jugulotympanic paragangliomas (JTPGLs) remains challenging with no clear guidelines for management or follow-up. The aim of this retrospective case-note study was to assess long-term results of operatively and conservatively managed JTPGLs between years 1974-2013. A total of 36 patients with JTPGLs were identified. Clinical characteristics and management outcomes of patients were reviewed. Data were extracted on demographics, symptoms, timing of diagnosis, tumor location and size, embolization, and management, including pre- and post-operative imaging, analysis of operative techniques, and follow-up. Pulsatile tinnitus and hearing loss were the most common presenting symptoms. Thirty-four (94 %) patients were treated with primary surgical therapy and two (6 %) with radiotherapy. The surgical approaches included endaural approach for Fisch Class A tumors and a variety of approaches for Fisch Class B-D tumors with an increasing predilection for function-preserving surgery. Eight (24 %) patients received subtotal resection. Five (15 %) patients had a local recurrence within 10 years after primary surgery. Two (6 %) patients suffered a permanent cranial nerve (CN) deficit after primary surgery. We advocate radical surgery when tumor resection is possible without compromising CNs. Function-preserving surgery with at least a 10-year follow-up for Fisch Class B-D tumors should be considered if CNs are in danger.
  • Haahtela, Tari Markku Kallevi; Valovirta, Erkka; Saarinen, Kimmo; Jantunen, Juha; Kauppi, Paula; Pelkonen, Anna Susanna; Lindström, Irmeli; Tommila, Erja; Petman, Leena; Ketola, Tuula; Mäkinen-Kiljunen, Soili; Csonka, Peter; Hellemaa, Paula; Pajunen, Sirpa; Puolanne, Mervi; Repo, Ilkka; Salava, Alexander; Savolainen, Johannes; Laatikainen, Tiina; Linna, Miika; von Hertzen, Leena C.; Abdulla Hama Salih, Krista; Hannuksela, Matti; Vasankari, Tuula; Mäkelä, Mika J (2020)
    Lähtökohdat : Allergiaohjelma 2008–2018 on kansallinen kansanterveysohjelma, jonka avulla välttö¬strategia on käännetty sietostrategiaksi ja painotettu allergiaterveyttä. Raportoimme 10 vuoden tulokset. Menetelmät : Ohjelmalla oli kuusi tavoitetta, joiden toteuttamiseksi määriteltiin tehtävät, työkalut ja mittarit. Ohjelmaa toteutettiin kouluttamalla terveydenhuoltoa ja viestimällä väestölle. Tulokset : Astman ja allergisen nuhan esiintyvyys tasoittui asevelvollisissa ja Helsingin aikuisväestössä. Helsingin aikuisista astmaatikoista 41 % oli ollut vuoden 2016 kyselyä edeltäneen vuoden oireettomia (31 % 2006). Lasten allergiaruokavaliot vähenivät koko maassa noin puoleen. Työperäiset allergiset sairaudet vähenivät 45 %. Astman sairaalahoidon tarve puolittui, mutta päivystyskäynnit vähenivät oleellisesti vain lapsilla. Anafylaksia aiheutti aiempaa enemmän päivystyskäyntejä. Allergiasta ja astmasta aiheutuvat vuosittaiset suorat ja epäsuorat kustannukset vähenivät 200 miljoonaa euroa ¬(30 %) verrattaessa vuosia 2007 ja 2018. Päätelmät : Allergian ja astman aiheuttama sairastavuus ja niistä koituvat kustannukset vähenivät merkittävästi. Haitat vähenivät aluksi nopeasti, myöhemmin hitaammin. Ammattilaiset ja suuri yleisö hyväksyivät uuden suunnan, jossa painottuivat sietokyky ja terveys allergiasta huolimatta. Tietoon perustuvat systemaattiset ohjelmat ovat vahva keino parantaa kansanterveyttä.
  • Lindahl, Jan (2019)
  • Häkkänen-Nyholm, Helinä; Lyytinen, Nina; Heinimaa, Markus; Heiskala, Mikko; Varis, Atte (2020)
    • Koronakriisissä työskentelevien terveydenhuollon ammattilaisten psyykkisen stressin ja sairastavuuden riski on huomattava. • Ulkomaisten tutkimusten mukaan psyykkiseen sairastavuuteen ovat voimakkaimmin yhteydessä huoli ja pelko tartunnasta, ns. etulinjassa työskenteleminen, epidemian alkuvaiheessa työskenteleminen ja kokemuksen puute. • Moraalisen vamman kokemus ja sen vaikutus psyykkiseen sairastavuuteen on huomioitava ongelmien ehkäisyssä. • Etänä toteutettavat psykoterapiat ja työnohjaukset mahdollistavat nopean avun saamisen psyykkisiin oireisiin.
  • Blomgren, Jenni; Jäppinen, Sauli; Rahkonen, Ossi; Pekkala, Johanna; Lahelma, Eero (2019)
    Lähtökohdat Tarkastelimme Kelan korvaamien sairauspoissaolojen esiintyvyyden ja poissaolopäivien määrän maakunnittaista vaihtelua ja sitä selittäviä tekijöitä. Menetelmät Kelan rekisteristä poimittiin vuoden 2012 lopun 25–62-vuotiaasta väestöstä 70 %:n satunnaisotos, johon yhdistettiin Kelan ja Tilastokeskuksen rekisteritietoja. Kelan korvaamalla sairauspäivärahakaudella olleiden väestöosuus ja poissaolopäivien keskimäärä vuonna 2013 laskettiin maakunnittain. Regressiomalleilla vakioitiin sukupuoli, ikä, siviilisääty ja ammattiasema sekä Kelan sairastavuusindeksi. Tulokset Maakuntien välillä oli selviä eroja sekä sairauspoissaolojen esiintyvyydessä että poissaolopäivien määrässä. Poissaolot olivat keskimääräistä harvinaisempia ja lyhyempiä Uudellamaalla. Sosiodemografisen väestörakenteen vakioiminen selitti neljänneksen maakuntien välisistä eroista poissaolleiden osuudessa ja noin puolet eroista poissaolopäivien keskimäärässä. Sairastavuusindeksin vakioiminen selitti osan lopuista alue-eroista. Päätelmät Pitkien sairauspoissaolojen maakunnittaiset erot ovat selvät, eivätkä ne selity väestörakenteen tai sairastavuuden eroilla. Sairauspoissaolojen alue-erojen taustasyitä on tärkeää selvittää.
  • Fältmarsch, Stella (Helsingin yliopisto, 2018)
    Globalt varierar fertila kvinnors hälsa mycket, i den afrikanska regionen lever kvinnorna i medeltal till 58 år medan de i Finland lever i medeltal till 84 år. I Finland är det cirka 10 % av de fertila kvinnorna som har ett specialersatt läkemedel beviljat av Folkpensionsanstalten, flest specialersatta läkemedel har beviljats av Folkpensionsanstalten för astmasjukdomar. Graviditetsdiabetes definieras som en avvikande glukosmetabolism som upptäcks första gången under graviditeten. Graviditetsdiabetes är ett tillstånd som påverkar både modern och fostret under graviditeten men kan även ha långsiktiga hälsoeffekter. Prevalensen globalt och i Finland ökar i och med att människorna blir allt mer överviktiga. I denna retrospektiva kohortstudie undersöks morbiditeten och associationen mellan morbiditeten och graviditetsdiabetes bland förstföderskor i Vanda. Kvinnorna som inkluderades i denna studie var finländska förstföderskor från Vanda. De födde mellan 1.1.2009 och 31.12.2015. Materialet för denna studie har vi fått från Institutet för hälsa och välfärd (Terveyden ja hyvinvoinnin laitos, THL), Statistikcentralen och från Folkpensionsanstaltens register över specialersatta läkemedel. Kvinnorna med specialersatta läkemedel hade större prevalens av graviditetsdiabetes än friska kvinnor, dessutom var åldern och BMI hos kvinnorna med specialersatta läkemedel högre än för de kvinnorna utan specialersatta läkemedel. Den sjukdom som hade största associationen med graviditetsdiabetes var gruppen reumatiska sjukdomar. Därefter följde astma och sedan gruppen psykossjukdomar. (208 ord)
  • Lindberg, N.; Miettunen, J.; Heiskala, A.; Kaltiala-Heino, R. (2017)
    Background: Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15-to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989-2010. Methods: The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender-and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care. Results: Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53-32.39, P <0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5 years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5 years. Conclusions: The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia. (C) 2017 Elsevier Masson SAS. All rights reserved.
  • Lindroos, Eeva K; Jyväkorpi, S.; Soini, H.; Muurinen, S.; Saarela, R. K. T.; Pitkala, K. H.; Suominen, M. H. (2017)
    Background: Swallowing difficulty (SWD) commonly occurs and is associated with malnutrition in old age. Less is known of how SWD is associated with various nutrient intakes. Objectives: To examine how SWD among residents in assisted living facilities. Materials and methods: In this cross-sectional study, we examined 345 residents in Helsinki in 2007. Detailed energy, protein and nutrient intakes were calculated from 1-day food diaries and compared with the Nordic Nutrition Recommendations (NNRs) as a measure of dietary adequacy. Swallowing was assessed by the closest nurse knowing the resident well. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Results: Of the participants, 14% (n = 48) suffered from SWD, often had prior stroke, increased comorbidities and lower body-mass index. A larger proportion of residents with SWD consumed oral nutritional supplements. The MNA showed that over 52% of residents with SWD were malnourished, whereas the respective figure was 17% among residents without SWD. A large proportion of the study population had lower than recommended intakes of energy, protein and micronutrients. However, those with SWD differed significantly from those without only in higher protein and lower zinc and folic acid intakes. Conclusion: Although malnutrition was more common among those with SWD than those without, the daily intakes of energy, protein and micronutrients were similar in these groups, highlighting that the risk of malnutrition and low nutrient intakes commonly occurred in both groups of residents in assisted living facilities. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
  • WSES Trauma Quality Indicators; Coccolini, Federico; Kluger, Yoram; Moore, Ernest E.; Leppaniemi, Ari; Catena, Fausto (2021)
    Introduction Quality in medical care must be measured in order to be improved. Trauma management is part of health care, and by definition, it must be checked constantly. The only way to measure quality and outcomes is to systematically accrue data and analyze them. Material and methods A systematic revision of the literature about quality indicators in trauma associated to an international consensus conference Results An internationally approved base core set of 82 trauma quality indicators was obtained: Indicators were divided into 6 fields: prevention, structure, process, outcome, post-traumatic management, and society integrational effects. Conclusion Present trauma quality indicator core set represents the result of an international effort aiming to provide a useful tool in quality evaluation and improvement. Further improvement may only be possible through international trauma registry development. This will allow for huge international data accrual permitting to evaluate results and compare outcomes.
  • Kivimäki, Mika; Lindbohm, Joni V.; Reijula, Kari (2019)