Skin Cancer Risk of Narrow-Band UV-B (TL-01) Phototherapy: A Multi-Center Registry Study with 4,815 Patients

Narrow-band TL-01 ultraviolet B phototherapy (TL-01) is an effective and widely used treatment for many skin diseases. The purpose of the investigation was to assess the risk of skin cancers in patients treated with TL-01 phototherapy who have not received any other phototherapy modalities. This cohort study included 4,815 TL-01 treated patients in Finland with psoriasis or atopic dermatitis. Clinical information was collected from the hospital records and linked with Finnish Cancer Registry data. The follow-up started from the first TL-01 treatment and the mean follow-up time was 8.4 years. Standardized incidence ratios were calculated for basal cell carcinoma, cutaneous melanoma, and squamous cell carcinoma. The standardized incidence ratio for basal cell carcinoma was 2.5 (95% confidence interval 1.8-3.5), for cutaneous melanoma 4.0 (95% confidence interval 2.1-6.8) and for squamous cell carcinoma 3.7 (95% confidence interval 1.7-7.0). For basal cell carcinoma and squamous cell carcinoma, the standardized incidence ratios remained similar during the whole follow-up time while the standardized incidence ratio for cutaneous melanoma was markedly higher during the first 5 years of follow-up. In conclusion, an increased incidence of skin cancers was observed among TL-01 treated patients. It should be confirmed in the future whether the skin cancer risk of TL-01 phototherapy will remain high in a longer follow-up.

Risk of cardiovascular comorbidities before and after the onset of rheumatic diseases

OBJECTIVES

To elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases.

METHODS

Patients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases.

RESULTS

The RR for 'any CVD' varied from 1.14 (95 % confidence interval [CI] 1.02-1.26) in PsA to 2.05 (95 % CI 1.67-2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis.

CONCLUSIONS

The risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course.

A quality assessment of inflammatory bowel disease nursing care in Finland: a nationwide cross-sectional descriptive study

OBJECTIVES OF THE ARTICLE

Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research.

MATERIALS AND METHODS

Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool.

RESULTS

Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol.

CONCLUSION

In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

Costs of abduction treatment in developmental dysplasia of the hip. Analysis of 900 patients

BACKGROUND

Developmental dysplasia of the hip (DDH) is a disorder of hip development that leads to dysplasia, subluxation, or total hip dislocation. Early detection of DDH is important, and early initiation of abduction treatment is key to successful correction of the hip joint. However, mild forms of DDH, including hip instability without complete dislocation, have good spontaneous healing potential, and a watchful waiting strategy in mild DDH has been found to be safe. In this study, we aimed to evaluate the cost differences between different treatment strategies for DDH.

MATERIAL AND METHODS

Data were collected retrospectively from the medical records of all children diagnosed with diagnosis and treatment of DDH in Tampere University hospital between 1998 and 2018. In total, 948 patients were included in the study. Patients who underwent casting or operative treatment (n = 48) were excluded from the analysis. All Ortolani positive children were subjected to early abduction treatment. Children with Ortolani negative DDH were subjected to either watchful waiting or early abduction treatment, based on the clinicians' decision. The regression model estimates for the number of clinical visits with and without ultrasound examination were assessed together with cost reports from Tampere University Hospital for the calculation of savings per patient in spontaneous recovery.

RESULTS

Alpha angles at one month of age (p < 0.001) and treatment method (p < 0.001) affected the number of clinical visits and ultrasound examinations during the treatment follow-up. A low alpha angle predicted closer follow-up, and children with spontaneous recovery had lower numbers of clinical visits and ultrasound examinations than children in abduction treatment. Spontaneous recovery was found to result in approximately 375€/patient savings compared to successful abduction treatment.

CONCLUSION

With correct patient selection, a watchful waiting strategy is cost-effective in treating mild developmental dysplasia of the hip, considering the high percentage of spontaneous recovery.

Dietary and supplemental intake of vitamins C and E is associated with altered DNA methylation in an epigenome-wide association study meta-analysis

BACKGROUND

Dietary intake of antioxidants such as vitamins C and E protect against oxidative stress, and may also be associated with altered DNA methylation patterns.

METHODS

We meta-analysed epigenome-wide association study (EWAS) results from 11,866 participants across eight population-based cohorts to evaluate the association between self-reported dietary and supplemental intake of vitamins C and E with DNA methylation. EWAS were adjusted for age, sex, BMI, caloric intake, blood cell type proportion, smoking status, alcohol consumption, and technical covariates. Significant results of the meta-analysis were subsequently evaluated in gene set enrichment analysis (GSEA) and expression quantitative trait methylation (eQTM) analysis.

RESULTS

In meta-analysis, methylation at 4,656 CpG sites was significantly associated with vitamin C intake at FDR ≤ 0.05. The most significant CpG sites associated with vitamin C (at FDR ≤ 0.01) were enriched for pathways associated with systems development and cell signalling in GSEA, and were associated with downstream expression of genes enriched in the immune response in eQTM analysis. Furthermore, methylation at 160 CpG sites was significantly associated with vitamin E intake at FDR ≤ 0.05, but GSEA and eQTM analysis of the top most significant CpG sites associated with vitamin E did not identify significant enrichment of any biological pathways investigated.

CONCLUSIONS

We identified significant associations of many CpG sites with vitamin C and E intake, and our results suggest that vitamin C intake may be associated with systems development and the immune response.

Immediate sequential bilateral cataract surgery: a 13-year real-life report of 56 700 cataract operations

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.

Missingness in the expanded prostate cancer index short form (EPIC-26) - prevalence, patterns, and explanatory factors

BACKGROUND

Researchers and clinicians using common clinical assessments need to attend to the prevalence of missing data to ensure the validity of the information gathered. The Expanded Prostate Cancer Index Short Form (EPIC-26) is a commonly used measurement scale used for assessing patients' quality of life, but the measure lacks comprehensive analysis on missing data. We aimed to explore the quantity of missing answers in EPIC-26 and to characterize patterns and possible explanations of missing data in the survey.

METHODS

The survey sample consisted of 625 Finnish prostate cancer patients who participated in a study with a 1-year follow-up with three measurement points (0, 6, and 12 months). Descriptive statistics were used to describe the study population and missingness level. A logistic regression was performed for each EPIC domain to study factors related to missingness during the follow-up.

RESULTS

Proportions of missing answers in EPIC-26 were low (3.1-3.9%) between survey rounds. As much as 37% of patients left at least one question unanswered during their follow-up. The hormonal domain produced the most missing answers. Questions about breast tenderness/enlargement (question 13.b.), hot flashes (question 13.a.), frequency of erections (question 10.), and ability to reach orgasm (question 8.b.) were most frequently left unanswered. Higher age, lower education level, no relationship, more severe cancer, lower function scores in some EPIC domains, lower treatment satisfaction or self-rated health were associated with missingness.

CONCLUSIONS

Questions 13.b. and 13.a. might be considered female-specific symptoms, thus difficult to comprehend unless patients had already experienced side effects from androgen deprivation therapy. Questions 10. and 8.b. might be difficult to answer if the patient has been sexually inactive. To improve the measure's validity, the questionnaire's hormonal section requires additional explanation that the inquired symptoms are common treatment side effects of anti-androgen therapy; questions 8-10 require a not-applicable category for sexually inactive patients.

Known risk factors of the developmental dysplasia of the hip predicting more severe clinical presentation and failure of Pavlik harness treatment

PURPOSE

Developmental dysplasia of the hip (DDH) varies from mild instability of the hip to subluxation or total dislocation of the joint. Well-known risk factors of DDH include pre-natal breech position, female sex, positive family history, hip side, primiparity and the mode of delivery. Aim of the present study was to further evaluate known risk-factors of DDH, find associations with more severe dysplasia (characterized with Ortolani positivity) and find risk factors of failure of the Pavlik harness treatment.

MATERIAL AND METHODS

All children with the diagnosis of DDH treated in Tampere University hospital in the years 1998-2018 were retrospectively identified for the study and the data was collected from the medical records. Teratological dislocations (n = 3) were excluded from the analysis. Total of 945 patients were included.

RESULTS

Breech presentation was strongly associated with Ortolani positivity (p < 0.001). Breech presentation was not associated with ending up for spica casting and/or operative treatment (p = 0.291) despite the association with Ortolani positivity. Ortolani positivity (p = 0.002), positive family history (p = 0.013) and girl sex (p = 0.029) were associated with ending up for spica casting and/or operative treatment.

CONCLUSION

Breech presentation seems to increase the risk of Ortolani positive DDH. However, these infants are likely to recover with initially started Pavlik harness treatment, as it was not associated with elevated risk for undergoing more robust treatments. Positive family history and girl sex are associated with the most severe cases of developmental dysplasia of the hip, and it may predispose to the failure of the Pavlik harness treatment.

Satisfaction and Dissatisfaction With Pain Relief and Birth Experience Among Induced and Spontaneous-onset Labours Ending in Vaginal Birth: A Prospective Cohort Study

Objective

To assess pain relief and overall birth experience in induced vs. spontaneous-onset labours and to clarify variables among induced parturients determining satisfaction and dissatisfaction.

Study design

A prospective study of 2042 women. 575 women with induced and 1467 with spontaneous-onset labour answered multiple questions in a questionnaire regarding the experience of birth giving. Satisfaction was numerically assessed via a visual analogue scale (VAS 0-10).

Results

Induction of labour (IOL) did not worsen the average experience of pain relief, but the proportion of women dissatisfied with pain relief was slightly higher after IOL compared with spontaneous-onset labour (SOL). IOL was associated with lower satisfaction with overall birth experience compared with SOL (VAS 8.0 vs. 8.4; p < 0.001). Among IOL parturients incorrect timing of pain relief was strongly associated with dissatisfaction with pain relief, as were deficient information and induction with misoprostol. Epidural blockade was the most important factor preventing dissatisfaction with pain relief. Unsatisfactory overall experience of birth was associated with deficient pain relief, its incorrect timing or deficient information, as well as vacuum extraction as the mode of delivery.

Conclusions

Induction of labour is a risk factor of dissatisfaction regarding pain relief and overall birth experience. The strongest impact on dissatisfaction among induced parturients concerning pain relief was delayed timing of effective labour analgesia. Poor pain relief, its incorrect timing and deficient information on pain relief were strong predictive factors of dissatisfaction with the overall birth experience.

Retrospective cohort study of long-term outcomes and prognostic factors for survival after lower extremity amputation in patients with diabetes

AIMS

Lower extremity amputation (LEA) is a pivotal event for patients with diabetes. This study aimed to provide updated data on the outcomes and prognostic factors after LEA for patients with diabetes.

METHODS

This retrospective cohort study included all LEAs (n = 1081) performed at Tampere University Hospital between February 2007 and September 2020. Overall survival (OS) and major amputation-free survival were evaluated.

RESULTS

Index amputation level was below ankle in 65 % (n = 704) of patients, below knee in 14 % (n = 154) of patients, and above knee in 21 % (n = 223) of patients. In the whole population, OS was 75.8 % (CI 95 %: 73.3-78.3) at one year and 38.3 % (CI 95 %: 34.7-41.7) at five years. Higher age, peripheral artery disease (PAD), more proximal amputation level, and lower glomerular filtration rate (GFR) reduced OS. Multiple amputations and diagnosed dyslipidemia or hypertension associated with improved OS. Further, age, PAD, and GFR were identified as significant factors for major amputation free survival.

CONCLUSIONS

OS after LEA is poor. After major amputation, the risk for death is higher compared to minor amputation. Recurrent amputation is associated with improved OS. Further, ischemia and renal disease are significant factors for inferior OS.

Analysis of flap failures in microvascular head and neck reconstructions: 11-year single-center results

Background Free flap reconstruction is the gold standard in head and neck reconstructions. The current paper analyses failed free flaps in the head and neck region during an eleven-year period in a single center aiming to discover factors that could be influenced in order to reduce the risk for flap failure. Methods During the study period, 336 patients underwent free flap reconstruction at Tampere University Hospital, Finland. The patients’ average age was 62 years (range 14-92 years). 201 (61.5%) of the patients were women. Medical records were reviewed and statistical analyses performed. Results Ten (3%) of free flaps failed. Patients' age, comorbidities, smoking, dosage of anticoagulation, flap type or the location of the defect did not influence the risk of flap failure. All lost flaps were postoperatively followed by clinical monitoring only. In contrast, 89% of all flaps had both Licox ® and clinical follow-up postoperatively. In six (60%) of the failed cases, a second free flap surgery was performed as a salvage, with a survival rate of 83.3%. Conclusion Our free flap success rate of 97% is in accordance with other head and neck centers. According to our findings, free flap reconstructions can be successfully performed on elderly patients and patients with comorbidities. Smoking did not increase the flap loss rate. We encourage the use of other methods in addition to clinical monitoring to follow the flaps postoperatively. All flap types used have high success rates, and reconstruction can be conducted with the most suitable flap for the defect.

Clinical and sonographic improvement of developmental dysplasia of the hip: analysis of 948 patients

BACKGROUND

Developmental dysplasia of the hip is a common condition, which varies in severity. Abduction treatment is widely used to correct the development of the hips, but mild forms of DDH can also recover spontaneously. The purpose of this study was to evaluate factors affecting the rate of improvement of developmental dysplasia of the hip, and evaluate any risk factors slowing the process.

MATERIAL AND METHODS

The study population consisted of patients diagnosed with DDH in Tampere University hospital in the years 1998-2018. Data were retrospectively collected, and associations between clinical variables and rate of improvement were analyzed. Alpha angles were assessed monthly, and associations between risk factors and improvement of alpha angles were studied. A total of 948 patients were included in the analysis.

RESULTS

More severe first status of the hips was associated with faster improvement in dynamic ultrasound compared to milder DDH in univariate design in first 3 months of age; in the multivariable design, Ortolani positivity was conversely associated with lower alpha angles in 1-month follow-up. Immediate abduction treatment was associated with faster recovery rate compared to delayed abduction or watchful waiting. Female sex and positive family history were associated with slower rate of improvement and lower alpha angles. In multivariable design, female sex, positive family history and treatment strategy remained statistically significant as initiation time of the treatment explained the first found association of clinical hip status and the recovery rate after 2 months of age.

CONCLUSION

Female sex and positive family history might be independent risk factors for slower recovery in DDH before 6 months of age. These children might need special attention in their follow-up plans and abduction treatment.

Glaucoma progression in patients receiving intravitreal anti‐VEGF treatment for neovascular age‐related macular degeneration

PURPOSE

The purpose of this study was to investigate how often glaucoma and neovascular age-related macular degeneration (nAMD) occur in the same patient and to evaluate whether glaucoma progression is faster in eyes treated with intravitreal anti-VEGF medications for nAMD.

METHODS

This single-centre retrospective real-world data (RWD) consists of medical records of 6314 glaucoma and 2166 nAMD patients treated in 2008-2017 in Tays Eye Centre, Finland. To study glaucoma progression, changes in visual fields (mean deviation [MD], dB/year), IOP (mmHg/year) and fundus photographs (progression, yes/no) were compared in glaucoma eyes with and without anti-VEGF treatment for nAMD and ≥1 year follow-up.

RESULTS

During the 10-year period, 147 patients with glaucoma received intravitreal anti-VEGF treatment for nAMD corresponding to 2% of glaucoma and 7% of nAMD patients. The mean change in MD was -0.70 dB/year (SD 1.8) vs. -0.27 dB/year (SD 1.7) (p = 0.027) in glaucoma eyes with (n = 37) and without (n = 4304) anti-VEGF injections, respectively. In patients with bilateral glaucoma and unilateral nAMD treated with anti-VEGF injections (n = 20), MD declined at -0.62 dB/year (SD 1.9) vs 0.33 dB/year (SD 1.5) (p = 0.654), and glaucoma progression was detected in 14/20 vs 10/20 (p = 0.219) fundus photographs in eyes with anti-VEGF treatment compared with their untreated fellow eyes.

CONCLUSION

nAMD and glaucoma were found co-existing in the same eye at rates that were similar to the age-corrected prevalence of the two diseases in the general population. Our results suggest that intravitreal anti-VEGF treatment for nAMD may accelerate glaucoma progression.

LIMPER trials: immediate mobilisation versus 2-week cast immobilisation after distal radius fracture treated with volar locking plate - a study protocol for a prospective, randomised, controlled trial

INTRODUCTION

Open reduction and internal fixation with volar locking plate has become the most common fixation method in the treatment of unstable distal radius fracture (DRF). There is, however, no consensus as to whether or for how long a wrist should be immobilised after operative treatment. To date, there have been relatively few studies that have evaluated the effect of immediate postoperative mobilisation on functional outcomes. The aim of postoperative rehabilitation is to obtain a good function and to reduce impairment, recovery time, socioeconomical costs and absence from work. Therefore, there is a need for studies that evaluate the optimal method of postoperative rehabilitation to optimise wrist function and return to work.

METHODS AND ANALYSIS

This study is a prospective, randomised, controlled trial in which a total of 240 working-age patients who undergo volar plating for DRF will be randomly assigned to either an early mobilisation group or a postoperative 2-week casting group. The aim of the study will be to compare early postoperative outcomes between the study groups. The primary outcome will be patient-rated wrist evaluation at 2 months after operation. A coprimary outcome will be the total length of sick leave. Our follow-up period will be 1 year, and secondary outcomes will include pain, patient satisfaction, perceived ability to work and complications identified at different time points. We expect those patients who undergo immediate mobilisation will have at least as rapid a return to work and function as those patients who undergo postoperative immobilisation, indicating/meaning that there will be no need for postoperative casting.

ETHICS AND DISSEMINATION

This study will be conducted according to the Standard Protocol Items: Recommendations for Interventional Trials statement. The Ethics committee of Tampere University Hospital has approved the protocol. Ethics committee approval number is R21111, and it is accepted on 7 September 2021. The results of this study will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT05150925.

The marital relationship and health-related quality of life of prostate cancer patients and their spouses: A prospective, longitudinal study

AIMS

This study aims to measure any changes in the marital relationship during the first year after a diagnosis of prostate cancer, identify the demographic characteristics that influenced such changes, and measure changes related to health-related quality of life (HRQoL).

BACKGROUND

Knowledge is limited on the impact of a diagnosis of prostate cancer on the marital relationship and HRQoL of patients and their spouses.

DESIGN

A 1-year longitudinal study.

METHODS

Data were collected from five Finnish hospitals between October 2013 and January 2017. Of the 350 recruited couples (N = 700), 179 patients and 166 spouses completed the Marital Questionnaire and the RAND 36-Item Health Survey 1 year after diagnosis.

RESULTS

No major changes were found in the marital relationship during the follow-up period. The spouses reported statistically significant changes in their marital relationships, but the patients did not. Furthermore, changes in the marital relationship were not associated with the patients' HRQoL. Among spouses, emotional well-being was associated with changes in the marital relationship.

CONCLUSION

The marital relationship was relevant in terms of the spouses' HRQoL during the first year after a diagnosis of prostate cancer. Nurses and other healthcare providers should assess counselling and support provided to spouses individually.

The importance of management in promoting hospital staff's mental well-being during the COVID-19 pandemic-A survey

Aim

To describe hospital staff's experiences of management actions to promote their mental well‐being during the COVID‐19 pandemic. Mental well‐being was examined on the basis of four entities: level of anxiety, support and encouragement from the manager, and the opportunity to discuss concerns about COVID‐19 with the manager.

Background

The workload of COVID‐19 affects the mental well‐being of staff. However, there is limited data on managers' actions to promote their mental well‐being during the pandemic.

Methods

A cross‐sectional study was used to collect survey data (n = 1995) among staff working in two specialized medical care hospitals. To gain deeper understanding related issues, the survey included open questions, which were answered by 178 participants.

Results

The results indicate that those staff who felt they had received support, encouragement, and the opportunity to discuss of COVID‐19 worries with a manager experienced less anxiety.

Conclusions

The study provides an insight into managers' actions to promote staff's mental well‐being during the COVID‐19 pandemic.

Implications for Nursing Management

The manager's actions have a significant effect on the anxiety levels of staff. During the pandemic, the well‐being of staff is a priority that should be visible to both hospital administrators and policymakers.

POS0324 RISK OF CARDIOVASCULAR COMORBIDITIES IN RHEUMATIC DISEASES

Background

Cardiovascular diseases (CVD’s) are the most significant comorbidities in rheumatic diseases, causing also increased mortality. [1,2] However, there is only limited data on how the risk of CV comorbidities varies between different rheumatic diseases.

Objectives

The aim of our study was to estimate the risk of certain CV comorbidities across rheumatic diseases.

Methods

The ongoing FinnGen project links nationwide healthcare register data with genome data. The study (data freeze 7) included 321 302 individuals, and from this group we identified patients with seropositive (N=4293) and seronegative (N=1733) rheumatoid arthritis (RA), ankylosing spondylitis (AS, N=1247), psoriatic arthritis (PsA, N=1235), systemic lupus erythematosus (SLE, N=386), primary Sjogren’s syndrome (pSS, N=557) and gout (N=2178). Each patient was matched based on age, sex and municipality of residence with twenty individuals without any rheumatic conditions. The CV comorbidities studied were any CV disease (CVD), major coronary heart disease event (myocardial infarction and/or revascularization; CHD), ischemic stroke, atrial fibrillation and flutter (AF), deep vein thrombosis of lower extremities (DVT) and pulmonary embolism (PE), chronic heart failure (CHF) and valvular heart disease excluding rheumatic fever (VHD). From the prevalence of each CV disease among rheumatic disease cohorts, we calculated the risk ratio (RR) for each CV disease by comparing the prevalence of these diseases between rheumatic diseases and controls.

Results

The average age at the time of diagnosis ranged from 39.6 to 64.4 years, and the average duration of follow-up varied from 9 to 19.5 years in different rheumatic diseases. The risk for any CVD was elevated in all rheumatic disease cohorts with RR varying from 1.14 in seropositive RA to 1.65 in SLE. SLE patients carried the highest relative risk for CV comorbidities, demonstrating over 2.5-fold risk for DVT/PE (RR 3.57), stroke (RR 2.57), CHF (RR 2.64) and VHD (RR 2.98). At least two-fold risk compared to controls was identified for AF (RR 2.03), DVT/PE (RR 2.44) and CHF (RR 3.03) in patients with gout, for DVT/PE (RR 2.15) and CHF (RR 2.0) in patients with pSS, and for DVT/PE (RR 2.03) in patients with PsA. Seropositive and seronegative RA demonstrated similar CV risk profiles. In patients with seropositive or seronegative RA, PsA, pSS or SLE, DVT/PE demonstrated the highest RR’s among various CV comorbidities.

Conclusion

The risk of CV comorbidities is increased in all studied rheumatic diseases, with the largest effects observed in patients with SLE and gout. Among CV comorbidities, DVT/PE displayed the largest effect sizes in several rheumatic diseases. The current results further strengthen the importance of evaluating and treating risk factors for CV comorbidities across rheumatic diseases, focusing also to the excess risk for thromboses.

References

[1]Han C., Robinson DW Jr et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. J Rheumatol. 2006;33(11):2167-2172.

[2]Avina-Zubieta JA, Choi HK et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008; 15;59(12):1690-1697.

Acknowledgements

Special thanks to Finnish Foundation of Rheumatology Research and the Foundation of Maire Lisko for issuing research grants to help with the research process and writing of this abstract.

Disclosure of Interests

Hanna-Kaisa Aaramaa: None declared, Pia Isomäki Speakers bureau: Speaker or chair for AbbVie, Eli Lilly and Pfizer., Consultant of: Consultant for AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma., Grant/research support from: A research grant from Pfizer., Nina Mars: None declared, Mika Helminen: None declared, Anne Kerola: None declared, Antti Palomäki Speakers bureau: Lecture free from Pfizer and Sanofi, Consultant of: Consulting fee from Abbvie, Amgen and Pfizer, Kari Eklund: None declared, Javier Gracia Tabuenca: None declared, Juha Sinisalo: None declared

Randomised double-blind phase 3 clinical study testing impact of atorvastatin on prostate cancer progression after initiation of androgen deprivation therapy: study protocol

INTRODUCTION

Blood cholesterol is likely a risk factor for prostate cancer prognosis and use of statins is associated with lowered risk of prostate cancer recurrence and progression. Furthermore, use of statins has been associated with prolonged time before development of castration resistance (CR) during androgen deprivation therapy (ADT) for prostate cancer. However, the efficacy of statins on delaying castration-resistance has not been tested in a randomised placebo-controlled setting.This study aims to test statins' efficacy compared to placebo in delaying development of CR during ADT treatment for primary metastatic or recurrent prostate cancer. Secondary aim is to explore effect of statin intervention on prostate cancer mortality and lipid metabolism during ADT.

METHODS AND ANALYSIS

In this randomised placebo-controlled trial, a total of 400 men with de novo metastatic prostate cancer or recurrent disease after primary treatment and starting ADT will be recruited and randomised 1:1 to use daily 80 mg of atorvastatin or placebo. All researchers, study nurses and patients will be blinded throughout the trial. Patients are followed until disease recurrence or death. Primary outcome is time to formation of CR after initiation of ADT. Serum lipid levels (total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and trigyserides) are analysed to test whether changes in serum cholesterol parameters during ADT predict length of treatment response. Furthermore, the trial will compare quality of life, cardiovascular morbidity, changes in blood glucose and circulating cell-free DNA, and urine lipidome during trial.

ETHICS AND DISSEMINATION

This study is approved by the Regional ethics committees of the Pirkanmaa Hospital District, Science centre, Tampere, Finland (R18065M) and Tarto University Hospital, Tarto, Estonia (319/T-6). All participants read and sign informed consent form before study entry. After publication of results for the primary endpoints, anonymised summary metadata and statistical code will be made openly available. The data will not include any information that could make it possible to identify a given participant.

TRIAL REGISTRATION NUMBER

Clinicaltrial.gov: NCT04026230, Eudra-CT: 2016-004774-17, protocol code: ESTO2, protocol date 10 September 2020 and version 6.

COVID-19: anxiety among hospital staff and associated factors

BACKGROUND

During the COVID-19 pandemic, hospital staff have experienced a variety of mental health challenges. European research on anxiety and stress among hospital workers during the pandemic is limited. This study aimed to describe the anxiety levels of Finnish hospital workers during the COVID-19 pandemic.

METHODS

The multidimensional, cross-sectional survey was distributed to all hospital staff working at two Finnish specialized medical care centres in the spring of 2020 (n = 1,995). The Generalized Anxiety Disorder 7-item (GAD-7) scale was used to measure the workers' anxiety.

RESULTS

The total mean GAD-7 score was 4.88, indicating normal anxiety levels. However, 30% (n =  1,079) of the respondents had mild, 10% (n = 194) moderate and 5% (n = 88) severe anxiety. Key risk factors were young age, working in a university hospital, problems in cooperation between co-workers, difficulty concentrating at work, a health-threatening physical and psychological workload, and a fear of being infected at work.

CONCLUSION

Hospital staff experienced a variety of work-related stress and anxiety issues that should be visible to hospital administrators and policymakers alike. The anxiety is independent of whether the worker is directly involved in caring for or in any way coming into contact with COVID-19 patients. Key message Fifty-five percent of hospital staff have normal anxiety levels. The remaining workers may need targeted support interventions, and a smaller proportion (15%) are in danger of developing longer-term problems affecting their well-being. The anxiety experienced by hospital workers during the COVID-19 pandemic is more severe than that of the population on average. If the pandemic continues, the well-being of hospital staff may be widely threatened. Despite the different geographical locations and COVID-19 situations, hospital workers in Finland and China had similar anxiety levels. The anxiety is independent of whether staff are working in the front line of managing the COVID-19 pandemic or of the number of covid-19 patients admitted to the hospital. The hospital workers felt anxiety because they were facing a new situation which causes changes in their work and daily routine. Health care employers should engage in long-term follow-up as regards the personnel's recovery from the burden caused by the pandemic and from work in general. It is necessary to make easily attainable, flexibly delivered and cost-effective treatment interventions for anxiety available to hospital staff.

Reliability of the freehand region-of-interest method in quantitative cerebral diffusion tensor imaging

Background

Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique used for evaluating changes in the white matter in brain parenchyma. The reliability of quantitative DTI analysis is influenced by several factors, such as the imaging protocol, pre-processing and post-processing methods, and selected diffusion parameters. The region-of-interest (ROI) method is most widely used of the post-processing methods because it is found in commercial software. The focus of our research was to study the reliability of the freehand ROI method using various intra- and inter-observer analyses.

Methods

This study included 40 neurologically healthy participants who underwent diffusion MRI of the brain with a 3 T scanner. The measurements were performed at nine different anatomical locations using a freehand ROI method. The data extracted from the ROIs included the regional mean values, intra- and inter-observer variability and reliability. The used DTI parameters were fractional anisotropy (FA), the apparent diffusion coefficient (ADC), and axial (AD) and radial (RD) diffusivity.

Results

The average intra-class correlation coefficient (ICC) of the intra-observer was found to be 0.9 (excellent). The single ICC results were excellent (> 0.8) or adequate (> 0.69) in eight out of the nine regions in terms of FA and ADC. The most reliable results were found in the frontobasal regions. Significant differences between age groups were also found in the frontobasal regions. Specifically, the FA and AD values were significantly higher and the RD values lower in the youngest age group (18–30 years) compared to the other age groups.

Conclusions

The quantitative freehand ROI method can be considered highly reliable for the average ICC and mostly adequate for the single ICC. The freehand method is suitable for research work with a well-experienced observer. Measurements should be performed at least twice in the same region to ensure that the results are sufficiently reliable. In our study, reliability was slightly undermined by artifacts in some regions such as the cerebral peduncle and centrum semiovale. From a clinical point of view, the results are most reliable in adults under the age of 30, when age-related changes in brain white matter have not yet occurred.

A Retrospective Review of Patient Records and Factors Associated with Decisions Made by Community Nurse-Paramedics' in Finland

Community paramedicine (CP) has extended the role of paramedics and the main goal is to provide non-emergency care, which reduces the visits to emergency departments. The aim of this study was to describe the Finnish CP and examine the factors that were involved in CNPs' decision-making processes. The study was based on data from 450 consecutive CP patient records from three hospital districts. A more detailed analysis was carried out on 339 cases in patients' homes and elderly care homes, and the data analysis included multivariate logistic regression to examine the impact of variables on the CNPs' decisions. These patients' most common health issues were general weakness (15.9%) and fever (10.6%), and over half (58.7%) could remain at home after the CP visit. There were five independent factors associated with the CNPs' decisions of the patient's care continuum: the hospital district, if the patient could walk, whether the troponin test was performed, a physician was consulted, and the nature of the task. CP units played a valuable role in non-emergency care. Understanding the factors associated with CNP decision-making can increase the safety and effectiveness of reducing hospital visits, by providing patient care at home, or in elderly care facilities.

Effects of force magnitude on dental arches in cervical headgear therapy

AIM

To study the influence of different force magnitudes on dental arches in cervical headgear (CHG) treatment.

MATERIAL AND METHODS

In this controlled clinical trial, patients (n = 40) were treated with CHG with light (L, 300 g, n = 22) or heavy force (H, 500 g, n = 18) magnitude. Subjects were asked to use CHG for 10 hours a day for 10 months. The outer bow of the CHG facebow was raised 10-20 degrees and the inner bow expanded 3-4 mm. Adherence to instructions and force magnitude were monitored with an electronic module (Smartgear, Swissorthodontics, Switzerland). Impressions for study models were taken before (T1) and after (T2) treatment and the study models were scanned into digital form (3Shape, R700 Scanner, Denmark). Measurements were made using the digital models (Planmeca Romexis, Model analyser, Finland).

RESULTS

During the treatment (T1-T2) the upper inter-canine distance increased by 2.83 mm (P = 0.000) and 2.60 mm (P = 0.000) in the L and H force magnitude groups, respectively. Upper inter-molar width increased by 3.16 mm (P = 0.000) and 2.50 mm (P = 0.000) in the L and H groups, respectively. Maxillary total arch perimeter increased by 6.39 mm (P = 0.001) and 6.68 mm (P = 0.001) in the L and H groups, respectively. In the amount of change over time, T1-T2, in the upper arch measurements, no significant difference was found between the groups. Lower inter-canine width increased by 0.94 mm (P = 0.005) and 1.16 mm (P = 0.000) in the L and H groups, respectively; no difference between the groups. Lower inter-molar distance increased by 2.17 mm (P = 0.000) and 1.11 mm (P = 0.008) in the L and H groups, respectively. At the end of the study, upper and lower inter-molar width was larger in the L group than in the H group (P = 0.039 and P = 0.022, respectively).

CONCLUSION

CHG therapy is an effective method for expanding and releasing moderate crowding of the upper dental arch. The lower arch spontaneously follows the upper arch in widening effects, and minor expansion can also be seen on the lower arch. In the L group, larger inter-molar width was achieved on the upper and lower arch; probably due to better adherence to instructions. Light force is recommended for use in CHG therapy.

Sugar-Sweetened Beverage Consumption May Modify Associations Between Genetic Variants in the CHREBP (Carbohydrate Responsive Element Binding Protein) Locus and HDL-C (High-Density Lipoprotein Cholesterol) and Triglyceride Concentrations

Supplemental Digital Content is available in the text.

Background:

ChREBP (carbohydrate responsive element binding protein) is a transcription factor that responds to sugar consumption. Sugar-sweetened beverage (SSB) consumption and genetic variants in the CHREBP locus have separately been linked to HDL-C (high-density lipoprotein cholesterol) and triglyceride concentrations. We hypothesized that SSB consumption would modify the association between genetic variants in the CHREBP locus and dyslipidemia.

Methods:

Data from 11 cohorts from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (N=63 599) and the UK Biobank (N=59 220) were used to quantify associations of SSB consumption, genetic variants, and their interaction on HDL-C and triglyceride concentrations using linear regression models. A total of 1606 single nucleotide polymorphisms within or near CHREBP were considered. SSB consumption was estimated from validated questionnaires, and participants were grouped by their estimated intake.

Results:

In a meta-analysis, rs71556729 was significantly associated with higher HDL-C concentrations only among the highest SSB consumers (β, 2.12 [95% CI, 1.16–3.07] mg/dL per allele; P<0.0001), but not significantly among the lowest SSB consumers (P=0.81; P_Diff <0.0001). Similar results were observed for 2 additional variants (rs35709627 and rs71556736). For triglyceride, rs55673514 was positively associated with triglyceride concentrations only among the highest SSB consumers (β, 0.06 [95% CI, 0.02–0.09] ln-mg/dL per allele, P=0.001) but not the lowest SSB consumers (P=0.84; P_Diff=0.0005).

Conclusions:

Our results identified genetic variants in the CHREBP locus that may protect against SSB-associated reductions in HDL-C and other variants that may exacerbate SSB-associated increases in triglyceride concentrations.

Registration:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005133, NCT00005121, NCT00005487, and NCT00000479.

Major Amputation Profoundly Increases Mortality in Patients With Diabetic Foot Infection

Introduction: An acute diabetic foot infection (DFI) is a serious condition and a leading cause of hospitalization and major amputation in patients with diabetes. Aim of this study was to evaluate the long term survival and risk factors for death and amputation after the DFI requiring hospital treatment.

Materials and Methods: A retrospective study included all adult patients hospitalized for DFI treatments during 2010–2014. Overall survival (OS) and amputation free survival (AFS) (without major amputation) was calculated. We performed a Cox regression analysis of several clinical parameters to evaluate the effects of clinical parameters on overall and amputation-free survival.

Results: Total of 324 patients with mean age of 66.8 (SD 12.8) years were included. The one- and five-year OS after DFI 81.2% (95%CI 77.5–84.9%) and 49.7% (95%CI 44.8–54.6%), respectively. Major amputation, wound ischemia, older age, and a low glomerular filtration rate reduced the OS after DFI. After a major amputation, the one- and five-year OS was 41.7% (95%CI 13.9–69.5) and 8.3% (95%CI 0.0–24.0%), respectively. Wound ischemia, older age, and elevated C-reactive protein reduced AFS. In contrast, hypertensive medication use was identified as a protective factor.

Conclusion: Mortality after a DFI remains high and is significantly increased after a major amputation. Findings highlight the importance of early wound and ischemia management for DFI prevention.

Attitudes, knowledge and sexual behavior among Finnish adolescents before and after an intervention

Adolescents are an important target group for sexual health promotion, and there are numerous programs and interventions carried out in this field. The aim of this study is to describe adolescents' attitudes, knowledge and sexual behavior before and after a sexual health promotion intervention. The intervention was developed in the study and consisted of three elements: (i) class-room session, (ii) information materials and (iii) free condom distribution. The study was carried out in eight randomly selected vocational schools in Finland. The participants were first year students aged 15-19 years. The data were collected using an electronic questionnaire before intervention (intervention baseline n = 500, control baseline n = 183) and two times after the intervention (intervention first follow-up n = 173/second follow-up n = 202, control first follow-up n = 115/second follow-up n = 46). There were significant differences before and after the intervention concerning better knowledge and more frequent testing for sexually transmitted infections (STIs). Schools are an important environment to reach adolescents during the phase where their sexual health is developing and there is an increased risk of STI transmission. More school-based interventions are therefore needed, and the results of this study can be utilized when developing sexual health promotion interventions among adolescents.

The impact of force magnitude on the first and second maxillary molars in cervical headgear therapy

AIM

To study the effect of force magnitude on the maxillary first and second molars in cervical headgear (CHG) therapy.

MATERIAL AND METHODS

In this controlled clinical trial, patients (n = 40) were treated with CHG with a light (L, 300 g, n = 22) or a heavy force (H, 500 g, n = 18) magnitude. The subjects were asked to wear CHG for 10 hours a day for 10 months. The outer bow of the CHG facebow was lifted up for 10-20 degrees and the inner bow was expanded 3-4 mm. Adherence to instructions and force magnitude were monitored using an electronic module (Smartgear, Swissorthodontics, Switzerland). Panoramic and lateral radiographs before (T1) and after treatment (T2) were analysed using a Romexis Cephalometric module (Planmeca, Finland) focussing on the angular, sagittal, and vertical positions of the permanent first and second molars.

RESULTS

According to the cephalometric analysis of the maxillary first and second molars, distal tipping occurred during T1-T2 in the H group (P = 0.010 and 0.000, respectively), and the change was greater in the H group compared to the L group (P = 0.045 and 0.019, respectively). Based on the panoramic analysis, tipping occurred in the distal direction during therapy in the H group in the second molars compared to the midline or condylar line (P = 0.001 and 0.001; P = 0.008 and 0.003 on the right and left, respectively).

CONCLUSION

With heavy force magnitude, the maxillary first and second molars can tilt more easily in the distal direction even if the CHG was used less. Distal tipping of the molar can be considered to be a side effect of CHG therapy.

Family composition and living arrangements-Cross-sectional study on family involvement to self-managed rehabilitation of people with coronary artery disease

Aim

To describe the family composition and living arrangements of persons diagnosed with coronary artery disease and those relationships to family involvement in self‐managed rehabilitation.

Design

A cross‐sectional study.

Methods

Data were collected with postal questionnaire from persons diagnosed with coronary artery disease (CAD) by using the Family Involvement in Rehabilitation (FIRE) scale. It measures family members' promotion of patients' rehabilitation and issues encumbering rehabilitation in family. Statistical methods were used to analyse the data.

Results

Patients' gender and having children in the family were predictors of issues encumbering rehabilitation in the family. But when examining living arrangements, patients who lived with a spouse or underage children had a better environment for recovery than those who lived alone or with adult children. More attention should be paid to targeting appropriate support for persons with coronary artery disease and their family members during the rehabilitation phase.

Randomized controlled and double-blinded study of Caphosol versus saline oral rinses in pediatric patients with cancer

BACKGROUND

Oral mucositis (OM) is a significant side effect of cancer treatment. The purpose of this study was to compare topically administered Caphosol to saline rinses in the prevention of mucositis in pediatric cancer patients.

PROCEDURE

A controlled, double-blinded, and randomized clinical crossover study recruited patients between 2 to 17.99 years of age who were diagnosed with a malignancy and were receiving either high-dose methotrexate (≥1 g/m² ), anthracycline, or cisplatin chemotherapy (NCT0280733). All patients received two 7-day cycles of the mouth rinses; that is, one cycle of Caphosol and one cycle of saline in a randomized order. Oral changes and symptoms were evaluated using the World Health Organisation (WHO) toxicity scale and the Children's International Mucositis Evaluation Scale (ChIMES). The primary endpoint was the frequency and severity of OM and oral symptoms.

RESULTS

A total of 56 patients were recruited to the study, of whom 45 were randomized with a median age of 6.5 years (range 2.1-17.1 years). No cases of severe OM were observed. Grade ≥ 3 oral symptoms were present at least once in six (13%) patients during the Caphosol cycle and 13 (29%) patients during the saline cycle (P = .12). The peak of symptom scores was evident at around day 4-7 after administration of the chemotherapy with no marked differences between the rinse solutions. Multivariable regression analysis did not indicate a benefit of using Caphosol over the saline solution.

CONCLUSIONS

No difference in prevention of oral mucositis was observed between the use of Caphosol or saline rinses.

The validity and reliability of the patient enablement instrument (PEI) after GP appointments in Finnish health care centres

BACKGROUND

The aim of this study was to assess the validity and reliability of the Patient Enablement Instrument (PEI) in Finnish health care centre patients. A pilot study was conducted to assess the content validity of the PEI. A questionnaire study in three health care centres in Western Finland was performed in order to assess acceptability, construct validity, internal consistency, and measurement error of the instrument. A telephone interview 2 weeks after the appointment was performed to evaluate reproducibility.

RESULTS

The pilot study with 17 participants indicated good content validity of the PEI. In the questionnaire study, altogether 483 with a completed PEI score were included in the analyses. Factor analysis and item-scale correlations suggested high structural validity. The internal consistency of the instrument was high (Cronbach's α = 0.93). The PEI score diminished strongly over the two-week period.

CONCLUSIONS

The PEI has good content validity and acceptability, good construct validity, high internal consistency but low reproducibility. Thus, the PEI seems to be an applicable tool to measure patient enablement in Finnish primary health care.

Pathogens Causing Diabetic Foot Infection and the Reliability of the Superficial Culture

Background: Diabetic foot infection (DFI) is a severe complication of diabetes and a leading cause of hospitalization in the population with diabetes. Empirical intravenous antibiotic agents are initiated according to guidelines based on previously published data on typical pathogens. Therefore, regular evaluation of the pathogens in DFI and their resistance is important to validate current therapies. We evaluated the most current data on bacterial cultures in patients treated at our hospital for DFI and the resistance to the most common antibiotic agents, as well as the reliability of superficial cultures compared with deep tissue cultures. Patients and Methods: This retrospective study was performed at the University Hospital of Tampere and comprised 325 patients with 405 hospitalizations for DFI during the years 2010-2014. Results: The most frequent pathogens in superficial and deep samples were Staphylococcus aureus (36.9%), gram-negative bacilli (24.6%), and β-hemolytic streptococci (BHS, 19.5%). Septicemia was caused most often by Staphylococcus aureus and BHS (34.6% each). The specificity of superficial culture was 91.8%-92.8% and sensitivity 66.7%-87.5%. Conclusions: This study indicates the need to cover Staphylococcus aureus, BHS, and gram-negative bacilli when treating DFI. The reliability of superficial culture was surprisingly good.

Quality of life several years after orthodontic-surgical treatment with bilateral sagittal split osteotomy

Objective: To analyse oral health related quality of life (OHRQoL) several years after orthognathic treatment in patients who had Class II malocclusion with retrognathic mandible.Material and methods: The initial study cohort comprised 151 patients with orthognathic treatment in 2007-2011. Of them, 77 patients (Group 1, mean age 41 years, range 19-71 years, 71% women) were clinically examined 6 years (range 4-8 years) after bilateral sagittal split osteotomy (BSSO). Group 2 included 24 former patients (mean 48 years, range 25-79 years, 50% women) who were willing to participate in a structured telephone interview. Group 3 consisted of 22 prospective patients (mean 35 years, range 18-56 years, 86% women) with a recent orthognathic treatment plan and awaiting treatment. QoL was assessed using two questionnaires, OHIP-14 and OQLQ.Results: Based on responses, patients who had received orthognathic treatment (Groups 1 and 2) had better QoL than those awaiting treatment (Group 3).Conclusion: Conventional orthognathic treatment, including mandibular advancement with BSSO, seems to have a positive long-term effect on patients' QoL. More long-term follow-up studies are needed to assess the real impact of treatment on patients' lives in the long run.

Mothers' parenting self-efficacy, satisfaction and perceptions of their infants during the first days postpartum

OBJECTIVE

The first aim of this study was to describe mothers' self-efficacy, satisfaction and perceptions when parenting their infants during the first days postpartum. Furthermore, the study aimed to explore the distinct sociodemographic as well as mother and infant related factors that are associated with the above parenting aspects.

DESIGN

A descriptive and cross-sectional study design was used.

SETTING

Three separate postpartum wards 1-7 days after childbirth in one university level hospital in Finland.

PARTICIPANTS

All mothers who gave birth during March 1st to May 20th, 2019 and filled the inclusion criteria, were invited to participate in this study. A convenience sample of 250 mothers with healthy singleton infants agreed to participate.

MEASUREMENTS AND FINDINGS

The following instruments were used: The Parenting Self-Efficacy (PSE) scale, the Evaluation subscale of What Being the Parent of a New Baby is Like-revised (WBPL-R) and the Perception of Infant scale. Mothers' parenting self-efficacy and parenting satisfaction were high during the first days postpartum. Age, marital status, education and type of birth were not associated with parenting self-efficacy nor satisfaction. Mothers who were unemployed or working only part-time reported higher scores across all categories of parenting self-efficacy, compared to full time employed mothers (p < .001). A higher number of children (≥ 3) were positively associated with both parenting self-efficacy and satisfaction. Mothers who reported poor breastfeeding initiation success also reported significantly lower scores in parenting self-efficacy and parenting satisfaction across all categories. Mothers' perceptions of their infants' fussiness were not associated with parenting self-efficacy (p = .113) nor parenting satisfaction (p = .091).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The results of this study can benefit postpartum maternity health care professionals by suggesting factors that could be focused on during the very short period that mothers stay in hospital. Discussing prior mothering experiences, work life before maternity leave, breastfeeding initiation experiences and perception of infant with the mothers after childbirth, may lead to better PSE and PS during the postpartum period.

Is securing normal dentofacial development an indication for tonsil surgery in children? A systematic review and meta-analysis

OBJECTIVE

Tonsil surgeries are common operations in the field of paediatric otorhinolaryngology. Often, the indication for these operations is hypertrophied tonsils. Paediatric sleep-disordered breathing and mouth-breathing are conventional situations caused by the hypertrophied tonsils. Both of these are further associated with dentofacial development alterations. Securing normal dentofacial development, or restoring it, is often used as an indication for tonsil surgery. In this review and meta-analysis, we assessed the contemporary literature to clarify whether tonsil surgery has an effect on dentofacial development in children.

METHODS

Studies with children aged 3-10 years who underwent tonsil surgery and were compared to non-operated controls using dentofacial parameters were included to the review. Search strategies were planned for specific databases. The Newcastle-Ottawa scale was used to assess the risk of bias. A meta-analysis was performed when the data was methodologically homogenous enough to be pooled.

RESULTS

The inclusion criteria for the review were fulfilled in 8 studies. The overall quality of the individual studies was judged to be moderate at best. The data were methodologically homogenous enough to be pooled for the meta-analysis in only 2 studies. The results of the meta-analysis revealed that tonsil surgery has a positive effect on the growth direction of the mandible (p < 0.001).

CONCLUSIONS

There is modest evidence that suggests that tonsil surgery has a positive effect on the dentofacial development in children with hypertrophied tonsils. Securing normal dentofacial development should be one component, but not the only one, when the indications for tonsil surgery in children are considered.

Association between snoring and deciduous dental development and soft tissue profile in 3-year-old children

INTRODUCTION

The aim was to study the association between snoring and development of occlusion, maxillary dental arch, and soft tissue profile in children with newly completed deciduous dentition.

METHODS

Thirty-two (18 female, 14 male) parent-reported snorers (snoring ≥3 nights/week) and 19 (14 female, 6 male) nonsnorers were recruited. Breathing preference (nose or mouth) was assessed at the mean age of 27 months by otorhinolaryngologist. At the mean age of 33 months, an orthodontic examination was performed, including sagittal relationship of second deciduous molars, overjet, overbite, and occurrence of crowding and lateral crossbite. Bite index was obtained to measure maxillary dental arch dimensions (intercanine and intermolar width, arch length). A profile photograph was obtained to measure facial convexity.

RESULTS

No significant differences were found between nonsnorers and snorers in any of the studied occlusal characteristics or in measurements of maxillary dental arch dimensions. Snorers were found to have a more convex profile than nonsnorers. Occurrence of mouth breathing was more common among snorers.

CONCLUSIONS

Parent-reported snoring (≥3 nights/week) does not seem to be associated with an adverse effect on the early development of deciduous dentition, but snoring children seem to have more convex profile than nonsnorers. Snoring is a mild sign of sleep-disordered breathing, and in the present study its short time lapse may not have had adequate functional impact on occlusion.

Decreasing trend in the incidence of serious pneumonias in Finnish children with juvenile idiopathic arthritis

OBJECTIVES

Children with juvenile idiopathic arthritis (JIA) may be predisposed to serious pneumonia due to modern disease-modifying anti-rheumatic treatment. In this nationwide retrospective study with clinical data, we describe the pneumonia episodes among children with JIA.

METHODS

Patients under 18 years of age with JIA and pneumonia during 1998-2014 were identified in the National Hospital Discharge Register in Finland. Each individual patient record was reviewed, and detailed data on patients with JIA and pneumonia were retrieved, recorded, and analyzed. If the patient was hospitalized or received intravenous antibiotics, the pneumonia was considered serious.

RESULTS

There were 157 episodes of pneumonia among 140 children with JIA; 111 episodes (71%) were serious (80% in 1998-2006 and 66% in 2007-2014). The mean age of the patients was 9 years. Forty-eight percent had active JIA and 46% had comorbidities. Disease-modifying anti-rheumatic drugs (DMARD) were used at the time of 135 episodes (86%): methotrexate (MTX) by 62% and biologic DMARDs (bDMARD) by 30%. There was no significant difference in the use of bDMARDs, MTX and glucocorticoids between the patient groups with serious and non-serious pneumonia episodes. During six of the episodes, intensive care was needed. Two patients (1.3%) died, the remaining ones recovered fully.

CONCLUSIONS

Although the incidence of pneumonia and the use of immunosuppressive treatment among children with JIA increased from 1998 to 2014, the proportion of serious pneumonias in these patients decreased. There was no significant difference in the use of anti-rheumatic medication between patients with serious and non-serious pneumonia.Key Points• The incidence of serious pneumonias decreased from 1998 to 2014 among children with juvenile idiopathic arthritis (JIA).• There was no significant difference in the use of the disease-modifying anti-rheumatic medication between JIA patients with serious and non-serious pneumonias.• Active JIA, comorbidities, and combination medication were associated with nearly half of the pneumonias.

Oral versus patient-controlled intravenous administration of oxycodone for pain relief after cesarean section

PURPOSE

The optimal postoperative analgesia after cesarean section (CS) remains to be determined. The primary objective of this study was to assess whether oral oxycodone provides the same or better pain control and satisfaction with pain relief as oxycodone given intravenously using a patient-controlled analgesia (PCA) infusion device. The secondary objectives were to compare the gastrointestinal symptoms and postsurgical recovery of the two groups.

METHODS

This prospective randomized trial was conducted at a University Hospital between February 2015 and June 2017. Altogether 270 CS patients were randomly assigned to receive postoperative oxycodone pain relief by IV PCA (n = 133) or orally (n = 137). Pain control and satisfaction with pain treatment were assessed by a numeric rating scale (NRS) at 2, 4, 8, and 24 h postoperatively.

RESULTS

No differences were found in NRS pain scores or satisfaction between the groups except at 24 h pain when coughing; there was a statistically significant difference favoring the IV PCA group (p = 0.006). In the IV PCA group, the patients experienced more nausea at 4 h (p = 0.001) and more vomiting at 8 h (p = 0.010). Otherwise, postoperative recovery was similar in both groups. The equianalgesic dose of oxycodone was significantly smaller in the oral group (p = 0.003).

CONCLUSIONS

This study indicates that oral oxycodone provides pain control and satisfaction with pain relief equal to IV oxycodone PCA for postoperative analgesia after cesarean section. Satisfaction with pain treatment was high in both groups, and both methods were well tolerated. Early nausea was less common with oral medication.

Continuation of domestic violence and changes in the assessment of family functioning, health, and social support in Finland

Our aim in this comparison study was to describe the continuation of domestic violence and to assess changes in the association among family functioning, health, and social support for participants who have or have not experienced violence for the years 2012 and 2015. We collected the data using a family functioning, health, and social support (FAFHES) questionnaire. We collected the baseline questionnaires (N = 188) from patients who visited a Finnish central hospital and mailed the follow-up survey (N = 71). The prevalence of violence remained constant. However, the violence varied and changed. Our findings should encourage health care professionals to better identify and intervene in violence.

The use of the brief child abuse potential inventory in the general population in Finland

Objective: The purpose of this research was to analyze psychometric information in the Brief Child Abuse Potential Inventory (BCAP) in a Finnish general population sample. Design: A self-report survey of parents in a primary health care setting and a hospital setting was used to evaluate the use of the BCAP. Setting: The study population consisted of parents who were visiting one of the following contexts: a primary maternity health care clinic, a child health care clinic, and the maternity outpatient clinic, various pediatric outpatient clinics, the general pediatric ward, the pediatric surgical ward, or the neonatal intensive care unit in a hospital setting. Subjects: The BCAP was given to parents at the 30-34th week of pregnancy, when the child was 5 months old or all parents depending on the context. The BCAP was delivered to 759 parents. The final size of the sample was 453 respondents. Main outcome measure: The BCAP, which consisted of 25 items to screen child abuse potential and nine items for evaluation of respondent validity. Results: The internal consistency of the Abuse Risk Scale was good (.770), and the validity scales worked well. The factor structure mirrors with the original factors structure. Conclusion: The psychometric properties of the BCAP reported in the analysis suggest that the BCAP could be a valid instrument to detect child abuse potential in the general population in Finnish health care settings. However, among Finnish respondents there is very little variation in some parts of the measure, which suggests that further research should assess the validity of the instrument in representative samples. Further analysis is also needed to evaluate the correct classification rate of the BCAP. Key points Identification of families at risk of child maltreatment requires valid tools to recognize risk within the general population, as part of child and family needs and risk assessments in family services. The BCAP is valid, reliable, and useful in bringing parental worries under discussion in child and family services. Results of this study can be used for a more systematic and valid child maltreatment risk assessment for identifying families who need help managing their everyday lives.

Impact of force magnitude on effectiveness in cervical headgear therapy: a cephalometric analysis

Aim

The main aim of this study was to study the impact of different force magnitudes on effectiveness in cervical headgear (CHG) therapy.

Materials and methods

Forty patients were treated with CHG with light (L; 300 g) or heavy (H; 500 g) force in this controlled clinical trial. Patients were asked to wear CHG for 10 hours/day for 10 months. The inner bow of the CHG was expanded (3–4 mm) and the long outer bow bent (10–20 degree) upward in relation to the inner bow. Adherence to instructions and force magnitude in CHG use was monitored by electronic module (Smartgear, Swissorthodontics, Switzerland). Lateral cephalograms were taken before (T1) and after (T2) the treatment and studied with modified Pancherz analysis using a Planmeca Romexis Ceph module (Planmeca, Finland).

Results

In both groups, skeletal and dental effects were seen. The only statistically significant difference in cephalometric analysis was the inclination of upper incisors at T1 (P = 0.010) and at T2 (P = 0.011). In both groups, a reduction in Sella-Nasion- point A (SNA) angle was found: L group T1 82.7degree (SD ± 3.6degree), T2 82.0degree (SD ± 3.5 degree) and H group T1 82.6 degree (SD ± 4.7 degree), T2 81.5 degree (SD ± 4.5 degree), but no statistically significant difference between the groups. Children in the L group used CHG statistically significantly more than those in the H group (10.0 ± 1.5 hour, and 8.3 ± 2.1 hour, respectively, P = 0.002).

Conclusion

Children with lower force CHG seem to adhere better to instructions for CHG use. After 10 months of use, no statistically significant differences were found in dental or skeletal outcome. However, in the H group, the outcome was achieved with less daily hours of use.

Temporomandibular disorders in Class II malocclusion patients after surgical mandibular advancement treatment as compared to non-treated patients

BACKGROUND

Severe malocclusions may cause functional and aesthetic problems and symptoms of temporomandibular disorders (TMD). Studies have investigated association between malocclusions and TMDs and shown controversial findings.

OBJECTIVE

Purpose of this investigation was to examine the prevalence of TMD sub-diagnoses, using Diagnostic Criteria for the TMD (DC/TMD), in patients with Class II malocclusion and retrognathic mandible who had undergone mandibular advancement surgery 4-8 years previously, and to compare their frequencies with non-treated patients with a similar pre-existing condition.

METHODS

Study cohort comprised 151 patients who had orthognathic treatment due to mandibular retrognathia in 2007-2011. Seventy-seven (51%) participated in the study (Group 1). Group 2 comprised 22 patients who were planned for orthognathic treatment but had not started their treatment. Patients filled in the Finnish version of the DC/TMD Symptom Questionnaire and were examined using to the DC/TMD Axis I. DC/TMD Symptom Questionnaire were inquired by phone from 24 of the 74 patients who did not participate in the study.

RESULTS

Results showed that Group 2 had more myalgia (13% vs 50%, P < 0.001) and arthralgia (18% vs 65%, P < 0.001) sub-diagnoses than Group 1. A tendency was noted that Group 2 had more pain-related TMD symptoms than Group 1. No differences were found between Groups 1 and 3 in gender and age distribution or frequency TMD symptoms.

CONCLUSION

Prevalence of especially pain-related TMD diagnoses was higher in Group 2 compared to Group 1, thus indicating a possible beneficial effect of this treatment for TMD.

Vocational school students' self-evaluations of a sexual health promotion intervention

Sexually transmitted infections (STIs) continue to pose a health risk among adolescents. School is therefore a logical place for promoting sexual health through interventions, but previous research has not examined student's self-evaluations of these interventions. The purpose of this study was to examine students' self-evaluations of a sexual health promotion intervention carried out in four randomly selected vocational schools in Finland in the year 2011. The participants (n = 168) were first-year students aged 15-19 years. The intervention (11 weeks) consisted of three components: (i) a teacher-delivered classroom lesson about sexual health, (ii) information materials about sexual health and (iii) free condom distribution in the school corridors. An electronic questionnaire was developed and administered to the students after the intervention. The participants' evaluations of the intervention were fairly positive. Almost all of the participants were at least partly satisfied with the classroom lesson. They mostly reported learning new information about STIs and sexuality. Information material was also read and participants self-evaluated themselves as having learned from the materials. Free condoms were obtained and the students felt that the condom distribution was useful. Sexual health promotion interventions might in the future include the classroom lesson, information material and free condom distribution components used in this study.

The use of the Brief Child Abuse Potential Inventory in the general population in Finland

OBJECTIVE

The purpose of this research was to analyze psychometric information in the Brief Child Abuse Potential Inventory (BCAP) in a Finnish general population sample.

DESIGN

A self-report survey of parents in a primary health care setting and a hospital setting was used to evaluate the use of the BCAP.

SETTING

The study population consisted of parents who were visiting one of the following contexts: a primary maternity health care clinic, a child health care clinic, and the maternity outpatient clinic, various pediatric outpatient clinics, the general pediatric ward, the pediatric surgical ward, or the neonatal intensive care unit in a hospital setting.

SUBJECTS

The BCAP was given to parents at the 30-34th week of pregnancy, when the child was 5 months old or all parents depending on the context. The BCAP was delivered to 759 parents. The final size of the sample was 453 respondents.

MAIN OUTCOME MEASURE

The BCAP, which consisted of 25 items to screen child abuse potential and nine items for evaluation of respondent validity.

RESULTS

The internal consistency of the Abuse Risk Scale was good (.770), and the validity scales worked well. The factor structure mirrors with the original factors structure.

CONCLUSION

The psychometric properties of the BCAP reported in the analysis suggest that the BCAP could be a valid instrument to detect child abuse potential in the general population in Finnish health care settings. However, among Finnish respondents there is very little variation in some parts of the measure, which suggests that further research should assess the validity of the instrument in representative samples. Further analysis is also needed to evaluate the correct classification rate of the BCAP. Key points Identification of families at risk of child maltreatment requires valid tools to recognize risk within the general population, as part of child and family needs and risk assessments in family services. 1. The BCAP is valid, reliable, and useful in bringing parental worries under discussion in child and family services. 2. Results of this study can be used for a more systematic and valid child maltreatment risk assessment for identifying families who need help managing their everyday lives.

Evaluation of frequency of Clinical Symptoms and Signs within Six Months Prior to Death in Patients with Advanced Solid Cancers

This retrospective study documented the frequency of the clinical symptoms and signs that increase in advanced cancer patients as they move toward death in order to create a sum score and correlate it with survival. Of 572 adult patients who were treated in four selected hospitals and who died in 1998 and 1999, data at six, three, and one month(s) prior to death was available for 257. The results showed that the number of symptoms and certain clinical findings accelerated toward death, increasing the sum score. Younger patients obtained higher sum scores at one month prior to death than did elderly ones (p=0.014); this suggests that elderly patients die at a point where they show less worsening in their clinical condition than do younger patients. The score was independent of cancer type or gender. The results of this analysis provide data for further development of a clinical tool to predict long-term survival in palliative care settings.

Adherence to instructions and fluctuation of force magnitude in cervical headgear therapy

OBJECTIVES

To investigate how patients adhere to instructions and how force magnitude fluctuates and influences the use of cervical headgear (CHG) therapy.

MATERIALS AND METHODS

In this controlled clinical trial, subjects (n = 40) were treated with CHG with light (L, 300 g) or heavy (H, 500 g) force. Patients were asked to wear CHG for 10 hours per day for 10 months (ie, during sleep), but the importance for treatment of wearing CHG also in the evening hours was emphasized. Adherence to instructions and force magnitude in CHG use were monitored by electronic module (Smartgear, Swissorthodontics, Switzerland).

RESULTS

Force magnitude can be set at a certain level, L or H, even if great individual variability is seen in all subjects (0-900 g). Children in the L group used CHG longer per day than those in the H group (9.3 hours ±1.5 hours and 7.8 hours ± 2.1 hours, respectively, P = .002). During evening hours, CHG was used more ( P = .02) in the L group than in the H group. In both groups, CHG was used less in the evening hours during school breaks than in the evening hours during school ( P < .001).

CONCLUSIONS

Children with lower force in CHG seem to adhere better to the instructions for CHG use. Daily rhythm also influences the time of appliance use regardless of force magnitude. The force can be set to a certain magnitude level, even though there is substantial individual variability.

Health-related quality of life in patients with prostate cancer and their spouses: Results from a longitudinal study

PURPOSE

The purpose of this study was to explore changes in HRQoL (health-related quality of life) and identify the associated factors in patients with prostate cancer and their spouses during the year following their diagnosis of prostate cancer.

METHODS

The longitudinal study design consisted of 179 patients and 166 spouses, using discretionary sampling, at five Finnish central hospitals. Participants completed a self-reported RAND-36-Item Health Survey at three time-points: time of diagnosis and 6 and 12 months later. Changes in HRQoL were analysed using descriptive statistics and non-parametric tests. Linear mixed-effects models were used to identify the factors associated with the changes in HRQoL in the patients and their spouses.

RESULTS

On average, the HRQoL of patients with prostate cancer changed in physical functioning (p = 0.015), emotional well-being (p = 0.029) and general health (p = 0.038) were statistically significant over the 12-month study period. In spouses, statistically significant changes in HRQoL were not observed. Interaction between the age of participants and changes in HRQoL were statistically significant.

CONCLUSIONS

Findings in this study suggest that interventions aimed at improving the HRQoL of patients should support a few different dimensions of HRQoL for the patients themselves than for their spouses. Nurses should pay more attention to elderly couples.