Browsing by Subject "Risk"

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  • Roivainen, Reina; Lauronen, Leena; Gaily, Eija; Metsähonkala, Liisa; Peltola, Maria; Laakso, Aki (2018)
  • González, Manuel; Mikkelä, Antti; Tuominen, Pirkko; Ranta, Jukka; Hakkinen, Marjaana; Hänninen, Marja-Liisa; Llarena, Ann-Katrin (Evira, 2016)
    Evira’s Research Reports 2/2016
    Campylobacter spp. are among the most common causes of gastrointestinal diseases in EU countries. Between four and five thousand human campylobacteriosis cases are registered each year in Finland, of which the majority are most probably acquired from abroad. The prevalence and concentration of campylobacters in foods are influenced by the whole production chain. Based on retail samples, the average annual prevalence of Campylobacter spp. was estimated at 5.5–11.7% (95% CI) in Finnish chicken meat and 1.8–5.9% (95% CI) in turkey meat. No Campylobacter spp. were detected from either domestic beef or pork, and their prevalence was estimated to be 0.0–1.2% (95% CI). The mean concentration of Campylobacter spp. in contaminated poultry meat was estimated to be low, and the probability of illness per one serving was thus also relatively small. Even so, the assessment implies that thousands of human cases can occur due to meat consumption annually in Finland, with the biggest proportion related to chicken meat. However, the predicted number of cases is affected by many factors with uncertainty, such as the level of cross-contamination, size of serving and total consumption. For a general overview, other campylobacters sources should also be identified and their impact on campylobacteriosis quantified.
  • Palojoki, Sari; Saranto, Kaija; Reponen, Elina; Skants, Noora; Vakkuri, Anne; Vuokko, Riikka (2021)
    Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.
  • Räsänen, Aleksi; Juhola, Sirkku; Nygren, Anja; Käkönen, Mira; Kallio, Maarit; Monge Monge, Adrian; Kanninen, Markku (2016)
    We systematically reviewed current climate change literature in order to examine how multiple processes that affect human vulnerability have been studied. Of the 125 reviewed articles, 79 % were published after 2009. There are numerous concepts that point out to stressors other than climate change that were used in reviewed studies. These different concepts were used interchangeably, and they illustrate processes that act on different scales. Most widely used concepts included non-climatic (40 % of the articles), multiple stressors (38 %) and other factors (37 %). About 75 % of the studies either acknowledged or carefully analyzed the social and environmental context in which vulnerability is experienced. One-third of the studies recognized climate change-related stressors as the most important, one-third argued that stressors other than climate are more important, and the rest of the studies did not analyze the relative importance of the different processes. Interactions between different stressors were mentioned in 76 % and analyzed explicitly in 28 % of the articles. Our review shows that there are studies that analyze the social context of vulnerability within climate change-related literature and this literature is rapidly expanding. Reviewed studies point out that there are multiple interacting stressors, whose interlinkages need to be carefully analyzed and targeted by policies, which integrate adaptation to climate change and other stressors. In conclusion, we suggest that future studies should include analytical frameworks that reflect dissimilarities between different types of stressors, methodological triangulation to identify key stressors and analysis of interactions between multiple stressors across different scales.
  • Syvänne, Mikko; Strandberg, Timo (2018)
  • Räsänen, Aleksi; Nygren, Anja; Monge Monge, Adrian Antonio; Käkönen, Mira; Kanninen, Markku; Juhola, Sirkku (2018)
    Land use changes have been recognized to have considerable impacts on water; and vice versa, changes in water use and governance may have implications on land use and governance. This study analyzes recent land use/land cover (LULC) changes, and how changes in land use and water governance are perceived to affect land use and water-related risks in three case-study areas exposed to frequent flooding and inadequate or deteriorating water quality. The areas studied included the Vantaa basin in Finland, a section of the Grijalva basin in Mexico, and the Lower Xe Bang Fai basin in Laos. We show how there are complex and context-specific interrelationships between land use, water governance, and water-related risks in each study area. In a remote sensing analysis of LULC changes during the past 30 years, we found that LULC changes have been the most dramatic in Xe Bang Fai, Laos in the form of expanding agriculture and built-up areas; however, there has also been an expansion of built-up areas in the two other sites. According to our stakeholder scenario workshop data, analysis of policy documents and field visits, the nexus between land, water and risks is recognized to some extent in each study area. There have been modest shifts toward more integrated land use and water governance in Vantaa and Grijalva, while the integrated governance seems to have been most absent in Xe Bang Fai. Tighter integration of land and water policies is needed in all the three cases to manage the land use changes in a way that their effects on water-related risks will be minimized.
  • Seppälä, Toni; Meretoja, Tuomo (2019)
  • Malm, Heli (2018)
    Valproaattia ei saa käyttää kaksisuuntaisen mielialahäiriön hoitoon raskauden aikana. Litiumin käyttöä voi jatkaa, jos hoitovaste on ollut hyvä. Epilepsialääkkeistä lamotrigiini ja mielialaa tasaavat toisen polven antipsykootit vaikuttavat suhteellisen turvallisilta.
  • Lankinen, Petteri; Parkkila, Anna-Kaisa; Roine, Risto P.; Turpeinen, Miia (2019)
    • Monia sähkökirurgisia instrumentteja käytettäessä syntyy kirurgista savua. • Henkilöstö voi altistua kumulatiivisesti savun haitallisille komponenteille. • Tavallinen kirurginen hengityssuojain antaa yli 90-prosenttisen suojan. Lisäksi tulisi käyttää asianmukaisella suodattimella varustettua paikallista savunpoistolaitteistoa. • Savulle altistumisen ei ole osoitettu lisäävän sairastavuutta tai syöpäriskiä.
  • Strandberg, Timo (2019)
    Tulokset antavat jo lisäaiheen tehostaa verenpainetaudin hoitoa.
  • Elovainio, Marko; Lumme, Sonja; Arffman, Martti; Manderbacka, Kristiina; Pukkala, Eero; Hakulinen, Christian (2021)
    Lack of social contacts has been associated with an increased risk of cancer mortality, but it is not known whether living alone increases the risk of cancer incidence or case fatality. We examined the association between living alone with cancer incidence, case-fatality and all-cause mortality in eight most common cancers. All patients with their first cancer diagnosis in 2000-2017 were identified from the nationwide Finnish Cancer Registry. Information on living arrangements was derived from Statistics Finland. The incidence analyses were conducted using Poisson regression. The total Finnish population served as the population at risk. Fine-Gray model was used to estimate case-fatality and Cox proportional regression model all-cause mortality. In men, we found an association between history of living alone and excess lung cancer incidence but living alone seemed to be associated with lower incidence of prostate cancer and skin melanoma. In women, living alone was more consistently associated with higher incidence of all studied cancers. Cancer patients living alone had an 11%-80% statistically significantly increased case-fatality and all-cause mortality in all studied cancers in men and in breast, colorectal and lung cancer in women. Living alone is consistently associated with increased cancer incidence risk in women but only in some cancers in men. Both men and women living alone had an increased risk of all-cause mortality after cancer diagnosis.
  • Heffron, Sean P.; Ruuth, Maija K.; Xia, Yuhe; Hernandez, Gustavo; Äikas, Lauri; Rodriguez, Crystalann; Öörni, Katariina; Berger, Jeffrey S. (2021)
    Background and aims: Peripheral artery disease (PAD) is a systemic manifestation of atherosclerosis that is associated with a high risk of major adverse cardiovascular events (MACE). LDL aggregation contributes to atherosclerotic plaque progression and may contribute to plaque instability. We aimed to determine if LDL aggregation is associated with MACE in patients with PAD undergoing lower extremity revascularization (LER). Methods: Two hundred thirty-nine patients with PAD undergoing LER had blood collected at baseline and were followed prospectively for MACE (myocardial infarction, stroke, cardiovascular death) for one year. Nineteen age, sex and LDL-C-matched control subjects without cardiovascular disease also had blood drawn. Subject LDL was exposed to sphingomyelinase and LDL aggregate size measured via dynamic light scattering. Results: Mean age was 72.3 10.9 years, 32.6% were female, and LDL-cholesterol was 68 +/- 25 mg/dL. LDL aggregation was inversely associated with triglycerides, but not associated with demographics, LDL-cholesterol or other risk factors. Maximal LDL aggregation occurred significantly earlier in subjects with PAD than in control subjects. 15.9% of subjects experienced MACE over one year. The 1st tertile (shortest time to maximal aggregation) exhibited significantly higher MACE (25% vs. 12.5% in tertile 2 and 10.1% in tertile 3, p = 0.012). After multivariable adjustment for demographics and CVD risk factors, the hazard ratio for MACE in the 1st tertile was 4.57 (95% CI 1.60-13.01; p = 0.004) compared to tertile 3. Inclusion of LDL aggregation in the Framingham Heart Study risk calculator for recurrent coronary heart disease events improved the c-index from 0.57 to 0.63 (p = 0.01). Conclusions: We show that in the setting of very well controlled LDL-cholesterol, patients with PAD with the most rapid LDL aggregation had a significantly elevated MACE risk following LER even after multivariable adjustment. This measure further improved the classification specificity of an established risk prediction tool. Our findings support broader investigation of this assay for risk stratification in patients with atherosclerotic CVD.
  • Anttila, Veli-Jukka (2019)
  • Korhonen, Päivi; Kaila, Minna (2019)
    Riski on ei-toivotun asian todennäköisyys, mutta sitä on varsinkin numerona ilmaistuna vaikeaymmärtää ja tulkita. Valtimotautien ehkäisyssä (primaaripreventio) pyritään vaikuttamaan satojentuhansien henkilöiden riskitekijöihin, jotta tuhannet säästyisivät sairastumiselta. Etenkin terveen ihmisen riskitekijöihin puuttuminen vaatii potilaan ja lääkärin yhteisymmärrystä saavutettavissa olevista hyödyistä, käytettävistä keinoista ja niiden mahdollisista haitoista.
  • Tiitinen, Aila; Kero, Katja (2020)
    Emättimen paikallisten estrogeenihoitojen ei ole todettu lisäävän rintasyöpäriskiä. Limakalvojen kuivuminen on yleinen oire vaihdevuosien jälkeen, ja rintasyöpähoidot voivat pahentaa oireita. Hoitona voidaan aina käyttää hormonittomia kosteuttavia geelejä tai tabletteja. Liukuvoiteen käyttö yhdynnöissä on suositeltavaa. Rintasyövän hoidon jälkeen voidaan käyttää paikallisia estrogeenejä. Paikallishoitoa voidaan nykytiedon mukaan harkita myös aromataasinestäjää käyttävillä. Ensisijaisia ovat estriolia sisältävät valmisteet.
  • Muranen, Taru A.; Mavaddat, Nasim; Khan, Sofia; Fagerholm, Rainer; Pelttari, Liisa; Lee, Andrew; Aittomäki, Kristiina; Blomqvist, Carl; Easton, Douglas F.; Nevanlinna, Heli (2016)
    The risk of developing breast cancer is increased in women with family history of breast cancer and particularly in families with multiple cases of breast or ovarian cancer. Nevertheless, many women with a positive family history never develop the disease. Polygenic risk scores (PRSs) based on the risk effects of multiple common genetic variants have been proposed for individual risk assessment on a population level. We investigate the applicability of the PRS for risk prediction within breast cancer families. We studied the association between breast cancer risk and a PRS based on 75 common genetic variants in 52 Finnish breast cancer families including 427 genotyped women and pedigree information on similar to 4000 additional individuals by comparing the affected to healthy family members, as well as in a case-control dataset comprising 1272 healthy population controls and 1681 breast cancer cases with information on family history. Family structure was summarized using the BOADICEA risk prediction model. The PRS was associated with increased disease risk in women with family history of breast cancer as well as in women within the breast cancer families. The odds ratio (OR) for breast cancer within the family dataset was 1.55 [95 % CI 1.26-1.91] per unit increase in the PRS, similar to OR in unselected breast cancer cases of the case-control dataset (1.49 [1.38-1.62]). High PRS-values were informative for risk prediction in breast cancer families, whereas for the low PRS-categories the results were inconclusive. The PRS is informative in women with family history of breast cancer and should be incorporated within pedigree-based clinical risk assessment.
  • May-Wilson, Sebastian; Sud, Amit; Law, Philip J.; Palin, Kimmo; Tuupanen, Sari; Gylfe, Alexandra; Hänninen, Ulrika A.; Cajuso, Tatiana; Tanskanen, Tomas; Kondelin, Johanna; Kaasinen, Eevi; Sarin, Antti-Pekka; Eriksson, Johan G.; Rissanen, Harri; Knekt, Paul; Pukkala, Eero; Jousilahti, Pekka; Salomaa, Veikko; Ripatti, Samuli; Palotie, Aarno; Renkonen-Sinisalo, Laura; Lepisto, Anna; Böhm, Jan; Mecklin, Jukka-Pekka; Al-Tassan, Nada A.; Palles, Claire; Farrington, Susan M.; Timofeeva, Maria N.; Meyer, Brian F.; Wakil, Salma M.; Campbell, Harry; Smith, Christopher G.; Idziaszczyk, Shelley; Maughan, Timothy S.; Fisher, David; Kerr, Rachel; Kerr, David; Passarelli, Michael N.; Figueiredo, Jane C.; Buchanan, Daniel D.; Win, Aung K.; Hopper, John L.; Jenkins, Mark A.; Lindor, Noralane M.; Newcomb, Polly A.; Gallinger, Steven; Conti, David; Schumacher, Fred; Casey, Graham; Aaltonen, Lauri A.; Cheadle, Jeremy P.; Tomlinson, Ian P.; Dunlop, Malcolm G.; Houlston, Richard S. (2017)
    Background: While dietary fat has been established as a risk factor for colorectal cancer (CRC), associations between fatty acids (FAs) and CRC have been inconsistent. Using Mendelian randomisation (MR), we sought to evaluate associations between polyunsaturated (PUFA), monounsaturated (MUFA) and saturated FAs (SFAs) and CRC risk. Methods: We analysed genotype data on 9254 CRC cases and 18,386 controls of European ancestry. Externally weighted polygenic risk scores were generated and used to evaluate associations with CRC per one standard deviation increase in genetically defined plasma FA levels. Results: Risk reduction was observed for oleic and palmitoleic MUFAs (OROA = 0.77, 95% CI: 0.65-0.92, P = 3.9 x 10(-3); ORPOA = 0.36, 95% CI: 0.15-0.84, P = 0.018). PUFAs linoleic and arachidonic acid had negative and positive associations with CRC respectively (ORLA = 0.95, 95% CI: 0.93-0.98, P = 3.7 x 10(-4); ORAA = 1.05, 95% CI: 1.02-1.07, P Z 1.7 x 10(-4)). The SFA stearic acid was associated with increased CRC risk (ORSA Z 1.17, 95% CI: 1.01-1.35, P = 0.041). Conclusion: Results from our analysis are broadly consistent with a pro-inflammatory FA profile having a detrimental effect in terms of CRC risk. (C) 2017 The Authors. Published by Elsevier Ltd.
  • Nurmi-Lüthje, Ilona; Lillsunde, Pirjo (2018)
    Päihteiden käyttö lisää tapaturmariskiä ja vammojen vakavuutta. Vaara kuolla päihtyneenä tapaturmassa on miehillä kuusinkertainen naisiin verrattuna. Alkoholin aiheuttama kuormitus päivystyksissä lisääntynee uuden alkoholilain vuoksi. Päivystysyksiköissä on hyödyllistä testata tapaturmapotilaan veren alkoholipitoisuus ja keskustella testin tuloksesta. Päihdeongelmien varhainen tunnistaminen sekä potilaan tukeminen ja hoitoonohjaus ovat tärkeitä haittojen ehkäisemiseksi.