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; Hälli, Outi; Härtel, Heidi; Herva, Tuomas; Seppä-Lassila, Leena; Tuunainen, Erja; Rautala, Helena; Soveri, Timo; Simojoki, Heli (2021)
    Both calf mortality and daily weight gain have a crucial impact on profitability of calf rearing farms. In addition, high calf mortality rates represent an animal welfare problem. Mortality rates on calf rearing farms have been reported in several studies in different countries, but scant data regarding daily weight gain of the calves are available. The objectives of this observational retrospective study were to determine the average mortality and daily weight gain of calves and youngstock on Finnish calf rearing farms and to identify factors associated with these production parameters. National cattle register and national herd health register databases together with meat companies' databases were used to collect weight, age, breed, medication, and origin farm data for 28 228 calves transported to the 87 calf rearing farms between 1 January and 1 October 2016. A telephone questionnaire was completed by selected farms to collect management and farm-specific data. Calves were retrospectively followed for maximum 180 days since arrival to the farm. Average arrival age of the calves were 24 days (SD 14). Average calf mortality on Finnish calf rearing farms was 4.5 %. Mortality was 5.3 % on fattening farms buying milk calves, 4.6 % on specialized calf rearing farms, and 2.5 % on fattening farms buying weaned calves. Size of the calf rearing farms varied, being smallest on fattening farms for weaned calves and largest on specialized calf rearing farms. Average daily gain of the study calves was 1.074 kg/day (SD 0.166). Multilevel mixed effects logistic and linear regression models, where herd and calf batch were used as random effects, were generated to study calf level mortality and daily gain, respectively. Activities preventing transmission of pathogens between arrival batches and different age groups of animals, including application of the all in/all out principle and proper washing and disinfection of compartments for milk feeding calves between arrival batches, were associated with lower mortality and increased daily gain. In addition, higher arrival age was associated with lower mortality during the rearing period and relatively higher arrival age of the calf, compared to other calf in a same arrival batch, was associated with higher daily gain. By contrast, increased number of individual medications during the rearing period was associated with both increased mortality and decreased daily gain. There was no significant difference in mortality between farm types. Current study highlights several factors that can be affected in future to further develop the beef production chain.
  • Mustonen, Erja; Hörhammer, Iiris; Patja, Kristiina; Absetz, Pilvikki; Lammintakanen, Johanna; Talja, Martti; Kuronen, Risto; Linna, Miika (2021)
    Background: Health coaching is a patient-centred approach to supporting self-management for the chronic conditions. However, long-term evidence of effectiveness of health coaching remains scarce. The object of this study was to evaluate the long-term effect of telephone health coaching (THC) on mortality and morbidity among people with type 2 diabetes (T2D), coronary artery disease (CAD) and congestive heart failure (CHF). Methods: 1535 T2D, CAD and CHF patients with unmet treatment targets were randomly allocated into an intervention group (n = 1034) and control group (n = 501). Intervention group received monthly individual strength-based, autonomy supportive THC sessions (average 30 min) for behavior change with a specially trained nurse for 12 months additional to usual health care. Control group received usual health care services. The primary outcome was a composite of death from cardiovascular causes or non-fatal stroke or non-fatal myocardial infarction (AMI) or unstable angina pectoris (UAP) during a follow-up of 8 years Three other composite endpoints with distinct combinations of fatal and non-fatal cardiovascular events and death from any cause were used as secondary outcomes. Other outcomes followed were the most relevant components of the composite endpoints. Randomized controlled trial (RCT) data was linked to Finnish national health and social care registries and electronic health records (EHR). Post-trial eight-year evaluation was conducted using intention-to-treat (ITT) and per-protocol (PP) analysis. Results: The composite primary outcome event rate per 100 person years was lower in the intervention group (3.45) than in control group (3.88) in ITT -analysis, but the difference was not statistically significant (hazard ratio in the intervention group 0.87; 95% CI, 0.71 to 1.07; P = 0.19). In the subgroup (T2D, CAD/CHF) analysis, there were no statistically significant effects. The secondary PP-analysis showed statistically significant benefits for those who participated in the study. Conclusions: No statistically significant effect of health coaching on mortality and morbidity was found in intention to treat analysis. The per protocol results suggest, however, that the intervention may be effective among patients who are willing and able to participate in health coaching. More research is needed to identify patients most likely to benefit from low-intensity health coaching. Trial registration: NCT00552903 (registration date: the 1st of November 2007, updated the 3rd of February 2009).
  • 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.
  • Nevalainen, Olli; Myllykangas, Markku (2022)
    • Luotettavin arvio hoidon tehosta saadaan meta-analyysistä, joka perustuu satunnaistettuihin hoitokokeisiin. • Päätetapahtumanäytön tulisi olla potilaalle merkityksellistä, kuten ennalta- ehkäisevässä hoidossa vähenemä sairastavuudessa tai kuolleisuudessa, eikä pelkkä muutos tapahtumien riskiä kuvaavissa korvikemuuttujissa. • Absoluuttisena vaikutuksena mitattuna ennaltaehkäisevästä hoidosta hyötyy todennäköisemmin suuremman kuin pienemmän sairastumisriskin potilas.
  • 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.
  • Coccolini, Federico; Corradi, Francesco; Sartelli, Massimo; Coimbra, Raul; Kryvoruchko, Igor A.; Leppaniemi, Ari; Doklestic, Krstina; Bignami, Elena; Biancofiore, Giandomenico; Bala, Miklosh; Marco, Ceresoli; Damaskos, Dimitris; Biffl, Walt L.; Fugazzola, Paola; Santonastaso, Domenico; Agnoletti, Vanni; Sbarbaro, Catia; Nacoti, Mirco; Hardcastle, Timothy C.; Mariani, Diego; De Simone, Belinda; Tolonen, Matti; Ball, Chad; Podda, Mauro; Di Carlo, Isidoro; Di Saverio, Salomone; Navsaria, Pradeep; Bonavina, Luigi; Abu-Zidan, Fikri; Soreide, Kjetil; Fraga, Gustavo P.; Carvalho, Vanessa Henriques; Batista, Sergio Faria; Hecker, Andreas; Cucchetti, Alessandro; Ercolani, Giorgio; Tartaglia, Dario; Galante, Joseph M.; Wani, Imtiaz; Kurihara, Hayato; Tan, Edward; Litvin, Andrey; Melotti, Rita Maria; Sganga, Gabriele; Zoro, Tamara; Isirdi, Alessandro; De'Angelis, Nicola; Weber, Dieter G.; Hodonou, Adrien M.; TenBroek, Richard; Parini, Dario; Khan, Jim; Sbrana, Giovanni; Coniglio, Carlo; Giarratano, Antonino; Gratarola, Angelo; Zaghi, Claudia; Romeo, Oreste; Kelly, Michael; Forfori, Francesco; Chiarugi, Massimo; Moore, Ernest E.; Catena, Fausto; Malbrain, Manu L. N. G. (2022)
    Background Non-traumatic emergency general surgery involves a heterogeneous population that may present with several underlying diseases. Timeous emergency surgical treatment should be supplemented with high-quality perioperative care, ideally performed by multidisciplinary teams trained to identify and handle complex postoperative courses. Uncontrolled or poorly controlled acute postoperative pain may result in significant complications. While pain management after elective surgery has been standardized in perioperative pathways, the traditional perioperative treatment of patients undergoing emergency surgery is often a haphazard practice. The present recommended pain management guidelines are for pain management after non-traumatic emergency surgical intervention. It is meant to provide clinicians a list of indications to prescribe the optimal analgesics even in the absence of a multidisciplinary pain team. Material and methods An international expert panel discussed the different issues in subsequent rounds. Four international recognized scientific societies: World Society of Emergency Surgery (WSES), Global Alliance for Infection in Surgery (GAIS), Italian Society of Anesthesia, Analgesia Intensive Care (SIAARTI), and American Association for the Surgery of Trauma (AAST), endorsed the project and approved the final manuscript. Conclusion Dealing with acute postoperative pain in the emergency abdominal surgery setting is complex, requires special attention, and should be multidisciplinary. Several tools are available, and their combination is mandatory whenever is possible. Analgesic approach to the various situations and conditions should be patient based and tailored according to procedure, pathology, age, response, and available expertise. A better understanding of the patho-mechanisms of postoperative pain for short- and long-term outcomes is necessary to improve prophylactic and treatment strategies.
  • 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.
  • Ruohoalho, Johanna; Xin, Guanyu; Bäck, Leif; Aro, Katri; Tapiovaara, Laura (2021)
    Purpose To identify complications of surgical tracheostomies in otorhinolaryngologic patients and adjust our processes to be properly prepared in the future. Methods We reviewed retrospectively all surgical tracheostomies (n = 255) performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between Jan 2014 and Feb 2017. Patient demographics, surgical details, surgical and medical complications, and tracheostomy-related mortality were recorded from the hospital charts. Risk factors for complications were assessed. Results Altogether, 55 (22%) complications were identified in 39 (15%) patients, with pneumonia, accidental decannulation, and bleeding being the most common. No patient or surgery-related factor reached significance in overall complication risk factor analysis. Medical complications were more common after elective tracheostomies compared to emergency procedures (10.6% vs. 3.5%, p <0.05). Majority of complications (78%) were classified as mild or moderate according to Clavien-Dindo. Only 2 (0.8%) tracheostomy-related deaths were recorded. Conclusion In otorhinolaryngologists service, severe complications and tracheostomy-related deaths are very rare. Reducing their prevalence even further with careful planning is possible.
  • 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.