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Danner E, Sund R, Sintonen H, Niuro L, Niinikoski H, Huopio H, Viikari LA, Jääskeläinen J. Quality of life and socioeconomic and educational status in patients with congenital hypothyroidism. Pediatr Res 2024:10.1038/s41390-024-03170-y. [PMID: 38565918 DOI: 10.1038/s41390-024-03170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/22/2024] [Accepted: 03/02/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The aim of this study was to investigate the influence of primary congenital hypothyroidism (CH) on quality of life, level of education and socioeconomic status (SES). METHODS Two independent study cohorts, a national and a regional, were collected from Finnish national registers and patient records. Data on social security benefits, SES, marital status, and education were collected from Statistics Finland. Health-related quality of life (HRQoL) was studied in the regional patient cohort with the standardized 15D and 16D instruments. RESULTS There were no statistically significant differences in education level, marital status, or SES between CH patients (n = 40) and their matched controls at the age of 25 years. The mean 15D score was both statistically significantly and clinically importantly lower in CH patients (n = 29) than controls (0.904 vs. 0.953, p = 0.008). CH patients reported significantly lower scores across various dimensions of physical and mental HRQoL, including breathing, sleeping, speech, excretion, mental function, distress, and vitality. The mean 16D score was lower in CH patients compared to controls (0.917, vs. 0.947), but without statistical significance. CONCLUSION SES of CH patients did not differ from matched controls. Thus, most CH patients integrate well into society, but their HRQoL is impaired. IMPACT Most patients with primary congenital hypothyroidism integrate well into society. In the current study, their socioeconomic and marital status did not differ from matched controls at the age of 25 years. However, health-related quality of life measured using 15D instrument was impaired. Every fourth patient reported that congenital hypothyroidism influenced everyday life.
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Affiliation(s)
- Emmi Danner
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland.
| | - Reijo Sund
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Laura Niuro
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Harri Niinikoski
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Hanna Huopio
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Liisa A Viikari
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jarmo Jääskeläinen
- Department of Pediatrics, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
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Tennilä J, Sintonen H, Utriainen P, Voutilainen R, Jääskeläinen J, Liimatta J. Health-related quality of life of young adult women with a history of premature adrenarche. Horm Res Paediatr 2024:000538283. [PMID: 38471476 DOI: 10.1159/000538283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Children with premature adrenarche (PA) have increased adrenal androgen concentrations and earlier pubertal development than their peers. Early sexual maturation and exposure to androgens have both been associated with an increased risk for neuropsychological adversities in adulthood. Such adversities would presumably influence the experienced health-related quality of life (HRQoL) of those affected. METHODS A longitudinal case-control cohort study, in which 30 PA girls and 40 age-matched controls were followed from childhood to young adult age. The main outcome measure was the total 15D HRQoL score. In addition, we assessed specific dimensions of the questionnaire, the subjects' relationship statuses and living arrangements. RESULTS There were no differences between the groups in the overall 15D scores (PA, 0.956 (0.052); control, 0.947 (0.055); p 0.482), or on any dimension of this instrument. CONCLUSION The study suggests that a history of PA does not lead to impaired HRQoL in adult age.
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Soukkio PK, Suikkanen SA, Sintonen H, Kukkonen-Harjula KT, Kautiainen H, Kääriä SM, Hupli MT, Aartolahti EM, Pitkälä KH, Sipilä S. Health-related quality of life after hip fracture: effects of a 12-month home-based exercise intervention-secondary analyses of an RCT. Qual Life Res 2024; 33:541-550. [PMID: 37932555 DOI: 10.1007/s11136-023-03545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE In this randomized controlled trial, we analyzed the effects of a 12-month home-based exercise intervention on the health-related quality of life (HRQoL) of patients with a hip fracture. METHODS Participants (n = 121) aged ≥ 60 years, with a Mini-Mental State Examination (MMSE) score of ≥ 12 and an operated hip fracture, were placed into Exercise (n = 61) or Usual care (n = 60) groups. Physiotherapist-supervised, home-based training was given twice a week over 12 months. HRQoL was assessed using the 15D instrument at baseline and at 3, 6, and 12 months. The total 15D scores and dimension scores were analyzed and compared to national age- and sex-matched reference data. RESULTS The participants' mean age was 81 years (SD 7), 75% were women, and 61% had a femoral neck fracture. The mean within-group change in total 15D score over 12 months was 0.023 (95% CI: -0.003 to 0.048) in the Usual care group, and 0.028 (CI: 0.003 to 0.054) in the Exercise group (between-group p = 0.76). We found a statistically significant change in total 15D score in the Exercise group, as well as in the dimension scores of mobility and usual activities in both groups. All 15D scores remained below the general population reference level. CONCLUSION Exercise training for 12 months did not enhance the HRQoL of home-dwelling patients with hip fractures any more than usual care. In addition, HRQoL remained below the population level in both groups.
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Affiliation(s)
- Paula K Soukkio
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland.
- Development Services, Wellbeing Services County of South Karelia, Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland.
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland.
| | - Sara A Suikkanen
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
- Faculty of Health Care and Social Services, LAB University of Applied Sciences, Yliopistonkatu 36, 53850, Lappeenranta, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO Box 20, 00014, Helsinki, Finland
| | - Katriina T Kukkonen-Harjula
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, PO BOX 100, 70029 KYS, Kuopio, Finland
- Folkhälsan Research Center, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Sanna M Kääriä
- Raatimiehet Oy, Raatimiehenkatu 18, 53100, Lappeenranta, Finland
| | - Markku T Hupli
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Valto Käkelän Katu 14D, 53130, Lappeenranta, Finland
| | - Eeva M Aartolahti
- Institute of Rehabilitation, JAMK University of Applied Sciences, Piippukatu 2, 40100, Jyväskylä, Finland
| | - Kaisu H Pitkälä
- Department of General Practice, University of Helsinki, Tukholmankatu 8 B, 00290, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Tukholmankatu 8 B, 00290, Helsinki, Finland
| | - Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland
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Hujanen P, Vaajanen A, Felin T, Lehtonen E, Syvänen U, Huhtala H, Helminen M, Sintonen H, Tuulonen A, Uusitalo-Järvinen H. Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations. Br J Ophthalmol 2023; 107:1782-1786. [PMID: 36229178 DOI: 10.1136/bjo-2021-320588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 09/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To assess the frequency of immediate sequential bilateral cataract surgery (ISBCS) and endophthalmitis during 13-year period in Tays Eye Centre, Tampere University Hospital, Tampere, Finland. METHODS All cataract surgeries performed between 1 January 2008 and 31 December 2020, and all endophthalmitis cases during the same period were searched from electronic patient records. Numbers and frequencies of ISBCS, and complications, including endophthalmitis and vitreous loss, were recorded and compared with unilateral operations. RESULTS The study included 56 700 cataract surgeries in 34 797 patients of whom 39% (n=13 445) had ISBCS. The median age of the patients was 75 (IQR 68-80, range 0.08-99) years at the time of surgery. The proportion of ISBCS patients increased from 4.2% in 2008 to 46% in 2020. Vitreous loss occurred in 480 (0.9%) of cataract surgeries. There were no postoperative endophthalmitis after cataract surgery (n=0) during the 13-year period. CONCLUSION The proportion of patients undergoing ISBCS increased from 4.2% in 2008 to 46% in 2020. No endophthalmitis were found to be associated with ISBCS.
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Affiliation(s)
- Pekko Hujanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anu Vaajanen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuukka Felin
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Eemil Lehtonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ulla Syvänen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Tampere University Hospital, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anja Tuulonen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
| | - Hannele Uusitalo-Järvinen
- Tays Eye Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Rautajoki T, Lehto JT, Sutinen E, Bergman P, Sintonen H, Rajala K, Mäkelä K, Hollmen M, Saarto T, Myllärniemi M. Dyspnea Associates With a Widely Impaired Quality of Life in Idiopathic Pulmonary Fibrosis Patients: A Longitudinal Study Using 15D. J Palliat Med 2023; 26:1357-1364. [PMID: 37366772 DOI: 10.1089/jpm.2022.0548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Background: Research on health-related quality of life (HRQoL) is crucial for developing comprehensive palliative care in idiopathic pulmonary fibrosis (IPF). Objectives: To study IPF patients' HRQoL compared with general population and its association with dyspnea in a longitudinal follow-up. Design: Assessment of IPF patients' HRQoL by a generic tool. Comparison of baseline data with the general population and a 30-month follow-up with 6 months intervals. Setting/Subjects: In total, 246 IPF patients were recruited from the Finnish nationwide real-life study, FinnishIPF. Measurements: Modified Medical Research Council (MMRC) dyspnea scale for dyspnea and the generic HRQoL tool 15D for the total and dimensional HRQoL were used. Results: At baseline, the mean 15D total score was lower (0.786, standard deviation [SD] 0.116) in IPF patients than in the general population (0.871, SD 0.043) (p < 0.001) and among the IPF patients with MMRC ≥2 compared with those with MMRC <2 (p < 0.001). In patients with MMRC ≥2, significant impairment compared with general population existed in 11 dimensions of HRQoL, such as breathing, usual activities, and sexual activity, whereas this was true in only 4 dimensions in MMRC <2 category. Mental function was not impaired in either group. During the follow-up, 15D total score decreased in both MMRC categories (p < 0.001) but stayed constantly worse in the MMRC ≥2 group. Seven and two dimensions of HRQoL significantly declined in the categories of MMRC <2 and MMRC ≥2, respectively. Conclusions: Patients with IPF, especially if dyspnea limits everyday life, suffer from widely impaired HRQoL, although self-assessed mental capability is preserved. Integrated palliative care is supported to face the multiple needs of IPF patients.
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Affiliation(s)
- Tuuli Rautajoki
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Juho T Lehto
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Eva Sutinen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Paula Bergman
- University of Helsinki, Helsinki, Finland
- Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Kati Mäkelä
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Maria Hollmen
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Tiina Saarto
- University of Helsinki, Helsinki, Finland
- Palliative Care Center, HUS Comprehensive Cancer Centre, Helsinki, Finland
| | - Marjukka Myllärniemi
- Individualized Drug Therapy Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Mäkelä T, Saisto T, Salmela-Aro K, Miettinen J, Sintonen H, Rouhe H. Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study. BMC Pregnancy Childbirth 2023; 23:468. [PMID: 37349712 DOI: 10.1186/s12884-023-05790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples. METHODS In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument. RESULTS PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women's mean 15D score was lower than partners' and that of age- and gender-standardized general population, while partners' mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively). CONCLUSIONS PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.
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Affiliation(s)
- Tia Mäkelä
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland.
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland.
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
| | - Katariina Salmela-Aro
- Department of Educational Sciences, University of Helsinki, PO BOX 9, Helsinki, 00014, Finland
| | - Jenny Miettinen
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
- Espoo Health Care Center, City of Espoo, PO BOX 1, Espoo, 02070, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, PO BOX 20, Helsinki, 00014, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, Helsinki University Hospital, PO BOX 140, Helsinki, 00029 HUS, Finland
- University of Helsinki, PO BOX 4, Helsinki, 00014, Finland
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Lähdeoja T, Pakkasjärvi N, Aronen P, Willamo P, Aronniemi J, Sintonen H, Nietosvaara Y, Paavola M. Outcomes at a Mean of 13 Years After Proximal Humeral Fracture During Adolescence. J Bone Joint Surg Am 2023:00004623-990000000-00786. [PMID: 37083587 DOI: 10.2106/jbjs.22.01131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND The long-term outcomes of a proximal humeral fracture during adolescence are not well known. We investigated the course of primary treatment for these injuries and the long-term outcomes in adulthood, comparing the outcomes with those from age-matched controls. We also compared outcomes after operative and nonoperative treatment via propensity score matching. METHODS We included children who sustained a proximal humeral fracture between the ages of 10.0 and 16.0 years and underwent treatment between 1995 and 2005. Data from primary treatment episodes were extracted from patient files. The patients were invited to a follow-up visit with outcome assessment and radiographs or to a telephone interview if unable to attend. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The secondary outcomes were the Simple Shoulder Test (SST), pain at rest and with strenuous use, shoulder range of motion, strength measurements, health-related quality of life (15D), and harms. Participant results were compared with the normal values of an age-matched population. The effect of operative treatment was assessed using propensity score matching and the average treatment effect was calculated. RESULTS This study included 209 patients (210 fractures). The mean follow-up (and standard deviation) was 13.1 ± 3.2 years. Outcome data were obtained from 152 participants (153 fractures); 78 participants attended the follow-up visit. The primary treatment episodes were uneventful. The mean scores were 2.5 (95% confidence interval [CI], 1.8 to 3.3 [range, 0 to 13]) for the DASH and 11.7 (95% CI, 11.5 to 11.8 [range, 8 to 12]) for the SST. Other outcomes were similarly good. There were no differences in function compared with the normal population values. Propensity matching showed no treatment effect for operative treatment compared with nonoperative treatment. CONCLUSIONS Proximal humeral fractures of adolescents heal well and rarely result in impairments whether treated operatively or nonoperatively. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tuomas Lähdeoja
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Niklas Pakkasjärvi
- Department of Pediatric Surgery, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Pasi Aronen
- Biostatistics Unit, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Patrick Willamo
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Aronniemi
- Department of Radiology, New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Yrjänä Nietosvaara
- Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Department of Pediatric Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Mika Paavola
- Finnish Centre for Evidence-Based Orthopaedics (FICEBO), Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ferreira S, Sintonen H, Raimundo A, Batalha N, Mendoza-Muñoz M, Perez-Gomez J, Parraca JA. Translation, Cultural Adaptation, and Reliability of the 15D Portuguese Version: A Generic Health-Related Quality of Life (HRQoL) Instrument. Healthcare (Basel) 2023; 11:healthcare11081099. [PMID: 37107933 PMCID: PMC10138184 DOI: 10.3390/healthcare11081099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/10/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
(1) Background: Purpose: The assessment of quality of life is essential to the human condition and can be measured through questionnaires. This study aims to translate and culturally adapt the 15D questionnaire to assess the population's quality of life, as well as explore its relative reliability and internal consistency; (2) Methods: The translation and cultural adaptation of the 15D questionnaire was carried out independently, considering two translations. The synthesis version was applied to eight subjects, distributed by gender. Cognitive interviews were conducted to observe clarity, acceptability, and familiarity with the version of the questionnaire. The final version of the questionnaire, in Portuguese, was again translated into the official language by two translators who had never had contact with the questionnaire. To assess the test-retest reliability and internal consistency of the 15D questionnaire, 43 participants were interviewed; (3) Results: Participants indicated that they had some doubts about dimensions, breathing, and discomfort and symptoms; however, as there were no suggestions for change, the questionnaire had no changes. Items were clear and understandable. Internal consistency was observed using Cronbach's alpha, with values between 0.76 and 0.98. The test-retest reliability values were between 0.77 and 0.97; and (4) Conclusions: The Portuguese version of the 15D questionnaire was proved to be equivalent to the English version and to be reliable for the Portuguese population. This instrument is easy to access and apply.
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Affiliation(s)
- Soraia Ferreira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais, 7004-516 Évora, Portugal
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, 00100 Helsinki, Finland
| | - Armando Raimundo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais, 7004-516 Évora, Portugal
| | - Nuno Batalha
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais, 7004-516 Évora, Portugal
| | - María Mendoza-Muñoz
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Research Group on Physical and Health Literacy and Health-Related Quality of Life (PHYQOL), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Jorge Perez-Gomez
- Health, Economy, Motricity, and Education (HEME) Research Group, Faculty of Sport Sciences, The University of Extremadura, 10003 Cáceres, Spain
| | - Jose A Parraca
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, 7004-516 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, Largo dos Colegiais, 7004-516 Évora, Portugal
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Reinikainen P, Lehtonen M, Lehtinen I, Luukkaala T, Sintonen H, Kellokumpu-Lehtinen PL. Health-related Quality of Life of Patients Treated With Different Fractionation Schedules for Early Prostate Cancer Compared to the Age-standardized General Male Population. Clin Genitourin Cancer 2023; 21:146-154. [PMID: 36038484 DOI: 10.1016/j.clgc.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/06/2022] [Accepted: 07/30/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effects of radiotherapy (RT) patients' health-related quality of life (HRQoL) are usually compared to those of other treatment modalities instead of HRQoL of the general population in oncological studies. We examined HRQoL of patients with an early prostate cancer (PC) not receiving hormonal treatment up to 3 years after RT using the 15D instrument and the FACT-P questionnaire. METHODS The 15D results were compared to those in the age-standardized general male population (N = 952) using an independent-sample t test. The study population (N = 73) received RT either with 78/2 Gy, 60/3 Gy or 36.25/7.25 Gy fractionation. RESULTS No significant differences in the mean total HRQoL scores were found between the RT groups and the general male population at any time point. Patients with PC had more depression (P = .015) and distress (P = .029) than the general male population before the treatment and depression up to 3 months after treatment (P = .019), which did not persist at 3 years. The sexual activity dimension had declined by the end of treatment, and this decline persisted 3 years later (P = .033). Excretion functions were worse compared to those in peers at the end of treatment (P < .001) but no longer at 3 months and later after RT. Regarding the FACT-P, HRQoL remained good at 3 years after RT in all the treatment groups and there were no significant differences between the different RT groups at this time point. CONCLUSION This study demonstrated that patients treated with RT for early PC had similar HRQoL compared to the age-standardized general male population at 3 years after treatment.
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Affiliation(s)
- Petri Reinikainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Pirkanmaa, Finland; Tampere University Hospital Cancer Center, Tampere, Pirkanmaa, Finland.
| | - Miikka Lehtonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Pirkanmaa, Finland
| | - Ilari Lehtinen
- Faculty of Information Technology and Communication Sciences, Tampere, Pirkanmaa, Finland
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Pirkanmaa, Finland; Faculty of Social and Health Sciences, Tampere University, Tampere, Pirkanmaa, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Pirkanmaa, Finland; Tampere University Hospital Cancer Center, Tampere, Pirkanmaa, Finland
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10
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Viitasalo S, Sintonen H, Lilja M, Hytonen M, Aaltonen LM. Quality of life after operative treatment of sinonasal inverted papilloma - a prospective study. Rhinology 2023; 61:71-76. [PMID: 36597891 DOI: 10.4193/rhin22.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Studies assaying morbidity related to sinonasal inverted papilloma (SNIP) and its treatment are lacking. We evaluated how operative treatment of SNIP affects patients' health-related quality of life (HRQoL) and symptoms. METHODS We prospectively recruited consecutive patients (n=52) operated for SNIP at Helsinki University Hospital, between years 2016 and 2019. In total, 42 patients filled in the 15D, a generic HRQoL instrument and a symptom questionnaire preoperatively and at 1 year and at 2 years postoperatively. The 15D HRQoL scores were compared to those of age- and sex-standardized general population. RESULTS Patients' mean baseline score for discomfort and symptoms (one of the 15D dimensions) was significantly better compared to general population, but this difference faded postoperatively. Frequency of epistaxis, nasal obstruction, lowered sense of smell, headache, tinnitus and epiphora decreased significantly during follow-up whereas frequency of numbness of the face or mouth increased. Difference in the mean 15D score of the patients compared with general population was insignificant at baseline and at 1 year and at 2 years postoperatively. CONCLUSIONS Measured by a generic HRQoL questionnaire, the mean score for discomfort and symptoms deteriorated after operative treatment of SNIP. Despite a relief of many symptoms, care should be taken when operating a benign tumour, as surgery may cause morbidity.
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Affiliation(s)
- S Viitasalo
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - M Lilja
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M Hytonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - L M Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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11
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Nieminen H, Roine R, Ristimäki A, Lantto E, Välimaa N, Kirveskari E, Sintonen H, Haglund C, Seppänen H. Health-related quality of life and anxiety levels among patients under surveillance for intraductal papillary mucinous neoplasm. BMC Gastroenterol 2023; 23:14. [PMID: 36647007 PMCID: PMC9841613 DOI: 10.1186/s12876-023-02639-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Because of the premalignant nature of intraductal papillary mucinous neoplasms (IPMNs), patients should undergo surveillance as long as they remain fit for surgery. This surveillance, with imaging and laboratory tests every 6 to 12 months, is expensive and may psychologically burden patients. This study aimed to determine the effects of IPMN surveillance on patients´ health-related quality of life (HRQoL) and anxiety levels. METHODS We included a random subgroup of all IPMN patients undergoing a follow-up check-up at Helsinki University Hospital (HUH) between August 2017 and November 2018. Patients were asked to complete the 15D HRQoL and state-trait anxiety inventory (STAI) questionnaires just before and three months after an IPMN control. RESULTS Among 899 patients in IPMN follow-up, 232 participated. The 15D HRQoL results showed differences in some IPMN patients' 15 analyzed dimensions compared to a sex- and age-standardized general population cohort, but the clinical relevance of these differences appear doubtful. We detected no significant difference in the anxiety levels determined using the STAI questionnaires before or three months after the IPMN control. CONCLUSION Surveillance should be less harmful than the risk of disease. Among our patients, the recommended IPMN follow-up carried minimal negative impact on patients' HRQoL or anxiety levels. This result is important, because the number of patients under IPMN surveillance is rapidly increasing and the cancer risk among the majority of these patients remains small. TRIAL REGISTRATION The Surgical Ethics Committee of Helsinki University Hospital approved this study (Dnro HUS 475/2017) and it was registered at ClinicalTrials.gov (NCT03131076) before patient enrollment began.
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Affiliation(s)
- Heini Nieminen
- grid.7737.40000 0004 0410 2071Department of Surgery, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4, PL340, Helsinki, Finland
| | - Risto Roine
- grid.9668.10000 0001 0726 2490Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland ,grid.7737.40000 0004 0410 2071Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ari Ristimäki
- grid.7737.40000 0004 0410 2071Department of Pathology, Faculty of Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland ,grid.15485.3d0000 0000 9950 5666HUSLAB, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Translational Cancer Medicine, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Eila Lantto
- grid.7737.40000 0004 0410 2071Helsinki University Hospital, University of Helsinki, Helsinki, Finland ,grid.440346.10000 0004 0628 2838Department of Radiology, Paijat-Hame Central Hospital, Lahti, Finland
| | - Norma Välimaa
- grid.7737.40000 0004 0410 2071Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Erika Kirveskari
- grid.7737.40000 0004 0410 2071HUS Diagnostic Center, Clinical Neurophysiology, Clinical Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- grid.7737.40000 0004 0410 2071Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Caj Haglund
- grid.7737.40000 0004 0410 2071Department of Surgery, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4, PL340, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Translational Cancer Medicine, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hanna Seppänen
- grid.7737.40000 0004 0410 2071Department of Surgery, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4, PL340, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Translational Cancer Medicine, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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12
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Rissanen A, Roine R, Marttunen M, Sintonen H, Lindberg N. Health care costs and changes in subjective health-related quality of life among Finnish adolescents referred to secondary psychiatric out-patient services: a one-year follow-up study. Scand J Child Adolesc Psychiatr Psychol 2023; 11:34-43. [PMID: 37273801 PMCID: PMC10236378 DOI: 10.2478/sjcapp-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Background There has been growing interest in economic evidence regarding treatment of mental disorders. Objective The purpose of this one-year follow-up study was to evaluate the secondary health care costs and changes in health-related quality of life (HRQoL) in three common adolescent psychiatric disorder groups. Further, HRQoL of patients was compared to that of population controls. Methods Twelve- to fourteen-year-old adolescents with behavioral and emotional disorders (n = 37), mood disorders (n = 35), and anxiety disorders (n = 34), completed the 16D HRQoL questionnaire when they entered the adolescent psychiatric outpatient clinics (baseline) and at follow-up. The direct secondary health care costs were calculated using a clinical patient administration system. Population controls included 373 same-aged pupils from randomly selected 13 comprehensive schools. Results The direct secondary health care costs did not differ significantly between the three patient groups. However, in adolescents with mood disorders, this investment generated a significant and clinically important improvement in HRQoL, which was not observed in the other two patient groups. Conclusions The costs of health care alone do not necessarily reflect its quality.
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Affiliation(s)
- Anne Rissanen
- Department of Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Risto Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nina Lindberg
- Department of Forensic Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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13
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Riihimäki K, Sintonen H, Vuorilehto M, Isometsä E. Health-related quality of life-based definition of remission from depression among primary care patients. Front Psychiatry 2023; 14:926410. [PMID: 37051167 PMCID: PMC10084667 DOI: 10.3389/fpsyt.2023.926410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
Background Depression undermines health-related quality of life (HRQoL). Remission is the central aim of all treatments for depression, but the degree of remission necessary for depressive patients' HRQoL to correspond to the normal range of the general population remains unknown. Methods The Vantaa Primary Care Depression Study prospectively followed-up a screening-based cohort of depressive primary care patients for 5 years. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to diagnose major depressive disorder. HRQoL was measured by the generic 15D instrument at baseline and at 5 years (N = 106, 77% of baseline patients), and compared with the 15D results of an age-standardized general population sample from the Finnish Health 2011 Survey (N = 4,157). Receiver operating characteristic analyses determined the optimal Hamilton Depression Rating Scale (HAMD), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) cut-offs for remission, using the 15D score as the construct validator. Remission was defined as the score at which HRQoL reached the general population range (minimum mean - 1 SD). As age may influence HRQoL, patients older and younger than the median 52 years were investigated separately. Results For HAMD, the optimal cut-off point score was 8.5, for BDI 10.5, and for BAI 11.5. The differences between the findings of the younger and older patients were small. Limitations Cross-sectional analysis, small number of patients in the cohort. Conclusion Depressive primary care patients' HRQoL reaches the normal variation range of the general population when their depression and anxiety scores reach the conventional clinical cut-offs for remission.
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Affiliation(s)
- Kirsi Riihimäki
- Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Maria Vuorilehto
- Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- *Correspondence: Erkki Isometsä,
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14
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Isokääntä S, Ruohoaho UM, Anttila M, Kokki H, Sintonen H, Toroi P, Kokki M. Resilience, pain, and health-related quality of life in gynecological patients undergoing surgery for benign and malignant conditions: a 12-month follow-up study. BMC Womens Health 2022; 22:345. [PMID: 35974326 PMCID: PMC9382813 DOI: 10.1186/s12905-022-01923-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Gynecological surgery has many impacts on women’s physical and mental health, and efforts to improve recovery from surgery are constantly under evaluation. Resilience is an ability to overcome stressors and adversities, such as traumas and surgeries. This study aimed to explore patients’ resilience and psychological symptoms in relation to recovery, health-related quality of life (HRQoL), and pain one year after gynecological surgery. Methods In a prospective cohort study, we enrolled consecutive elective gynecologic surgery patients who completed questionnaires before and at one year after surgery: the Resilience Scale-25, the 15D instrument of HRQoL (15D), the Life Satisfaction Scale-4, and the Hospital Anxiety and Depression Scale. Their mean 15D scores were compared to those of an age-matched sample of women from the general Finnish population (n = 2743). Results We enrolled 271 women who underwent gynecological surgery due to benign (n = 190) and malignant (n = 81) diagnoses. Resilience was equally high in women with benign and malignant diagnoses at both time points. Higher resilience associated with less pain, analgesic use, and better pain relief from the use of pain medication at 12 months after surgery. Pain intensity was similar in the two groups, but patients with benign diseases had less pain at 12 months than before surgery. Before surgery, patients’ HRQoL was worse than that of the general population, but at 12 months the mean HRQoL of patients with benign diseases had improved to the same level as that in the general population but had decreased further in patients with malignant diseases. Anxiety was higher and life satisfaction was lower in patients with malignant diseases before surgery. At 12 months, anxiety had decreased in both groups, and life satisfaction had increased in patients with malignant diseases. Depression was similarly low in both groups and time points. Conclusions Resilience correlated with less pain one year after surgery. After surgery, HRQoL improved in patients with benign diseases but deteriorated in patients with malignant diseases. Patients with low resilience should be identified during preoperative evaluation, and health care professionals should give these patients psychological support to enhance their resilience. Trial Registration ClinicalTrials.gov; registered October 29, 2019; identifier: NCT04142203; retrospectively registered.
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15
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Oulasvirta E, Pohjola A, Koroknay-Pál P, Hafez A, Roine R, Sintonen H, Laakso A. Long-term health-related quality of life in patients with ruptured arteriovenous malformations treated in childhood. J Neurosurg Pediatr 2022; 30:1-9. [PMID: 35901751 DOI: 10.3171/2022.5.peds2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to reveal the long-term health-related quality of life (HRQOL), educational level, and impact on occupation in 55 patients who experienced ruptured brain arteriovenous malformations (AVMs) that were treated during childhood. METHODS In 2016, questionnaires including the 15D instrument were sent to all living patients older than 18 years (n = 432) in the Helsinki AVM database. The cohort was further specified to include only patients with ruptured AVMs who were younger than 20 years at the time of diagnosis (n = 55). Educational level was compared with the age-matched general population of Finland. The mean 15D scores were calculated for independent variables (Spetzler-Ponce classification, admission age, symptomatic epilepsy, and multiple bleeding episodes) and tested using the independent-samples t-test or ANCOVA. Linear regression was used to create a multivariate model. Bonferroni correction was used with multiple comparisons. RESULTS The mean follow-up time from diagnosis to survey was 24.2 (SD 14.7) years. The difference in the mean 15D scores between Spetzler-Ponce classes did not reach statistical significance. The youngest age group (< 10 years at the time of diagnosis) performed less well on the dimension of usual activities than the older patients. Symptomatic epilepsy significantly reduced the long-term HRQOL. Multiple hemorrhages significantly reduced the scores on three dimensions: mobility, speech, and sexual activity. In the regression model, symptomatic epilepsy was the only significant predictor for a lower 15D score. The educational level of the cohort was for the most part comparable to that of the general population in the same age group. AVM was the reason for early retirement in 11% of the patients, while lowered performance because of the AVM was reported by 37% of the patients. CONCLUSIONS Patients with ruptured AVMs treated in childhood can live an independent and meaningful life, even in the case of the highest-grade lesions. Symptomatic epilepsy significantly reduced the long-term HRQOL, highlighting the need for continuing support for these patients.
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Affiliation(s)
- Elias Oulasvirta
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Anni Pohjola
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Koroknay-Pál
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Ahmad Hafez
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Risto Roine
- 2Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland; and
| | - Harri Sintonen
- 3Department of Public Health, Helsinki University Hospital, Helsinki, Finland
| | - Aki Laakso
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Hirvonen MJ, Pasternack R, Lipitsä T, Vihervaara A, Harvima R, Ranta M, Sintonen H, Huilaja L. Patients with Hidradenitis Suppurativa Suffer from Low Health-Related Quality of Life as Measured by the Generic 15D Instrument. Skin Appendage Disord 2022; 8:221-227. [PMID: 35702276 PMCID: PMC9149471 DOI: 10.1159/000520839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/27/2021] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with various comorbidities and diminished quality of life (QoL). Among dermatological conditions, HS is reported to most severely diminish QoL. This study aimed to analyse the health-related QoL (HRQoL) of patients with HS in more detail by using generic to disease-specific HRQoL questionnaires. Correlations between the HRQoL measures and HS disease severity measures were assessed. METHODS We analysed the HRQoL and clinical severity of patients with HS (N = 92) treated in 5 Finnish hospitals using HRQoL measurement tools most often used in dermatological clinics, as well as the generic 15D instrument (standardized and self-administered 15-dimensional measure of HRQoL). The disease severity was assessed using the Hurley stage, International Hidradenitis Suppurativa Severity Score System, and disease severity evaluation by the investigator. RESULTS The mean 15D score of HS patients was low and comparable with that of patients with cancers. No correlation was found between HS severity measures and 15D score, indicating that even mild HS has a high impact on HRQoL. CONCLUSIONS Our findings strengthen the understanding about HS as a debilitating disease and even compared with non-dermatological conditions and highlight the need of comprehensive care of patients with HS.
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Affiliation(s)
| | - Rafael Pasternack
- Department of Dermatology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Tiina Lipitsä
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Armi Vihervaara
- Department of Dermatology, Turku University Hospital, Turku, Finland
| | - Rauno Harvima
- Department of Dermatology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | | | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Laura Huilaja
- Department of Dermatology and Medical Research Center Oulu, Oulu University Hospital, PEDEGO Research Unit, University of Oulu, Oulu, Finland
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17
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Punkkinen J, Nyyssönen M, Walamies M, Roine R, Sintonen H, Koskenpato J, Haakana R, Arkkila P. Behavioral therapy is superior to follow-up without intervention in patients with supragastric belching-A randomized study. Neurogastroenterol Motil 2022; 34:e14171. [PMID: 33991432 DOI: 10.1111/nmo.14171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/13/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Behavioral therapy (BT) has been proven effective in the treatment of supragastric belching (SGB) in open studies. The aim was to compare BT to follow-up without intervention in patients with SGB in a randomized study. METHODS Forty-two patients were randomized to receive 5 sessions of BT, comprising diaphragmatic breathing exercises, or to follow-up without intervention. Patients were evaluated at 6 months, at which point the control group was also offered BT and evaluated after another 6 months. The frequency and intensity of belching and mental well-being were evaluated with a visual analog scale (VAS). Depression, anxiety, and health-related quality of life (HRQoL) were evaluated with four questionnaires: BDI, BAI, 15D, and RAND-36. KEY RESULTS The frequency and intensity of SGB were significantly lower in the therapy group (n = 19) than in the control group (n = 18) at the 6-month control (p < 0.001). When all patients (n = 36) were evaluated 6 months after BT, in addition to relief in the frequency and intensity of belching (p < 0.001), mental well-being had also improved (p < 0.05). Of all 36 patients, 27(75%) responded to BT. Depression scores were lower after therapy (p < 0.05). Only minor changes occurred in anxiety and HRQoL. CONCLUSIONS AND INFERENCES Behavioral therapy is superior to follow-up without intervention in patients with SGB in reducing belching and depression; it also improves mental well-being but has only a modest effect on anxiety and HRQoL.
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Affiliation(s)
- Jari Punkkinen
- Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.,Hyvinkää Hospital, Endoscopy Outpatient Clinic, Hyvinkää, Finland
| | - Meri Nyyssönen
- Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
| | - Markku Walamies
- Clinical Physiology Unit, HUS Diagnostic Center, Peijas Hospital, Vantaa, Finland
| | - Risto Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jari Koskenpato
- Department of Gastroenterology, Aava Kamppi Medical Centre, Helsinki, Finland
| | - Riikka Haakana
- Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland
| | - Perttu Arkkila
- Department of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine, University of Helsinki, Helsinki, Finland
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Kariola L, Varimo T, Huopio H, Tenhola S, Voutilainen R, Kosola S, Toppari J, Sintonen H, Miettinen PJ, Raivio T, Hero M. Health-related quality of life in boys with constitutional delay of growth and puberty. Front Endocrinol (Lausanne) 2022; 13:1028828. [PMID: 36518253 PMCID: PMC9743641 DOI: 10.3389/fendo.2022.1028828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Constitutional delay of growth and puberty (CDGP) is the most common reason for delayed puberty in healthy male adolescents. The main indication for medical treatment for this condition is psychosocial burden. However, to the best of our knowledge, no previous study has addressed the impact of puberty-promoting treatment on health-related quality of life (HRQoL) among boys with CDGP. METHODS We investigated HRQoL in 22 boys with CDGP, who participated in a randomized controlled trial in four Finnish pediatric endocrinology outpatient clinics between 2013 and 2017. The boys were randomized to receive either aromatase inhibitor letrozole (2.5mg/day; n=11) or intramuscular testosterone (1mg/kg/every 4 weeks; n=11) for 6 months and followed up to 12 months. HRQoL was assessed with a generic self-assessment 16D© instrument developed and validated for adolescents aged 12 to 15 years. The 16D includes 16 dimensions (vitality, sight, breathing, distress, hearing, sleeping, eating, discomfort and symptoms, speech, physical appearance, school and hobbies, mobility, friends, mental function, excretion and depression). The results were compared with an age-matched reference population that included 163 boys from the Finnish capital-city area. The study protocol is registered to ClinicalTrials.gov (registration number: NCT01797718). RESULTS At baseline, the mean 16D score of the CDGP boys was similar to the age-matched reference population (0.95 vs 0.96, p=0.838). However, the physical appearance score (satisfaction with general appearance, height and weight) was significantly lower in the CDGP boys (0.75 vs 0.92, p=0.004) than their peers. Twelve months after treatment, Appearance had improved significantly (0.75 vs 0.87, p=0.004) and no HRQoL dimension was inferior compared to the age-matched reference population. DISCUSSION In terms of HRQoL, the main impact of delayed puberty was dissatisfaction with physical appearance. Puberty promoting therapy was associated with a positive change in perceived appearance, with no clear difference between low-dose testosterone and letrozole treatments.
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Affiliation(s)
- Laura Kariola
- Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki University, Helsinki, Finland
| | - Tero Varimo
- Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki University, Helsinki, Finland
| | | | - Sirpa Tenhola
- Department of Pediatrics, Kymenlaakso Central Hospital, Kotka, Finland
| | | | - Silja Kosola
- Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki University, Helsinki, Finland
| | - Jorma Toppari
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Centre for Population Health Research, University of Turku, and Department of Pediatrics, Turku University Hospital, Turku, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Päivi J. Miettinen
- Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki University, Helsinki, Finland
| | - Taneli Raivio
- Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki University, Helsinki, Finland
- Translational Stem Cell Biology and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Matti Hero
- Helsinki University Hospital, New Children’s Hospital, Pediatric Research Center, Helsinki University, Helsinki, Finland
- *Correspondence: Matti Hero,
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Ylivuori M, Airaksinen L, Sintonen H, Roine RP, Hytönen M, Virkkula P. Do aggravating rhinologic symptoms at work indicate occupational exposure? A cross-sectional outpatient clinic study. Asian Pac J Allergy Immunol 2021. [PMID: 34953477 DOI: 10.12932/ap-070621-1151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Air impurities can exacerbate or cause rhinologic diseases. However, only a few studies have assessed rhinologic patients' symptoms at work. OBJECTIVE This study surveys the impact of work on rhinology clinic patients' quality of life in relation to work-related respiratory exposures. In addition, we surveyed patients' sick leave periods. METHODS We recruited adult employed rhinology patients referred to the otorhinolaryngology clinic. A total of 177 patients were included. We collected data on patients' medical history, rhinologic disease-specific and generic quality of life, current or most recent job title, a description of current work, nasal symptoms, possible worked-related symptom triggers and sick leave periods during the preceding year. RESULTS In total, 101 (57.1%) patients reported exacerbated rhinologic symptoms at work and reported more severe rhinologic disease and a lower disease-specific quality of life compared to non-work-related rhinologic patients (P = 0.008). A minority, 24.3% of our patients were exposed to any specific occupational respiratory sensitizer or irritant at work. The mean sick leave period due to rhinologic disease was 7.7 days per year. CONCLUSIONS Exposure to specific occupational sensitizers or irritants did not associate with increasing symptoms at work or quality of life amongst our patients. Most rhinology patients reported exacerbated symptoms at work. They appeared to be more symptomatic than the rest of the patients and, therefore, possibly hyperreactive to unspecific respiratory triggers at work. Rhinologic diseases caused our patients a marked burden with high work absenteeism.
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Affiliation(s)
- Maija Ylivuori
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Risto P Roine
- Group Administration, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; and Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paula Virkkula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Sakki AJ, Roine RP, Mäkinen LK, Sintonen H, Nokso-Koivisto J. Impact of tonsillotomy versus tonsillectomy on health-related quality of life and healthcare costs in children with sleep-disordered breathing. J Laryngol Otol 2021; 136:1-22. [PMID: 34819188 DOI: 10.1017/s0022215121003832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveThis study aimed to explore health-related quality of life and use of healthcare services and ensuing costs before and after tonsillotomy in children with sleep-disordered breathing and to compare the results to an earlier cohort of children who had undergone tonsillectomy.MethodChildren undergoing tonsillotomy answered the 17-dimensional, standardised health-related quality of life instrument questionnaire and a questionnaire on use of healthcare services and sick leave before and after surgery. Costs of specialist care were obtained pre- and post-operatively. The data were compared with similar data collected previously from children with tonsillectomy.ResultsTonsillotomy improved mean total health-related quality of life score significantly at 6 and 12 months. Healthcare costs and number of sick-leave days diminished significantly from 3 months pre-operatively to 12 months after surgery. Tonsillotomy had similar positive effects compared with tonsillectomy regarding health-related quality of life and healthcare costs.ConclusionTonsillotomy improves health-related quality of life in children with sleep-disordered breathing and reduces healthcare service needs and sick leave similarly to tonsillectomy.
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Affiliation(s)
- Anniina J Sakki
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Risto P Roine
- Helsinki and Uusimaa Hospital Group, Group Administration, Finland and University of Eastern Finland, Department of Health and Social Management
| | - Laura K Mäkinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Johanna Nokso-Koivisto
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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21
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Gamberini L, Mazzoli CA, Prediletto I, Sintonen H, Scaramuzzo G, Allegri D, Colombo D, Tonetti T, Zani G, Capozzi C, Dalpiaz G, Agnoletti V, Cappellini I, Melegari G, Damiani F, Fusari M, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Papa R, Potalivo A, Montomoli J, Taddei S, Mazzolini M, Ferravante AF, Nicali R, Ranieri VM, Russo E, Volta CA, Spadaro S. Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study. Respir Med 2021; 189:106665. [PMID: 34717097 PMCID: PMC8531241 DOI: 10.1016/j.rmed.2021.106665] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. METHODS We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. RESULTS We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. CONCLUSIONS HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. TRIAL REGISTRATION NCT04411459.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Irene Prediletto
- Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna, Italy; IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant'Orsola-Malpighi - Respiratory and Critical Care Unit, Bologna, Italy.
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Davide Colombo
- Anaesthesia and Intensive Care Department - SS. Trinità Hospital, ASL Novara, Italy; Health Science Department - Eastern Piedmont University, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Chiara Capozzi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Vanni Agnoletti
- Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
| | - Iacopo Cappellini
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Gabriele Melegari
- Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy - Imola Hospital, Imola, Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Postoperative Intensive Care Unit. Medical and Surgical Department of Digestive, Liver and Endocrine-Metabolic Diseases. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care - Infermi Hospital, Rimini, Italy
| | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care - Infermi Hospital, Rimini, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | | | | | - Roberta Nicali
- Outpatient Pneumology Department. - SS. Trinità Hospital Borgomanero, ASL NO, Novara, Italy
| | - Vito Marco Ranieri
- Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
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Nummi A, Mulari S, Stewart JA, Kivistö S, Teittinen K, Nieminen T, Lampinen M, Pätilä T, Sintonen H, Juvonen T, Kupari M, Suojaranta R, Kankuri E, Harjula A, Vento A. Epicardial Transplantation of Autologous Cardiac Micrografts During Coronary Artery Bypass Surgery. Front Cardiovasc Med 2021; 8:726889. [PMID: 34595223 PMCID: PMC8476794 DOI: 10.3389/fcvm.2021.726889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Cardio-regenerative cell therapies offer additional biologic support to coronary artery bypass surgery (CABG) and are aimed at functionally repairing the myocardium that suffers from or is damaged by ischemia. This non-randomized open-label study assessed the safety and feasibility of epicardial transplantation of atrial appendage micrografts (AAMs) in patients undergoing CABG surgery. Methods: Twelve consecutive patients destined for CABG surgery were included in the study. Six patients received AAMs during their operation and six patients were CABG-operated without AAMs transplantation. Data from 30 elective CABG patients was collected for a center- and time-matched control group. The AAMs were processed during the operation from a biopsy collected from the right atrial appendage. They were delivered epicardially onto the infarct scar site identified in preoperative late gadolinium enhancement cardiac magnetic resonance imaging (CMRI). The primary outcome measures at the 6-month follow-up were (i) patient safety in terms of hemodynamic and cardiac function over time and (ii) feasibility of therapy administration in a clinical setting. Secondary outcome measures were left ventricular wall thickness, change in myocardial scar tissue volume, changes in left ventricular ejection fraction, plasma concentrations of N-terminal pro-B-type natriuretic peptide levels, NYHA class, number of days in hospital and changes in the quality of life. Results: Epicardial transplantation of AAMs was safe and feasible to be performed during CABG surgery. CMRI demonstrated an increase in viable cardiac tissue at the infarct site in patients receiving AAMs treatment. Conclusions and Relevance: Transplantation of AAMs shows good clinical applicability as performed during cardiac surgery, shows initial therapeutic effect on the myocardium and has the potential to serve as a delivery platform for cardiac gene therapies. Trial Registration:ClinicalTrials.gov, identifier: NCT02672163.
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Affiliation(s)
- Annu Nummi
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Severi Mulari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juhani A Stewart
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sari Kivistö
- Department of Radiology, Helsinki University Hospital (HUS) Medical Imaging Center and Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kari Teittinen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tuomo Nieminen
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Milla Lampinen
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tommi Pätilä
- Pediatric Cardiac Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Markku Kupari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Raili Suojaranta
- Department of Anesthesiology and Intensive Care, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Esko Kankuri
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ari Harjula
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Antti Vento
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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23
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Gamberini L, Mazzoli CA, Sintonen H, Colombo D, Scaramuzzo G, Allegri D, Tonetti T, Zani G, Capozzi C, Giampalma E, Agnoletti V, Becherucci F, Bertellini E, Castelli A, Cappellini I, Cavalli I, Crimaldi F, Damiani F, Fusari M, Gordini G, Laici C, Lanza MC, Leo M, Marudi A, Nardi G, Ottaviani I, Papa R, Potalivo A, Ranieri VM, Russo E, Taddei S, Volta CA, Spadaro S. Quality of life of COVID-19 critically ill survivors after ICU discharge: 90 days follow-up. Qual Life Res 2021; 30:2805-2817. [PMID: 33977415 PMCID: PMC8113006 DOI: 10.1007/s11136-021-02865-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE The onset of the coronavirus disease 19 (COVID-19) pandemic in Italy induced a dramatic increase in the need for intensive care unit (ICU) beds for a large proportion of patients affected by COVID-19-related acute respiratory distress syndrome (ARDS). The aim of the present study was to describe the health-related quality of life (HRQoL) at 90 days after ICU discharge in a cohort of COVID-19 patients undergoing invasive mechanical ventilation and to compare it with an age and sex-matched sample from the general Italian and Finnish populations. Moreover, the possible associations between clinical, demographic, social factors, and HRQoL were investigated. METHODS COVID-19 ARDS survivors from 16 participating ICUs were followed up until 90 days after ICU discharge and the HRQoL was evaluated with the 15D instrument. A parallel cohort of age and sex-matched Italian population from the same geographic areas was interviewed and a third group of matched Finnish population was extracted from the Finnish 2011 National Health survey. A linear regression analysis was performed to evaluate potential associations between the evaluated factors and HRQoL. RESULTS 205 patients answered to the questionnaire. HRQoL of the COVID-19 ARDS patients was significantly lower than the matched populations in both physical and mental dimensions. Age, sex, number of comorbidities, ARDS class, duration of invasive mechanical ventilation, and occupational status were found to be significant determinants of the 90 days HRQoL. Clinical severity at ICU admission was poorly correlated to HRQoL. CONCLUSION COVID-19-related ARDS survivors at 90 days after ICU discharge present a significant reduction both on physical and psychological dimensions of HRQoL measured with the 15D instrument. TRIAL REGISTRATION NCT04411459.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Carlo Alberto Mazzoli
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Davide Colombo
- Anaesthesia and Intensive Care Department, SS. Trinità Hospital, ASL Novara, Italy
- Traslational Medicine Department, Eastern Piedmont University, Vercelli, Italy
| | - Gaetano Scaramuzzo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Tommaso Tonetti
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Università Di Bologna, Bologna, Italy
| | - Gianluca Zani
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Chiara Capozzi
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Vanni Agnoletti
- Anaesthesia and Intensive Care Unit, M.Bufalini Hospital, Cesena, Italy
| | - Filippo Becherucci
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Bertellini
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
- Anaesthesia and Intensive Care Residency Program-Traslational Medicine Dept., Eastern Piedmont University, Vercelli, Italy
| | - Andrea Castelli
- Cardio-Anesthesiology Unit, Cardio-Thoracic-Vascular Department, S.Orsola Hospital, University of Bologna, Bologna, Italy
| | - Iacopo Cappellini
- Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
| | - Irene Cavalli
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Università Di Bologna, Bologna, Italy
| | - Federico Crimaldi
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
- Anaesthesia and Intensive Care Residency Program-Traslational Medicine Dept., Eastern Piedmont University, Vercelli, Italy
| | - Federica Damiani
- Department of Anaesthesia, Intensive Care and Pain Therapy, Imola Hospital, Imola, Italy
| | - Maurizio Fusari
- Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Giovanni Gordini
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Cristiana Laici
- Division of Anesthesiology, Hospital S. Orsola Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Maria Concetta Lanza
- Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Mirco Leo
- Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio E Biagio E Cesare Arrigo, Alessandria, Italy
| | - Andrea Marudi
- Department of Anaesthesiology, University Hospital of Modena, Via del Pozzo 71, 41100, Modena, Italy
- Anaesthesia and Intensive Care Residency Program-Traslational Medicine Dept., Eastern Piedmont University, Vercelli, Italy
| | - Giuseppe Nardi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Irene Ottaviani
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
| | - Raffaella Papa
- Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, Rimini, Italy
| | - Vito Marco Ranieri
- Alma Mater Studiorum, Dipartimento Di Scienze Mediche E Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico Di Sant'Orsola, Università Di Bologna, Bologna, Italy
| | - Emanuele Russo
- Anaesthesia and Intensive Care Unit, M.Bufalini Hospital, Cesena, Italy
| | - Stefania Taddei
- Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
| | - Carlo Alberto Volta
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anaesthesia and Intensive Care, University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro, 8, 44121, Cona, Ferrara, Italy.
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Lappalainen L, Stenvall H, Lavikainen P, Miettinen H, Martikainen J, Sintonen H, Tolppanen AM, Roine RP, Hartikainen J. Patient-reported outcomes in coronary artery disease: the relationship between the standard, disease-specific set by the International Consortium for Health Outcomes Measurement (ICHOM) and the generic health-related quality of life instrument 15D. Health Qual Life Outcomes 2021; 19:206. [PMID: 34454528 PMCID: PMC8401180 DOI: 10.1186/s12955-021-01841-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) instruments measure health gains, including changes in health-related quality of life (HRQoL). Previous studies have assessed the reliability and relationship of multiple HRQoL instruments in search of the optimal instrument for feasible measurement of PROs. Although the 15D instrument was shown to have the best sensitivity and construct validity among cardiac patients, it is unknown how well it captures relevant disease-specific information scores compared to instruments included in the International Consortium for Health Outcomes Measurement (ICHOM) standard set. The aim of this study was to investigate whether the disease-specific PRO instruments and a generic HRQoL instrument capture disease related symptoms in coronary artery disease (CAD) patients. METHODS Health status and HRQoL were assessed with the instruments included in the ICHOM standard set: Seattle Angina Questionnaire short-form (SAQ-7), Rose Dyspnea Scale (RDS), two-item Patient Health Questionnaire (PHQ-2), and with the 15D HRQoL instrument at baseline and 1 year from the treatment in a university hospital setting. Spearman correlation and explanatory factor analysis were used to assess the relationship of baseline scores and 1-year change in scores of 297 patients. RESULTS At baseline, the overall 15D score and SAQ-physical limitation (SAQ-PL), 15D "breathing" and SAQ-PL, as well as "breathing" and RDS showed moderately strong correlations. The factor interpreted to reflect "Breathing-related physical activity", based on high loadings of "breathing", RDS, SAQ-PL, "mobility", "vitality", and "usual activities", explained 19.2% of the total variance. Correlations between 1-year changes in scores were fair. The factor of "Breathing-related physical activity", with significant loading of RDS, SAQ-PL, "breathing, "usual activities", "vitality", "sexual activity", "mobility", and disease-specific quality of life explained 20.5% of the total variance in 1-year change in scores. The correlation of angina frequency measured by SAQ-7 and the 15D instrument was poor. CONCLUSIONS The 15D detects dyspnea and depression similarly to RDS and PHQ-2 but not angina similarly to the SAQ-7. This may call for supplementing the 15D instrument with a disease-specific instrument when studying CAD patients.
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Affiliation(s)
- Laura Lappalainen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland.
| | | | - Piia Lavikainen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Heikki Miettinen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland
| | | | | | | | - Risto P Roine
- University of Helsinki, Helsinki, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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25
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Sipilä M, Kiukas EL, Lindford A, Ylä-Kotola T, Lauronen J, Sintonen H, Lassus P. The four category systematic approach for selecting patients for face transplantation. J Plast Surg Hand Surg 2021; 56:79-86. [PMID: 34255990 DOI: 10.1080/2000656x.2021.1933995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
There is a need for a systematic approach to evaluate patients for potential face transplantation (FT). Ten patients with severe facial defects treated between 1995 and 2017 formed the study group. Data was collected from patient charts and clinical, radiological and laboratory examinations. Facial deficiencies were subdivided into four different categories: anatomical region (10 facial subunits), facial function, aesthetic defect (range 0-9-worst), and impact on health-related quality of life (HRQoL) (15D questionnaire, range 0-1). Immunological status and possible contraindications were also evaluated. Defect aetiology consisted of burns (4), ballistic injury (3), blunt injury (1), blast injury (1), and neurofibromatosis type I (1). All patients had central facial deficiencies and 6 patients had 8 to 10 injured facial subunits. All patients had at least partial loss of facial function. The mean aesthetic disfigurement score was 6.4. The median lowering of 15D score was -0.107. None were significantly sensitized although four patients had relative contraindications and one patient had an absolute contraindication for FT. Three patients with a severe overall facial deficiency were considered as potential FT candidates. We herein propose a comprehensive and systematic tool to evaluate potential candidates for FT. This approach includes assessment of 4 key categories: anatomical regions affected, facial function, aesthetics, and HRQoL.
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Affiliation(s)
- Matias Sipilä
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Emma-Lotta Kiukas
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Andrew Lindford
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Tuija Ylä-Kotola
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
| | - Jouni Lauronen
- Finnish Red Cross Blood Service, Histocompatibility Laboratory, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Patrik Lassus
- Department of Plastic Surgery, Helsinki University Hospital University of Helsinki, Helsinki, Finland
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Pynnä K, Räsänen P, Roine RP, Vuorela P, Sintonen H. Where does the money go to? Cost analysis of gynecological patients with a benign condition. PLoS One 2021; 16:e0254124. [PMID: 34242306 PMCID: PMC8270439 DOI: 10.1371/journal.pone.0254124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives The impact of benign gynecological conditions on life of women and on costs for the society is high. The purpose of this study is to gain knowledge and understanding of costs of the treatment of these disorders in order to be able to improve the clinical care processes, gain insight into feasible savings opportunities and to allocate funds wisely. Methods The healthcare processes of 311 women attending university or community hospitals in the Helsinki and Uusimaa Hospital District between June 2012 and August 2013 due to a benign gynecological condition were followed up for two years and treatment costs analysed. Results Total direct hospital costs averaged 689€ at six months and 2194€ at two years. The most expensive treatment was that of uterine fibroids in the short term and that of endometriosis and fibroids later on. Costs did not depend on hospital size. Surgical operations caused nearly half of hospital costs. Productivity loss caused biggest expenses outside of the hospital. LNG-IUD (levonorgestrel-releasing intrauterine device) accounted for the largest pharmaceutical costs for patients. Hospital treatment was associated with a reduced need for outpatient services during follow-up. Conclusions A majority of direct hospital costs arise over time. This stresses the need for prolonged healthcare management. To control costs, the need for repetitive doctors’ appointments, monitoring tests, and ward treatments should be carefully evaluated. Procedures not needing an operation theatre (for example hysteroscopy for polypectomy), should be done ambulatorily.
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Affiliation(s)
- Kristiina Pynnä
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- * E-mail:
| | - Pirjo Räsänen
- Hospital District of Helsinki and Uusimaa, External Evaluation Unit, Helsinki, Finland
| | - Risto P. Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Piia Vuorela
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Biomedicum Helsinki, Helsinki, Finland
- City of Vantaa, Department of Health and Social Welfare, Vantaa, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Roine E, Sintonen H, Kellokumpu-Lehtinen PL, Penttinen H, Utriainen M, Vehmanen L, Huovinen R, Kautiainen H, Nikander R, Blomqvist C, Hakamies-Blomqvist L, Saarto T. Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study. Breast 2021; 59:110-116. [PMID: 34225091 PMCID: PMC8264211 DOI: 10.1016/j.breast.2021.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 06/16/2021] [Accepted: 06/23/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial. METHODS Survivors (aged 35-68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors. RESULTS The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference -0.017, 95% CI: -0.031 to -0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference -0.019, 95% CI: -0.031 to -0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up. CONCLUSIONS HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.
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Affiliation(s)
- Eija Roine
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland.
| | - Harri Sintonen
- University of Helsinki, Department of Public Health, Helsinki, Finland
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Tampere University, Faculty of Medicine and Medical Technology, and Tampere University Hospital, Cancer Center, Center of Research, Development and Innovation, Tampere, Finland
| | - Heidi Penttinen
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Meri Utriainen
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Leena Vehmanen
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Riikka Huovinen
- Turku University Hospital, Department of Oncology, and University of Turku, Faculty of Medicine, Turku, Finland
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit, Kuopio, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Riku Nikander
- University of Jyväskylä, Faculty of Sport and Health Sciences, GeroCenter Foundation for Aging Research & Development, and Central Finland Hospital District, Department of Research & Education, Jyväskylä, Finland
| | - Carl Blomqvist
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland; Örebro University Hospital, Department of Oncology, Örebro, Sweden
| | - Liisa Hakamies-Blomqvist
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Tiina Saarto
- Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland
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Ylivuori M, Ruuhela R, Sintonen H, Virkkula P, Roine RP, Hytönen M. Seasonal Variation in Generic and Disease-Specific Health-Related Quality of Life in Rhinologic Patients in Southern Finland. Int J Environ Res Public Health 2021; 18:ijerph18126428. [PMID: 34198538 PMCID: PMC8296228 DOI: 10.3390/ijerph18126428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/04/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022]
Abstract
Background: Seasonal variation in exacerbations, hospitalisations, and mortality statistics has been reported for some diseases. To our knowledge, however, no published studies exist on the seasonality of health-related quality of life (HRQoL) amongst rhinologic patients. Aims/Objectives: This study, therefore, aimed to investigate the possible seasonal variation in rhinologic patients’ HRQoL using the rhinologic disease-specific Sino-Nasal Outcome Test-22 (SNOT-22) and the generic 15D HRQoL instrument. Material and Methods: We enrolled unselected adult rhinologic patients requiring specialist care at the Helsinki University Hospital in this cross-sectional, questionnaire-based prospective study during four seasons: February (winter), May (spring), August (summer), and November (autumn). Patients received SNOT-22 and 15D questionnaires via post. The Finnish Meteorological Institute supplied climate data from these months. Results: SNOT-22 and 15D data were available for 301 and 298 patients, respectively. We found no statistically significant differences (p = 0.948) between the mean monthly 15D scores or mean SNOT-22 scales. Furthermore, the mean SNOT-22 subscales did not differ between the monthly study periods. Conclusions and Significance: Our study shows that seasonality did not impact rhinologic patients’ SNOT-22 or 15D HRQoL scores. Thus, these questionnaires can be used for follow-up amongst rhinologic patients regardless of season.
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Affiliation(s)
- Maija Ylivuori
- Department of Otorhinolaryngology—Head & Neck Surgery, Helsinki University Hospital, Kasarmikatu 11–13, 00029 Helsinki, Finland; (P.V.); (M.H.)
- Correspondence:
| | - Reija Ruuhela
- Weather and Climate Change Impact Research, Finnish Meteorological Institute, 00560 Helsinki, Finland;
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland;
| | - Paula Virkkula
- Department of Otorhinolaryngology—Head & Neck Surgery, Helsinki University Hospital, Kasarmikatu 11–13, 00029 Helsinki, Finland; (P.V.); (M.H.)
| | - Risto P. Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland;
- Department of Health and Social Management, University of Eastern Finland, 70211 Kuopio, Finland
| | - Maija Hytönen
- Department of Otorhinolaryngology—Head & Neck Surgery, Helsinki University Hospital, Kasarmikatu 11–13, 00029 Helsinki, Finland; (P.V.); (M.H.)
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Kivelä AJ, Kauppi J, Räsänen J, But A, Sintonen H, Vironen J, Kruuna O, Scheinin T. Long-Term Health-Related Quality of Life (HRQoL) After Redo-Fundoplication. World J Surg 2021; 45:1495-1502. [PMID: 33502565 PMCID: PMC8026436 DOI: 10.1007/s00268-021-05954-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aim to shed light on long-term subjective outcomes after re-operations for failed fundoplication. METHODS 1809 patients were operated on for hiatal hernia and/or gastroesophageal reflux disease (GERD) at the Helsinki University Hospital between 2000 and 2017. 111 (6%) of these had undergone a re-operation for a failed antireflux operation. Overall, HRQoL was assessed in 89 patients at the latest follow-up using the generic 15D© instrument. The results were compared to a sample of the general population, weighted to reflect the age and gender distribution of patients. Disease-specific HRQoL was assessed using the GERD-HRQoL questionnaire. We studied variation in the overall HRQoL with respect to disease-specific HRQoL and known patients' parameters using univariate and multivariable linear regression models. RESULTS The median postoperative follow-up period was 9.3 years. All patients were operated on laparoscopically (6% conversion rate), and 87% were satisfied with the re-operation. Postoperative complications were minimal (5%). Twelve patients (11%) underwent a second re-operation. The median GERD-HRQoL score was nine. In multivariable analysis, four variables were independently associated with the 15D score, suggesting a decrease in the 15D score with increasing GERD-HRQoL score, increasing Charlson Comorbidity Index (CCI) and the presence of chronic pain syndrome (CPS) and depression. CONCLUSION Re-do LF is a safe procedure in experienced hands and may offer acceptable long-term alleviation in patients with recurring symptoms after antireflux surgery. Decreased HRQoL in the long run is related to recurring GERD and co-morbidities.
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Affiliation(s)
- Antti J Kivelä
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland.
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Anna But
- University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Vironen
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland
| | - Olli Kruuna
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland
| | - Tom Scheinin
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, FI 00029, Espoo, Helsinki, HUS, Finland
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30
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Isokääntä S, Honkalampi K, Kokki H, Sintonen H, Kokki M. Resilience and health-related quality of life in patients with pulmonary diseases receiving ambulatory oxygen therapy. BMC Pulm Med 2021; 21:144. [PMID: 33933036 PMCID: PMC8088314 DOI: 10.1186/s12890-021-01515-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/26/2021] [Indexed: 11/11/2022] Open
Abstract
Background Pulmonary diseases affect health-related quality of life (HRQoL), but there are few data on patients’ adaptation to a serious illness. This study assessed resilience and its associations with HRQoL, life satisfaction, anxiety and depression in patients with pulmonary diseases receiving ambulatory oxygen therapy. Methods In this prospective cohort study, we enrolled 42 patients with pulmonary diseases receiving ambulatory oxygen therapy. The patients completed the following questionnaires at baseline and after one and three months; the Resilience Scale-25, the Life Satisfaction Scale-4, the 15D instrument of HRQoL, the Hospital Anxiety and Depression Scale (HADS) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). To compare HRQoL, we recruited age- and gender-matched controls from the general population (n = 3574). The primary outcome was the proportion of patients with low resilience. Results Half (42–48%) of the patients had low resilience, which was correlated with low HRQoL, low levels of life satisfaction and higher levels of anxiety and depression. Patients had very low HRQoL compared to controls. Dissatisfaction with life increased during the 3-months follow-up, but only a few patients had anxiety or depression. Patient satisfaction with assistive technology was high; the median QUEST 2.0 score (scale 1–5) was 4.00 at baseline, 3.92 at one month and 3.88 at three months. Conclusions Resilience was low in half of the patients with pulmonary diseases receiving ambulatory oxygen therapy. Higher resilience was positively correlated with HRQoL and life satisfaction and negatively correlated with anxiety and depression. Trial registration: ClinicalTrials.gov Protocol Record 507A023. Registered 17 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT04554225&cntry=&state=&city=&dist=.
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Affiliation(s)
- Siiri Isokääntä
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland.,School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Hannu Kokki
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Merja Kokki
- Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Puijonlaaksontie 2, PO Box 100, 70029, Kuopio, Finland.
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Pynnä K, Räsänen P, Sintonen H, Roine RP, Vuorela P. The health-related quality of life of patients with a benign gynecological condition: a 2-year follow-up. J Comp Eff Res 2021; 10:685-695. [PMID: 33880938 DOI: 10.2217/cer-2020-0243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess health-related quality of life (HRQoL) of patients with benign gynecological disorders. Materials & methods: Prospective 2-year follow-up with the 15D HRQoL-instrument of 311 women treated in Helsinki-area hospitals in 2012-2013. Results: The initially impaired HRQoL regarding excretion, discomfort and symptoms, and vitality and sexual activity improved after treatment. However, only sexual activity reached similar levels as in the general population. Treatment of endometriosis, fibroids and polyps resulted in best and that of unspecific pelvic pain and bleeding disorders in worst HRQoL scores. Results were independent of hospital size. Conclusion: The impaired HRQoL dimensions were improved by treatment but HRQoL still remained poorer than in the general female population. Treatment of unspecific pelvic pain and bleeding disorders needs further evaluation.
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Affiliation(s)
- Kristiina Pynnä
- Department of Obstetrics & Gynecology, University of Helsinki & Helsinki University Hospital, PB 140 FI-00029 HUS, Finland
| | - Pirjo Räsänen
- External Evaluation Unit, Hospital District of Helsinki & Uusimaa, PB 780 FI-00029 HUS, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, P.O. Box 20, University of Helsinki FI-00014, Finland
| | - Risto P Roine
- Department of Health & Social Management, University of Eastern Finland, PB 1627, Kuopio FI-70211, Finland.,Group Administration, University of Helsinki & Helsinki University Hospital, PB 705 FI-00029 HUS, Finland
| | - Piia Vuorela
- Department of Obstetrics & Gynecology, University of Helsinki & Helsinki University Hospital, Biomedicum Helsinki, Helsinki 00029, Finland.,Department of Health & Social Welfare, City of Vantaa, Peltolantie 2D, Vantaa 01300, Finland
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von Hintze J, Niemeläinen M, Sintonen H, Nieminen J, Eskelinen A. Outcomes of the rotating hinge knee in revision total knee arthroplasty with a median follow-up of 6.2 years. BMC Musculoskelet Disord 2021; 22:336. [PMID: 33827526 PMCID: PMC8028074 DOI: 10.1186/s12891-021-04205-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to determine the mid-term clinical, radiographic and health-related quality of life (HRQoL) outcomes and define the survival rate in patients who had undergone revision total knee arthroplasty (TKA) using the single rotating hinged knee (RHK) design. Methods Between January 2004 and December 2013, 125 revision TKAs were performed at our institution using the single RHK implant. We conducted both a retrospective analysis of prospectively collected outcome data of these patients and a prospective follow-up study of all 39 living patients (41 knees). The follow-up phase included an optional extra follow-up visit, PROM questionnaires, and plain radiographs. Results The ten-year Kaplan-Meier survival rate of the revision RHK knees was 81.7% (95% CI 71.9–91.6%) with re-revision for any reason as the endpoint. Overall, 15 knees (12% of the total) underwent re-revision surgery during the follow-up. The median follow-up was 6.2 years (range, 0–12.7 years) post-operatively for the baseline group. One mechanical hinge mechanism-related failure occurred without any history of trauma or infection. At the time of the final follow-up, the majority of patients evinced a fairly good clinical outcome measured with patient-reported outcome measures and none of the components were radiographically loose. Conclusion We found that in patients undergoing complex revision TKA, fairly good functional outcome and quality of life can be achieved using an RHK implant. Further, it seems that in this type of patient cohort, revision TKA using an RHK implant relieves pain more than it improves ability to function. The NexGen® RHK design can be regarded as a suitable option in complex revision TKA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04205-9.
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Affiliation(s)
- Jake von Hintze
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland.
| | - Mika Niemeläinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jyrki Nieminen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland
| | - Antti Eskelinen
- Coxa Hospital for Joint Replacement, and Faculty of Medicine and Health Technologies, Tampere University, Niveltie 4, 33520, Tampere, Finland
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Junkkari A, Sintonen H, Danner N, Jyrkkänen HK, Rauramaa T, Luikku AJ, Koivisto AM, Roine RP, Viinamäki H, Soininen H, Jääskeläinen JE, Leinonen V. 5-Year health-related quality of life outcome in patients with idiopathic normal pressure hydrocephalus. J Neurol 2021; 268:3283-3293. [PMID: 33651154 PMCID: PMC8357651 DOI: 10.1007/s00415-021-10477-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Health-related quality of life (HRQoL) is severely impaired in persons with idiopathic normal pressure hydrocephalus (iNPH). The HRQoL improves in a number of patients after the placement of a cerebrospinal fluid (CSF) shunt, but long-term follow-up of HRQoL is rare. METHODS Extended follow-up (60 months) of a prospective cohort study involving 189 patients with iNPH who underwent shunt surgery. Preoperative variables were used to predict favorable HRQoL outcome (improvement or non-deterioration) measured by the 15D instrument 5 years after shunting. RESULTS Out of the 189 initially enrolled study participants, 88 had completed 5-year HRQoL follow-up (46%), 64 had died (34%), and 37 (20%) failed to complete the HRQoL follow-up but were alive at the end of the study. After initial post-operative HRQoL improvement, HRQoL deteriorated so that 37/88 participants (42%) had a favorable HRQoL outcome 5 years after shunting. Multivariate binary logistic regression analysis indicated that younger age (adjusted OR 0.86, 95% CI 0.77-0.95; p < 0.005), lower body mass index (adjusted OR 0.87, 95% CI 0.77-0.98; p < 0.05) and better Mini-Mental State Examination performance (adjusted OR 1.16, 95% CI 1.01-1.32; p < 0.05) before surgery predicted favorable 5-year outcome. CONCLUSIONS This extended follow-up showed that the self-evaluated HRQoL outcome is associated with iNPH patients' pre-operative cognitive status, overweight and age. The post-operative deterioration may reflect the natural progression of iNPH, but also derive from aging and comorbidities. It indicates a need for long-term follow-up.
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Affiliation(s)
- A Junkkari
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, 70029 KYS, POB 100, Kuopio, Finland.
| | - H Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - N Danner
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, 70029 KYS, POB 100, Kuopio, Finland
| | - H K Jyrkkänen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, 70029 KYS, POB 100, Kuopio, Finland
| | - T Rauramaa
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - A J Luikku
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, 70029 KYS, POB 100, Kuopio, Finland.,Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - A M Koivisto
- Department of Neurology, University of Eastern Finland, Kuopio, Finland.,Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department Neurology, University of Helsinki, Helsinki, Finland.,Department Neurology, Helsinki University Hospital, Helsinki, Finland
| | - R P Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - H Viinamäki
- Department of Psychiatry, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - H Soininen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - J E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, 70029 KYS, POB 100, Kuopio, Finland
| | - V Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, 70029 KYS, POB 100, Kuopio, Finland
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Kivelä AJ, Kauppi J, Räsänen J, But A, Sintonen H, Vironen J, Kruuna O, Scheinin T. Correction to: Long-Term Health-Related Quality of Life (HRQoL) After Redo-Fundoplication. World J Surg 2021; 45:1503. [PMID: 33620542 DOI: 10.1007/s00268-021-06009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Antti J Kivelä
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, 00029, Espoo, Helsinki, HUS, Finland.
| | - Juha Kauppi
- Chief of Division-Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jari Räsänen
- Chief of Division-Department of General Thoracic and Esophageal Surgery, Lung and Heart Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Anna But
- University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Vironen
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, 00029, Espoo, Helsinki, HUS, Finland
| | - Olli Kruuna
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, 00029, Espoo, Helsinki, HUS, Finland
| | - Tom Scheinin
- Department of GI Surgery, Abdominal Centre, Helsinki University Hospital and Helsinki University, Jorvi Hospital, Turuntie 150, P.O. Box 800, 00029, Espoo, Helsinki, HUS, Finland
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Pulkkinen M, Jousela I, Sintonen H, Engblom J, Salanterä S, Junttila K. A randomized clinical trial of a new perioperative practice model on anxiety and health-related quality of life in arthroplasty patients. Nurs Open 2021; 8:1593-1605. [PMID: 33576579 PMCID: PMC8186686 DOI: 10.1002/nop2.776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/23/2022] Open
Abstract
Aims To explore the effectiveness of a new perioperative practice model on anxiety and health‐related quality of life in patients undergoing total hip arthroplasty and total knee arthroplasty under spinal anaesthesia. Design A randomized clinical trial. Methods Control group participants (N = 222) received standard perioperative care, meaning they were cared for by various nurses during their perioperative process without postoperative visits. Intervention group participants (N = 231) were assigned one named anaesthesia nurse during their entire perioperative process who visited them postoperatively. Both groups responded to two self‐reported questionnaires: the generic 15D health‐related quality of life instrument and the State‐Trait Anxiety Inventory (STAI) measuring anxiety two to three weeks pre‐operatively and three months postoperatively. Results There were no statistically significant differences between the groups at baseline or at follow‐up in health‐related quality of life or anxiety.
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Affiliation(s)
- Maria Pulkkinen
- Helsinki University HospitalHelsinki UniversityHelsinkiFinland
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
| | - Irma Jousela
- Helsinki University HospitalHelsinki UniversityHelsinkiFinland
- University of Eastern FinlandKuopioFinland
| | - Harri Sintonen
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - Janne Engblom
- Department of Mathematics and StatisticsUniversity of TurkuTurkuFinland
- School of EconomicsUniversity of TurkuTurkuFinland
| | - Sanna Salanterä
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University HospitalTurkuFinland
| | - Kristiina Junttila
- Helsinki University HospitalHelsinki UniversityHelsinkiFinland
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Nursing Research CenterHelsinki University HospitalHelsinkiFinland
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Peltola E, Hannula P, Huhtala H, Sintonen H, Metso S, Sand J, Laukkarinen J, Tiikkainen M, Schalin-Jäntti C, Sirén J, Soinio M, Nuutila P, Moilanen L, Ebeling T, Jaatinen P. Long-term health-related quality of life in persons diagnosed with an insulinoma in Finland 1980-2010. Clin Endocrinol (Oxf) 2021; 94:250-257. [PMID: 32974918 DOI: 10.1111/cen.14336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Insulinomas are rare pancreatic neoplasms, which can usually be cured by surgery. As the diagnostic delay is often long and the prolonged hyperinsulinemia may have long-term effects on health and the quality of life, we studied the long-term health-related quality of life (HRQoL) in insulinoma patients. DESIGN, PATIENTS AND MEASUREMENTS The HRQoL of adults diagnosed with an insulinoma in Finland in 1980-2010 was studied with the 15D instrument, and the results were compared to those of an age- and gender-matched sample of the general population. The minimum clinically important difference in the total 15D score has been defined as ±0.015. The clinical characteristics, details of insulinoma diagnosis and treatment, and the current health status of the subjects were examined to specify the possible determinants of long-term HRQoL. RESULTS Thirty-eight insulinoma patients participated in the HRQoL survey (response rate 75%). All had undergone surgery with a curative aim, a median of 13 (min 7, max 34) years before the survey. The insulinoma patients had a clinically importantly and statistically significantly better mean 15D score compared with the controls (0.930 ± 0.072 vs 0.903 ± 0.039, P = .046) and were significantly better off regarding mobility, usual activities and eating. Among the insulinoma patients, younger age at the time of survey, higher level of education and smaller number of chronic diseases were associated with better overall HRQoL. CONCLUSIONS In the long term, the overall HRQoL of insulinoma patients is slightly better than that of the general population.
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Affiliation(s)
- Elina Peltola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Päivi Hannula
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Endocrinology, Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Saara Metso
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Endocrinology, Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Juhani Sand
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Johanna Laukkarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Mirja Tiikkainen
- Endocrinology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
- Endocrinology, Abdominal Center, University of Helsinki, Helsinki, Finland
| | - Jukka Sirén
- Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Minna Soinio
- Endocrinology, Department of Internal Medicine, Turku University Hospital, Turku, Finland
| | - Pirjo Nuutila
- Endocrinology, Department of Internal Medicine, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Leena Moilanen
- Department of Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tapani Ebeling
- Faculty of Medicine, University of Oulu, Oulu, Finland
- Endocrinology, Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - Pia Jaatinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Division of Internal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Endocrinology, Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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Grönroos S, Helmiö M, Juuti A, Tiusanen R, Hurme S, Löyttyniemi E, Ovaska J, Leivonen M, Peromaa-Haavisto P, Mäklin S, Sintonen H, Sammalkorpi H, Nuutila P, Salminen P. Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss and Quality of Life at 7 Years in Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA Surg 2021; 156:137-146. [PMID: 33295955 DOI: 10.1001/jamasurg.2020.5666] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Laparoscopic sleeve gastrectomy (LSG) is currently the predominant bariatric procedure, although long-term weight loss and quality-of-life (QoL) outcomes compared with laparoscopic Roux-en-Y gastric bypass (LRYGB) are lacking. Objective To determine weight loss equivalence of LSG and LRYGB at 7 years in patients with morbid obesity, with special reference to long-term QoL. Design, Setting, and Participants The SLEEVE vs byPASS (SLEEVEPASS) multicenter, multisurgeon, open-label, randomized clinical equivalence trial was conducted between March 10, 2008, and June 2, 2010, in Finland. The trial enrolled 240 patients with morbid obesity aged 18 to 60 years who were randomized to undergo either LSG or LRYGB with a 7-year follow-up (last follow-up, September 26, 2017). Analysis was conducted on an intention-to-treat basis. Statistical analysis was performed from June 4, 2018, to November 8, 2019. Interventions Laparoscopic sleeve gastrectomy (n = 121) or LRYGB (n = 119). Main Outcomes and Measures The primary end point was percentage excess weight loss (%EWL) at 5 years. Secondary predefined follow-up time points were 7, 10, 15, and 20 years, with included 7-year secondary end points of QoL and morbidity. Disease-specific QoL (DSQoL; Moorehead-Ardelt Quality of Life questionnaire [range of scores, -3 to 3 points, where a higher score indicates better QoL]) and general health-related QoL (HRQoL; 15D questionnaire [0-1 scale for all 15 dimensions, with 1 indicating full health and 0 indicating death]) were measured preoperatively and at 1, 3, 5, and 7 years postoperatively concurrently with weight loss. Results Of 240 patients (167 women [69.6%]; mean [SD] age, 48.4 [9.4] years; mean [SD] baseline body mass index, 45.9 [6.0]), 182 (75.8%) completed the 7-year follow-up. The mean %EWL was 47% (95% CI, 43%-50%) after LSG and 55% (95% CI, 52%-59%) after LRYGB (difference, 8.7 percentage units [95% CI, 3.5-13.9 percentage units]). The mean (SD) DSQoL total score at 7 years was 0.50 (1.14) after LSG and 0.49 (1.06) after LRYGB (P = .63), and the median HRQoL total score was 0.88 (interquartile range [IQR], 0.78-0.95) after LSG and 0.87 (IQR, 0.78-0.95) after LRYGB (P = .37). Greater weight loss was associated with better DSQoL (r = 0.26; P < .001). At 7 years, mean (SD) DSQoL scores improved significantly compared with baseline (LSG, 0.50 [1.14] vs 0.10 [0.94]; and LRYGB, 0.49 [1.06] vs 0.12 [1.12]; P < .001), unlike median HRQoL scores (LSG, 0.88 [IQR, 0.78-0.95] vs 0.87 [IQR, 0.78-0.90]; and LRYGB, 0.87 [IQR, 0.78-0.92] vs 0.85 [IQR, 0.77-0.91]; P = .07). The overall morbidity rate was 24.0% (29 of 121) for LSG and 28.6% (34 of 119) for LRYGB (P = .42). Conclusions and Relevance This study found that LSG and LRYGB were not equivalent in %EWL at 7 years. Laparoscopic Roux-en-Y gastric bypass resulted in greater weight loss than LSG, but the difference was not clinically relevant based on the prespecified equivalence margins. There was no difference in long-term QoL between the procedures. Bariatric surgery was associated with significant long-term DSQoL improvement, and greater weight loss was associated with better DSQoL. Trial Registration ClinicalTrials.gov Identifier: NCT00793143.
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Affiliation(s)
- Sofia Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Mika Helmiö
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Anne Juuti
- Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Roosa Tiusanen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Saija Hurme
- Department of Biostatistics, University of Turku, Turku, Finland
| | | | - Jari Ovaska
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland
| | - Marja Leivonen
- Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Pipsa Peromaa-Haavisto
- Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.,Department of Surgery, Hatanpää City Hospital, Tampere, Finland
| | - Suvi Mäklin
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Henna Sammalkorpi
- Abdominal Center, Department of Abdominal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Nuutila
- Department of Endocrinology, Turku University Hospital, Turku, Finland.,Turku PET Centre, University of Turku, Turku, Finland
| | - Paulina Salminen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,Department of Surgery, University of Turku, Turku, Finland.,Department of Surgery, Pori, Satakunta Central Hospital, Pori, Finland
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Kauppila TK, Pelkonen AS, Roine RP, Paassilta M, Kukkonen K, Sintonen H, Mäkelä M. Health-related quality of life in patients who had partaken in milk oral immunotherapy and comparison to the general population. Allergy 2021; 76:387-390. [PMID: 32738148 DOI: 10.1111/all.14525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 07/05/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Tiina Kaisa Kauppila
- University of Helsinki, Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anna S. Pelkonen
- Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Risto P. Roine
- Department of Health and Social Management University of Eastern Finland Kuopio Finland
| | | | - Kaarina Kukkonen
- Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Harri Sintonen
- Department of Public Health University of Helsinki Helsinki Finland
| | - Mika Mäkelä
- Skin and Allergy Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
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Luoto KE, Lindholm LH, Koivukangas A, Lassila A, Sintonen H, Leinonen E, Kampman O. Impact of Comorbid Alcohol Use Disorder on Health-Related Quality of Life Among Patients With Depressive Symptoms. Front Psychiatry 2021; 12:688136. [PMID: 34690824 PMCID: PMC8531581 DOI: 10.3389/fpsyt.2021.688136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aim: In psychiatric clinical practice, comorbidity of depression and alcohol use disorder (AUD) is common. Both disorders have a negative impact on health-related quality of life (HRQoL) in general population. However, research on the impact of comorbid AUD on HRQoL among clinically depressed patients is limited. The purpose of this study was to explore the impact of a psychosocial treatment intervention on HRQoL for depressive patients in specialized psychiatric care with a special focus on the impact of AUD on HRQoL. Material and Methods: Subjects were 242 patients of the Ostrobothnia Depression Study (ClinicalTrials.gov Identifier NCT02520271). Patients referred to specialized psychiatric care who scored at least 17 points on the Beck Depression Inventory at baseline and who had no psychotic disorders were included in the ODS. The treatment intervention in ODS comprised behavioral activation for all but began with motivational interviewing for those with AUD. HRQoL was assessed regularly during 24-month follow-up by the 15D instrument. In the present study, HRQoL of ODS patients with or without AUD was compared and the factors explaining 15D score analyzed with a linear mixed model. In order to specify the impact of clinical depression on HRQoL during the early phase of treatment intervention, a general population sample of the Finnish Health 2011 Survey was used as an additional reference group. Results: HRQoL improved among all ODS study sample patients regardless of comorbid AUD during the first year of follow-up. During 12-24 months of follow-up the difference between groups was seen as HRQoL continued to improve only among the non-AUD patients. A combination of male gender, anxiety disorder, and AUD was associated with the poorest HRQoL in this sample. In combined sample analyses with the reference group, clinical depression had an impact on HRQoL in short-term follow-up regardless of the treatment intervention. Conclusions: This study suggests that, in terms of improvement in HRQoL, the heterogenous group of depressive patients in specialized psychiatric care can be successfully treated with behavioral activation in combination with motivational interviewing for those with AUD. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02520271. Ostrobothnia Depression Study (ODS). A Naturalistic Follow-up Study on Depression and Related Substance Use Disorders. (2015). Available online at: https://clinicaltrials.gov/ct2/show/NCT02520271.
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Affiliation(s)
- Kaisa E Luoto
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Lars H Lindholm
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Antti Koivukangas
- Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Antero Lassila
- Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Esa Leinonen
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Olli Kampman
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
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Uimonen M, Repo JP, Homsy P, Jahkola T, Poulsen L, Roine RP, Sintonen H, Popov P. Health-related quality of life in patients having undergone abdominoplasty after massive weight loss. J Plast Reconstr Aesthet Surg 2020; 74:2296-2302. [PMID: 33436334 DOI: 10.1016/j.bjps.2020.12.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/01/2020] [Accepted: 12/19/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Due to lack of validated body contouring-specific patient-reported outcome (PRO) instruments, the outcomes of abdominoplasty after massive weight loss have been evaluated rather rarely and mainly using generic health-related quality of life (HRQoL) instruments. The aim of the current study was to examine, using body contouring-specific (BODY-Q) and generic (15D) HRQoL instruments, the HRQoL, and key factors related to HRQoL among patients having undergone massive weight loss and abdominoplasty. METHODS Altogether 52 patients who underwent abdominoplasty due to massive weight loss completed the BODY-Q and the 15D HRQoL instruments. The 15D scores were compared to those of age-, gender-, and BMI-adjusted control sample of the general population. RESULTS The mean score of the BODY-Q Abdomen scale was 50.7 out of 100 (SD 24.4). The HRQoL of abdominoplasty patients was lower than that of age-, gender-, and BMI-adjusted general population (p = 0.001). Sleeping, discomfort and symptoms, depression, excretion, and sexual activity were the patients' main concerns. Body image and psychological well-being were strongly associated with the perceived HRQoL. The satisfaction with appearance of the abdominal area was not associated with generic HRQoL. CONCLUSIONS The HRQoL of abdominoplasty patients is lower than that of general population with similar age, gender and BMI. The most important factors associated with the HRQoL of the patients were body image, psychological well-being, and physical function.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Jussi P Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Pauliina Homsy
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Tiina Jahkola
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Risto P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, HUS, Finland; Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pentscho Popov
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland; Department of Plastic Surgery, Eira Hospital, Helsinki, Finland
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Rajantie H, Kaukola L, Snäll J, Roine R, Sintonen H, Thorén H. Health-related quality of life in patients surgically treated for orbital blow-out fracture: a prospective study. Oral Maxillofac Surg 2020; 25:373-382. [PMID: 33280065 PMCID: PMC8352817 DOI: 10.1007/s10006-020-00923-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to evaluate patients’ health-related quality of life (HRQoL) before and after surgical treatment of orbital blow-out fracture. Methods This prospective study comprises of all adult patients undergoing a surgical reconstruction of an orbital blow-out fracture in 2006–2010. Their HRQoL was evaluated for 6 months postoperatively with the aid of the standardized 15D instrument and was compared with that of an age- and gender-standardized sample of the general Finnish population. A complementary questionnaire for more detailed information was also administered. Results Twenty-six patients completed the study. Mean 15D score among the patients preoperatively (0.898) was statistically significantly and clinically importantly worse than the score of the control population (0.936). Six months postoperatively, the mean 15D score was 0.920, with no significant difference compared with the control population and the significant differences on the different dimensions had disappeared. The most common complaint at 6 months postoperatively was diplopia in daily life (19%). Disturbances in facial sensation (27%) and defects in facial appearance (15%) were the most unpleasant subjective outcomes. Conclusion The HRQoL is significantly decreased after orbital blow-out fracture compared with the general population but will recover completely in 6 months. Thus, the negative impact of orbital blow-out fracture on HRQoL is only transient. Disturbances in facial sensation, defects in facial appearance, and diplopia are the most common subjective complaints after the injury and its surgical treatment. However, these do not appear to affect the overall quality of life in the long term. Supplementary Information The online version contains supplementary material available at 10.1007/s10006-020-00923-x.
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Affiliation(s)
- Hanna Rajantie
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Leena Kaukola
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Johanna Snäll
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
- Helsinki and Uusimaa Hospital District, Administration, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Hanna Thorén
- Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Turku University Hospital, Turku, Finland
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Roine E, Sintonen H, Kellokumpu-Lehtinen PL, Penttinen H, Utriainen M, Vehmanen L, Huovinen R, Kautiainen H, Nikander R, Blomqvist C, Saarto T. Health-related Quality of Life of Breast Cancer Survivors Attending an Exercise Intervention Study: A Five-year Follow-up. In Vivo 2020; 34:667-674. [PMID: 32111767 DOI: 10.21873/invivo.11821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/03/2019] [Accepted: 12/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM As the number of breast cancer survivors is increasing, their long-term health-related quality of life (HRQoL) has become an important issue. The aim of the study is to follow up the HRQoL of breast cancer survivors (BCS) in a prospective randomized exercise intervention study and to compare HRQoL to that of the age-matched general female population. PATIENTS AND METHODS Following adjuvant treatment, 537 patients aged 35-68 and capable of exercise training were randomized to a 12-month exercise trial. In 182 of those patients, HRQoL was measured by the generic 15D at baseline and followed up for five years. Furthermore, the HRQoL of all BCS answering the 15D at five-year follow-up (n=390) was compared to that of a representative sample of the general population. RESULTS After five years, the BCS' mean HRQoL demonstrated a statistically and clinically significant impairment compared to that of the general population (difference -0.023, p<0.001). The mean HRQoL of BCS followed up from baseline until five years did not improve significantly (change=0.007, p=0.27), whereas the dimensions of usual activities (0.043, p=0.004), depression (0.038, p=0.007), distress (0.030, p=0.036), and sexual activity (0.057, p=0.009) did. CONCLUSION The HRQoL of BCS was still impaired five years following treatment.
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Affiliation(s)
- Eija Roine
- Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Heidi Penttinen
- Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Meri Utriainen
- Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Leena Vehmanen
- Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riika Huovinen
- Department of Oncology, Turku University Hospital, and Faculty of Medicine, University of Turku, Turku, Finland
| | - Hannu Kautiainen
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Riku Nikander
- Department of Sport and Health Sciences, University of Jyväskylä and GeroCenter Foundation for Aging Research & Development, Jyväskylä, Finland.,Department of Research & Education, Central Hospital District of Finland, Jyväskylä, Finland
| | - Carl Blomqvist
- Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Tiina Saarto
- Comprehensive Cancer Center, Helsinki University Hospital, and Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Ojala AK, Sintonen H, Roine RP, Strandberg TE, Schalin-Jäntti C. Impaired breathing, sleeping, vitality, and depression, and negative impact of L-T4 treatment characterize health-related quality of life in older people with stable CVD. Aging Clin Exp Res 2020; 32:2041-2047. [PMID: 32277433 PMCID: PMC7532955 DOI: 10.1007/s40520-020-01537-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and thyroid dysfunction are common in older people, but little is known about how they affect health-related quality of life (HRQoL). METHODS We assessed HRQoL with the 15D instrument in 329 home-dwelling patients aged ≥ 75 years with stable CVD and compared the results to those of an age- and gender-matched general population (n = 103). We also studied the impact of age, BMI, number of medications, thyroid-stimulating hormone (TSH) concentration, levothyroxine (L-T4) substitution and Mini-Mental State Examination (MMSE) on HRQoL. RESULTS Overall HRQoL was impaired in older people with stable CVD (mean 15D score 0.777 vs 0.801, p = 0.001), and also on single dimensions of breathing, sleeping, discomfort and symptoms, distress, vitality (all p < 0.001), and depression (p = 0.016) compared to the age- and gender-matched general population. Furthermore, in the patients, L-T4 substitution associated with impaired sleeping (p = 0.018) and sexual activity (p = 0.030). Moreover, MMSE points, number of medications used, age (all p < 0.001) and BMI (p = 0.009) predicted impaired HRQoL. CONCLUSIONS Older people with stable CVD are characterized by impaired HRQoL compared to age- and gender-matched controls. We demonstrate that this is the consequence of impaired breathing, sleeping, discomfort and symptoms, distress, vitality, and depression. L-T4 substitution has a negative impact on HRQoL in old patients with stable CVD. MMSE score, number of medications, age and BMI predict worse HRQoL.
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Affiliation(s)
- Anna K Ojala
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, P.O. Box 340, 00290, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Risto P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Timo E Strandberg
- University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Camilla Schalin-Jäntti
- Endocrinology, Abdominal Center, Helsinki University Hospital and University of Helsinki, P.O. Box 340, 00290, Helsinki, Finland.
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Bergius S, Roine RP, Taari K, Sintonen H. Health-Related Quality of Life and Survival in Prostate Cancer Patients in a Real-World Setting. Urol Int 2020; 104:939-947. [PMID: 32957098 DOI: 10.1159/000510319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/19/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To analyze the health-related quality of life (HRQoL) and survival of real-world prostate cancer (PC) patients and to calculate quality-adjusted life-years (QALYs) experienced under different treatment strategies. MATERIALS AND METHODS PC patients undergoing active surveillance (n = 226), radiation treatment (n = 280), surgery (n = 299), or hormonal treatment (n = 62) responded to the generic 15-dimensional (15D) HRQoL questionnaire at the time of the diagnosis and were followed up 3, 6, 12, and 24 months later. QALYs experienced during the follow-up were calculated for each treatment group, and variables associated with survival were analyzed using Cox proportional hazards models. RESULTS HRQoL was stable during the first 2 years after diagnosis in all other treatment groups, except in patients treated with hormonal therapy. The overall survival within 6.5-year follow-up time was 84.4%. The number of QALYs experienced during the 2-year follow-up was similar in patients in active surveillance (1.790), surgery (1.784), and radiation groups (1.767), but significantly lower in the hormonal therapy group (1.665). CONCLUSIONS Patients receiving hormonal treatment had significantly impaired HRQoL and survival compared with other treatments. Although the number of QALYs experienced was similar in the 3 other treatment lines, there were marked differences between treatment lines on some 15D dimensions.
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Affiliation(s)
- Susanne Bergius
- Department of Public Health, University of Helsinki, Helsinki, Finland, .,Amgen AB, Espoo, Finland,
| | - Risto P Roine
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Taari
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Kuorikoski J, Brinck T, Roine RP, Sintonen H, Söderlund T. Finnish translation and external validation of the Trauma Quality of Life questionnaire. Disabil Rehabil 2020; 44:1129-1135. [PMID: 32720535 DOI: 10.1080/09638288.2020.1797191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Major trauma impairs health-related quality of life (HRQoL). The aim of this study was the Finnish translation and external validation of the Trauma Quality of Life (TQoL) questionnaire. PATIENTS AND METHODS The Finnish version of the TQoL questionnaire and the 15D, a generic HRQoL questionnaire, were sent by mail to 417 patients identified from the Helsinki Trauma Registry. RESULTS Altogether 222 patients (53.2%) returned the questionnaires. Participants' mean age was 49.9 ± 18.1 years and 68.8% were males. The mean 15D score was significantly lower than that of the age- and sex-standardized general Finnish population (0.817 vs. 0.918, p < 0.001). The correlation between the Finnish translation and 15D scores was high (0.805). Factor analysis revealed that the Finnish TQoL questionnaire and the 15D have four common factors. Internal validation identified some differences between the Finnish and the original versions. CONCLUSIONS The correlation between the Finnish TQoL questionnaire and the 15D was high. The factor structures of the original and Finnish versions of the TQoL questionnaire were not identical, which may be a consequence of cultural or patient population differences.Implications for rehabilitationTrauma causes a long-term decrease in health-related quality of life (HRQoL), and this impact should be assessed in rehabilitation.The Trauma-Specific Quality of Life (TQoL) questionnaire has many shared features with the generic HRQoL questionnaire, but it also contains features related to post-traumatic disorder syndrome.The TQoL questionnaire is a valid tool for monitoring HRQoL after trauma.
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Affiliation(s)
- Joonas Kuorikoski
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine, University of Helsinki, Helsinki, Finland
| | - Tuomas Brinck
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine, University of Helsinki, Helsinki, Finland
| | - Risto P Roine
- Department of Medicine, University of Helsinki, Helsinki, Finland.,Department of Surgery, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tim Söderlund
- Trauma Unit, HUH Musculoskeletal and Plastic Surgery, Helsinki University Hospital, Helsinki, Finland.,Department of Medicine, University of Helsinki, Helsinki, Finland
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Mattsson NK, Karjalainen PK, Tolppanen AM, Heikkinen AM, Sintonen H, Härkki P, Nieminen K, Jalkanen J. Pelvic organ prolapse surgery and quality of life-a nationwide cohort study. Am J Obstet Gynecol 2020; 222:588.e1-588.e10. [PMID: 31836546 DOI: 10.1016/j.ajog.2019.11.1285] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment, and large, prospective clinical studies reporting the patient-reported surgical outcomes are needed. OBJECTIVE To evaluate the effect of female pelvic organ prolapse surgery on health-related quality of life and patient satisfaction and to determine predictors of outcome. STUDY DESIGN This prospective nationwide cohort study consisted of 3515 women undergoing surgery for pelvic organ prolapse in 2015. The outcomes were measured by validated health-related quality of life instruments (generic 15D, Pelvic Floor Distress Inventory-20, and Patient Global Impression of Improvement) at 6 months and 2 years postoperatively. The baseline predictors of outcomes were studied with logistic regression analysis. RESULTS In total, 2528 (72%) women were eligible for analysis at 6 months and 2351 (67%) at 2 years. The mean change in the total 15D score suggested a clinically important improvement at 6 months but not at 2 years. However, an improvement in sexual activity, discomfort and symptoms, and excretion was observed during both follow-up assessments. Altogether, 77% and 72% of the participants reported a clinically significant improvement in Pelvic Floor Distress Inventory-20 at the 6-month and 2-year follow-ups, respectively. A total of 84% were satisfied with the outcome and 90% reported an improvement in comparison with the preoperative state with Patient Global Impression of Improvement-I. The strongest predictive factors for a favorable outcome were advanced apical prolapse (adjusted odds ratio, 2.06; 95% confidence interval, 1.58-2.70) and vaginal bulge (1.90, 1.30-2.80). Smoking was associated with an unfavorable outcome as measured by Patient Global Index of Improvement-I (1.69, 1.02-2.81). CONCLUSION Pelvic organ prolapse surgery improved health-related quality of life in 7 of 10 patients over a 2-year follow-up period, and patient satisfaction was high. Apical prolapse beyond the hymen and vaginal bulge were the most consistent predictors for improvement. Our results suggest that patients should be encouraged to stop smoking to avoid an unfavorable outcome.
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Affiliation(s)
- Nina K Mattsson
- Department of Obstetrics and Gynecology, Kanta-Häme Central Hospital, Hämeenlinna, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Päivi K Karjalainen
- Department of Obstetrics and Gynecology, Central Finland Central Hospital, Jyväskylä, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Anna-Mari Heikkinen
- Terveystalo, Helsinki, Finland; Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Päivi Härkki
- Helsinki University Hospital and University of Helsinki Helsinki, Finland
| | - Kari Nieminen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Jyrki Jalkanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Central Finland Hospital District, Jyväskylä, Finland
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Hietaniemi H, Ilonen I, Järvinen T, Kauppi J, Andersson S, Sintonen H, Räsänen J. Health-related quality of life after laparoscopic repair of giant paraesophageal hernia: how does recurrence in CT scan compare to clinical success? BMC Surg 2020; 20:109. [PMID: 32434571 PMCID: PMC7238581 DOI: 10.1186/s12893-020-00772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background Computed tomography (CT) is widely used in the diagnosis of giant paraesophageal hernias (GPEH) but has not been utilised systematically for follow-up. We performed a cross-sectional observational study to assess mid-term outcomes of elective laparoscopic GPEH repair. The primary objective of the study was to evaluate the radiological hernia recurrence rate by CT and to determine its association with current symptoms and quality of life. Methods All non-emergent laparoscopic GPEH repairs between 2010 to 2015 were identified from hospital medical records. Each patient was offered non-contrast CT and sent questionnaires for disease-specific symptoms and health-related quality of life. Results The inclusion criteria were met by 165 patients (74% female, mean age 67 years). Total recurrence rate was 29.3%. Major recurrent hernia (> 5 cm) was revealed by CT in 4 patients (4.3%). Radiological findings did not correlate with symptom-related quality of life. Perioperative mortality occurred in 1 patient (0.6%). Complications were reported in 27 patients (16.4%). Conclusions Successful laparoscopic repair of GPEH requires both expertise and experience. It appears to lead to effective symptom relief with high patient satisfaction. However, small radiological recurrences are common but do not affect postoperative symptom-related patient wellbeing.
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Affiliation(s)
- Henriikka Hietaniemi
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland. .,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland.
| | - Ilkka Ilonen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Tommi Järvinen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Juha Kauppi
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Saana Andersson
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jari Räsänen
- Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.,Department of Surgery, Clinicum, University of Helsinki, Helsinki, Finland
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Padureanu R, Albu CV, Pirici I, Mititelu RR, Subtirelu MS, Turcu-Stiolica RA, Sintonen H, Padureanu V, Turcu-Stiolica A. Personal Autonomy as Quality of Life Predictor for Multiple Sclerosis Patients. J Clin Med 2020; 9:jcm9051349. [PMID: 32380685 PMCID: PMC7290289 DOI: 10.3390/jcm9051349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, severe disease, characterized by a progressive alteration in neuronal transmission, which decreases personal independence and quality of life (QoL). This study aimed to investigate the relationship between QoL and personal autonomy in patients with MS, as well as its correlation with age, educational level, and diseases severity. Twenty-six MS patients were followed-up for six months. All patients completed the 15D questionnaire two times: at T0, when they started a new treatment, and at T1 after six months of treatment. At the end point, all patients completed the Personal Autonomy Questionnaire. The average patient age was 43 years (SD = 10), and 89% of them were female. The mean severity and duration of MS were 3.5 (SD = 1.75) and 9.5 (SD = 5.1), respectively. The average QoL of MS patients at T0 was 0.66 (SD = 0.18), and that at T1 was 0.71 (SD = 0.16). The scores of patients with different types of MS, i.e., relapsing–remitting MS (RRMS) or secondary progressive MS (SPMS), were compared. SPMS patients were older than RRMS patients (mean age 47.5 vs. 39.7 years; p = 0.032), and more RRMS patients were working (0.014). SPMS patients described the same QoL and personal autonomy as RRMS patients. Results from bivariate correlation analyses showed a significant relationship between QoL and age, education, and severity of MS. Also, the analysis showed no significant correlation between QoL and personal autonomy.
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Affiliation(s)
- Rodica Padureanu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.P.); (R.R.M.)
| | - Carmen Valeria Albu
- Department of Neurology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Ionica Pirici
- Department of Anatomy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Radu Razvan Mititelu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (R.P.); (R.R.M.)
| | - Mihaela Simona Subtirelu
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.S.S.); (A.T.-S.)
| | | | - Harri Sintonen
- Department of Public Health, University of Helsinki, 00100 Helsinki, Finland;
| | - Vlad Padureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence: ; Tel.: +40-0722-567874
| | - Adina Turcu-Stiolica
- Department of Pharmacoeconomics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (M.S.S.); (A.T.-S.)
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Riihimäki K, Sintonen H, Vuorilehto M, Jylhä P, Saarni S, Isometsä E. Health-related quality of life of primary care patients with depressive disorders. Eur Psychiatry 2020; 37:28-34. [DOI: 10.1016/j.eurpsy.2016.04.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/19/2016] [Accepted: 04/19/2016] [Indexed: 11/30/2022] Open
Abstract
AbstractBackgroundDepressive disorders are known to impair health-related quality of life (HRQoL) both in the short and long term. However, the determinants of long-term HRQoL outcomes in primary care patients with depressive disorders remain unclear.MethodsIn a primary care cohort study of patients with depressive disorders, 82% of 137 patients were prospectively followed up for five years. Psychiatric disorders were diagnosed with SCID-I/P and SCID-II interviews; clinical, psychosocial and socio-economic factors were investigated by rating scales and questionnaires plus medical and psychiatric records. HRQoL was measured with the generic 15D instrument at baseline and five years, and compared with an age-standardized general population sample (n = 3707) at five years.ResultsDepression affected the 15D total score and almost all dimensions at both time points. At the end of follow-up, HRQoL of patients in major depressive episode (MDE) was particularly low, and the association between severity of depression (Beck Depression Inventory [BDI]) and HRQoL was very strong (r = −0.804). The most significant predictors for change in HRQoL were changes in BDI and Beck Anxiety Inventory (BAI) scores. The mean 15D score of depressive primary care patients at five years was much worse than in the age-standardized general population, reaching normal range only among patients who were in clinical remission and had virtually no symptoms.ConclusionsAmong depressive primary care patients, presence of current depressive symptoms markedly reduces HRQoL, with symptoms of concurrent anxiety also having a marked impact. For HRQoL to normalize, current depressive and anxiety symptoms must be virtually absent.
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Vannas M, Färkkilä M, Sintonen H, Åberg F, Isoniemi H. Health-related quality of life before and after liver transplantation in patients with primary sclerosing cholangitis. Scand J Gastroenterol 2020; 55:347-353. [PMID: 32191135 DOI: 10.1080/00365521.2020.1725106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Liver transplantation (LTx) remains the only curative treatment in patients with primary sclerosing cholangitis (PSC) and liver failure. In Helsinki we have also performed pre-emptive LTx in PSC patients without liver insufficiency but considered to have a high risk for cholangiocarcinoma. The present study evaluates the possible differences in health-related quality of life (HRQoL) in these two PSC groups before and after LTx.Methods: The total study population was 48 patients, 16 were transplanted due to increased risk of cholangiocarcinoma without liver insufficiency (the premalignant group) and 32 patients with end-stage liver disease (the symptomatic group).Results: HRQoL remained good after LTx in the premalignant group, and this difference was also clinically important compared with the symptomatic group, although not statistically significant. Both groups had slightly lower mean HRQoL scores after LTx than the age- and gender-standardized general population, and this difference was not clinically important in either group and statistically significant only in the symptomatic group.Conclusions: HRQoL does not decrease markedly after LTx in the premalignant PSC group, and this group does cope better than the symptomatic PSC group. After LTx, mean HRQoL of the premalignant group stays close to that of the age- and gender-standardized general population.
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Affiliation(s)
- Marko Vannas
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Martti Färkkilä
- Clinic of Gastroenterology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Fredrik Åberg
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Isoniemi
- Transplantation and Liver Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
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