1
|
Cajanus K, Kytö V, Ruuskanen JO, Luoto TM, Rautava P, Tornio A, Posti JP. Association of Central Nervous System-Affecting Medications With Occurrence and Short-Term Mortality of Traumatic Brain Injury. Neurosurgery 2024; 94:721-728. [PMID: 37850916 DOI: 10.1227/neu.0000000000002732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/01/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The use of medications commonly prescribed after traumatic brain injury (TBI) has been little studied before TBI. This study examined the association between the use of medications that affect the central nervous system (CNS) and the occurrence and short-term mortality of TBI. METHODS Mandatory Finnish registries were used to identify TBI admissions, fatal TBIs, and drug purchases during 2005-2018. Patients with TBI were 1:1 matched to nontrauma control patients to investigate the association between medications and the occurrence of TBI and 30-day mortality after TBI. Number needed to harm (NNH) was calculated for all medications. RESULTS The cohort included 59 606 patients with TBI and a similar number of control patients. CNS-affecting drugs were more common in patients with TBI than in controls [odds ratio = 2.07 (2.02-2.13), P < .001)]. Benzodiazepines were the most common type of medications in patients with TBI (17%) and in controls (11%). The lowest NNH for the occurrence of TBI was associated with benzodiazepines (15.4), selective serotonin uptake inhibitors (18.5), and second-generation antipsychotics (25.8). Eight percent of the patients with TBI died within 30 days. The highest hazard ratios (HR) and lowest NNHs associated with short-term mortality were observed with strong opioids [HR = 1.41 (1.26-1.59), NNH = 33.1], second-generation antipsychotics [HR = 1.36 (1.23-1.50), NNH = 37.1], and atypical antidepressants [HR = 1.17 (1.04-1.31), NNH = 77.7]. CONCLUSION Thirty-seven percent of patients with TBI used at least 1 CNS-affecting drug. This proportion was significantly higher than in the control population (24%). The highest risk and lowest NNH for short-term mortality were observed with strong opioids, second-generation antipsychotics, and atypical antidepressants. The current risks underscore the importance of weighing the benefits and risks before prescribing CNS-affecting drugs in patients at risk of head injury.
Collapse
Affiliation(s)
- Kristiina Cajanus
- Department of Clinical Pharmacology, Turku University Hospital and University of Turku, Turku , Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research, Turku University Hospital and University of Turku, Turku , Finland
- Research Services, Turku University Hospital, Turku , Finland
| | - Jori O Ruuskanen
- Neurocenter, Department of Neurology, Turku University Hospital and University of Turku, Turku , Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere , Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital and University of Turku, Turku , Finland
| | - Aleksi Tornio
- Department of Clinical Pharmacology, Turku University Hospital and University of Turku, Turku , Finland
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku , Finland
| |
Collapse
|
2
|
Grönroos L, Rautava P, Setänen S, Nyman A, Ekholm E, Lehtonen L, Ylijoki M. Associations between the aetiology of preterm birth and mortality and neurodevelopment up to 11 years. Acta Paediatr 2024; 113:471-479. [PMID: 37926858 DOI: 10.1111/apa.17027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
AIM To investigate how the aetiology of very preterm birth/very low birth weight is associated with mortality and later neurodevelopmental outcomes. METHODS Very preterm/very low-birth weight singletons were categorised based on the aetiology of preterm birth: spontaneous preterm birth (n = 47, 28.1%), preterm premature rupture of membranes (n = 56, 33.5%) or placental vascular pathology (n = 64, 38.3%). Mortality, cerebral palsy, severe cognitive impairment by 11 years of age (<2SD) and mean full-scale intelligence quotient at 11 years were studied in association with birth aetiology. RESULTS There was no difference in mortality or rate of cerebral palsy according to birth aetiologies. The rate of severe cognitive impairment was lower (4.9% vs. 15.3%) in the preterm premature rupture of the membrane group in comparison to the placental vascular pathology group (OR 0.2, 95% CI 0.03-0.9, adjusted for gestational age). At 11 years, there was no statistically significant difference in the mean full-scale intelligence quotient. CONCLUSION Placental vascular pathology, as the aetiology of very preterm birth/very low birth weight, is associated with a higher rate of severe cognitive impairments in comparison to preterm premature rupture of membranes, although there was no difference in the mean full-scale intelligence quotient at 11 years. The aetiology of very preterm birth/very low birth weight was not associated with mortality or the rate of cerebral palsy.
Collapse
Affiliation(s)
- Linda Grönroos
- Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| | - Anna Nyman
- Department of Psychology, University of Turku, Turku, Finland
| | - Eeva Ekholm
- Department of Obstetrics and Gynaecology, University of Turku and Turku University Hospital, Turku, Finland
| | - Liisa Lehtonen
- Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Milla Ylijoki
- Department of Pediatric Neurology, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
3
|
Leppänen M, Pape B, Ripatti L, Karukivi M, Haataja L, Rautava P. Burden of mental, behavioral, and neurodevelopmental disorders in the Finnish most preterm children: a national register study. Eur Child Adolesc Psychiatry 2024; 33:431-438. [PMID: 36847865 PMCID: PMC10869390 DOI: 10.1007/s00787-023-02172-1] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023]
Abstract
Etiologies and the whole picture in childhood mental, behavioral, and neurodevelopmental disorders related to gestational age are unclear. This study included all Finnish children (N = 341,632) born between January 1, 2001, and December 31, 2006, whose data including their mothers (N = 241,284) were collected from national registers. Children with unclear gestational age (GA) (N = 1245), severe congenital malformations (N = 11,746), and moderate/severe/undefined cognitive impairment (N = 1140), and those who died during the perinatal period (N = 599) were excluded. The main outcome was the prevalence of mental and behavioral disorders (International Classification of Disorders) at 0 - 12 years of age in association with GA, adjusted for gender and prenatal variables. Out of all included (N = 326,902) children 16.6% (N = 54,270) were diagnosed to have any mental health disorder at 0 - 12 years. Adjusted Odd Ratio (OR) were for any disorder in preterm (< 37 weeks) 1.37 [1.28 - 1.46] and 4.03 [3.08 - 5.26] in extreme preterm (≤ 28 weeks) versus term born children, p < 0.05. The lower the GA at birth, the higher the risk for multiple disorders and earlier onset of disorder, p < 0.05. Adjusted ORs were for male/female 1.94 [1.90 - 1.99], maternal mental health disorder (yes/not) 1.99 [1.92 - 2.07], and smoking during pregnancy (yes/not) 1.58 [1.54 - 1.62], and these risks were more common in preterm versus term born children (p < 0.05). Extreme early birth was a strong risk factor per se for any or multiple and early shown mental health disorders. Other risk factors for mental health accumulated to preterm children.
Collapse
Affiliation(s)
- Marika Leppänen
- Neuropsychiatric Outpatient Clinic, Turku University Hospital, and Preventive Medicine, University of Turku, 20014, Turun Yliopisto, Turku, Finland.
| | - Bernd Pape
- Department of Mathematics and Statistics, University of Vaasa, and Turku University Hospital, Turku, Finland
| | - Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital, Turku, Finland
| | - Max Karukivi
- Department of Adolescent Psychiatry, University of Turku, and Turku University Hospital, Turku, Finland
| | - Leena Haataja
- Department of Pediatric Neurology, Pediatric Research Centre, University of Helsinki, and Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Rautava
- Research Services, Turku University Hospital, and Preventive Medicine, University of Turku, Turku, Finland
| |
Collapse
|
4
|
Sipilä JO, Kaasinen V, Rautava P, Kytö V. Case-Fatality Rate in Parkinson's Disease: A Nationwide Registry Study. Mov Disord Clin Pract 2024; 11:152-158. [PMID: 38386489 PMCID: PMC10883402 DOI: 10.1002/mdc3.13948] [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] [Received: 07/30/2023] [Revised: 11/05/2023] [Accepted: 11/15/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) may have an increased risk of mortality, but robust estimates are lacking. OBJECTIVE To compare mortality rates nationally between patients with PD and controls. METHODS The case-fatality rates of Finnish PD patients diagnosed in 2004-2018 (n = 23,688; 57% male, mean age at diagnosis = 71 years) and randomly selected sex- and age-matched control subjects (n = 94,752) were compared using data from national registries. The median follow-up duration was 5.8 years (max 17 years). RESULTS The case-fatality rate in patients with PD was higher than that in matched controls (HR 2.29; 95% CI 2.24-2.33; P < 0.0001). Excess fatality among PD patients was already present at 1 year from diagnosis and then plateaued at 29% at 12 years after diagnosis. The long-term relative hazard of death in PD patients vs. matched controls did not differ based on sex. Patients with early-onset PD (age at diagnosis <50 years old) had the highest relative hazard of death (HR 3.36) compared to matched control subjects, and the relative hazard decreased with higher age at diagnosis. The seven-year excess risk of death decreased during the study period, especially in men. In patients with PD, male sex, increasing age, and increasing comorbidity burden were associated with an increased risk of death. CONCLUSIONS An increased risk of death among PD patients was evident from early on. The increase in risk was greatest among young-onset patients. The excess risk in early PD declined during the study period, particularly in men. The reasons for this are unknown.
Collapse
Affiliation(s)
- Jussi O.T. Sipilä
- Department of NeurologySiun Sote North Karelia Central HospitalJoensuuFinland
- Clinical NeurosciencesUniversity of TurkuTurkuFinland
| | - Valtteri Kaasinen
- Clinical NeurosciencesUniversity of TurkuTurkuFinland
- NeurocenterTurku University HospitalTurkuFinland
| | - Päivi Rautava
- Department of Public HealthUniversity of TurkuTurkuFinland
- Turku Clinical Research CenterTurku University HospitalTurkuFinland
| | - Ville Kytö
- Turku Clinical Research CenterTurku University HospitalTurkuFinland
- Heart CenterTurku University Hospital and University of TurkuTurkuFinland
| |
Collapse
|
5
|
Posti JP, Cajanus K, Tornio A, Ruuskanen JO, Luoto TM, Rautava P, Kytö V. Causes of fatal traumatic brain injury in Finland. J Neurosurg 2023; 139:1506-1513. [PMID: 37148228 DOI: 10.3171/2023.3.jns23148] [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: 01/27/2023] [Accepted: 03/27/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE The phenotype of patients who suffer fatal traumatic brain injury (TBI) is poorly characterized. The authors examined the external causes, contributing diseases, and preinjury medication in adult patients with fatal TBI in a nationwide Finnish cohort. METHODS Deaths caused by TBIs in Finland were examined among decedents aged ≥ 16 years during 2005-2020 from the national Cause of Death Registry. Usage of prescription medications prior to TBI was studied using medication purchase data from the Social Insurance Institution of Finland. RESULTS The cohort consisted of 71,488,347 person-years, 821,259 total deaths, and 14,630 TBI-related deaths during 2005-2020, of which 67% (n = 9792) occurred in men. Women were older than men among those who suffered TBI-related death (mean age 77.2 ± 17.1 vs 64.5 ± 19.5 years, p < 0.0001). The overall crude incidence rate of fatal TBIs was 20.5/100,000 person-years (28.1/100,000 in men and 13.2/100,000 in women). TBI was the cause of death in 1.8% of all deaths in the Finnish population during the study years, but in patients aged 16-19 years, TBIs caused more than 17% of all deaths. The most common external cause of fatal TBI was a fall (70%), followed by poisoning or toxic effects (20%) and violence or self-harm (15%) overall. In men, the order of the most common causes of fatal TBI was similar to overall results (64%, 25%, and 19%, respectively), while in women, the most common cause was a fall (82%), followed by complications in healthcare (10%) and poisoning or toxic effects (9%). Cardiovascular diseases, psychiatric diseases, and infections were the most common diseases contributing to death. Blood pressure (lowering) medications were the most common type of medications used before fatal TBI. CNS medications were the second most common medication group. In the context of fatal TBI in Europe, Finland remains at the upper end of fatal TBI incidence. CONCLUSIONS TBI is a common cause of death in young adults, whereas the incidence of fatal TBI becomes increasingly higher with age in Finland. Cardiovascular diseases and psychiatric conditions were the most common diseases related to death, with opposite age trends. Healthcare facility complications were an alarmingly common cause of death in women with fatal TBI.
Collapse
Affiliation(s)
- Jussi P Posti
- 1Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku
| | - Kristiina Cajanus
- 2Department of Clinical Pharmacology, Turku University Hospital and University of Turku
| | - Aleksi Tornio
- 2Department of Clinical Pharmacology, Turku University Hospital and University of Turku
| | - Jori O Ruuskanen
- 3Neurocenter, Department of Neurology, Turku University Hospital and University of Turku
| | - Teemu M Luoto
- 4Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere
| | - Päivi Rautava
- 5Clinical Research Center, Turku University Hospital and University of Turku
| | - Ville Kytö
- 5Clinical Research Center, Turku University Hospital and University of Turku
- 7Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| |
Collapse
|
6
|
Laitinen L, Nurmi M, Koivisto M, Rautava P, Polo-Kantola P. Recalling the severity of nausea and vomiting of pregnancy - a study using Pregnancy-Unique Quantification of Emesis Questionnaire. J OBSTET GYNAECOL 2023; 43:2153025. [PMID: 36495300 DOI: 10.1080/01443615.2022.2153025] [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: 12/14/2022]
Abstract
The accuracy of the recall of the severity of nausea and vomiting of pregnancy (NVP) with Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire has been questioned. We aimed to compare PUQE scores of women recalling the worst episode of NVP of their current pregnancy in different gestational weeks (gwks). Total of 2343 pregnant women (gwks 7-40) were recruited. Four groups were formed according to the gwks at reply: ≤16 gwks (n = 554), ≤20 gwks (n = 1209), >20 gwks (n = 1134) and ≥24 gwks (n = 495). PUQE scores were similar between the groups. Consequently, consistency of PUQE scores across the groups endorses the useability of the PUQE questionnaire in retrospective assessment of the overall severity of NVP in different gwks, regardless of passing of the peak NVP symptoms.Impact statementWhat is already known on this subject? Retrospective evaluation of the severity of nausea and vomiting of pregnancy (NVP) has been argued to be disposed to recall bias. Structured Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is a validated tool for assessing the severity of NVP.What do the results of this study add? When the women recalled the most severe NVP symptoms of their current pregnancy, no differences in the PUQE scores were found despite different gestational weeks at reply. Of distinct PUQE questions, women answering in early pregnancy reported longer duration of nausea than women answering in late pregnancy, but other questions were rated similarly.What the implications are of these findings for clinical practice and/or further research? Our aim was to compare the PUQE scores between the women who filled in the PUQE questionnaire in early or in late pregnancy, instructed to recall their worst symptoms in their current pregnancy. As there were no differences between the groups in total PUQE scores, our results support the application of PUQE questionnaire to assess the severity of NVP during pregnancy not only concurrent to the peak symptoms but also retrospectively.
Collapse
Affiliation(s)
- Linda Laitinen
- Department of Obstetrics and Gynecology, Hospital Nova of Central Finland, Jyväskylä, Finland.,Department of Obstetrics and Gynecology, University of Turku, Turku, Finland
| | - Miina Nurmi
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland.,Department of Public Health, University of Turku, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, University of Turku, Turku, Finland.,Department of Obstetrics and Gynecology, Turku University Hospital, Turku, Finland
| |
Collapse
|
7
|
Ripatti L, Kauko T, Kytö V, Rautava P, Sipilä J, Lastikka M, Helenius I. The incidence and management of slipped capital femoral epiphysis: a population-based study. Acta Orthop Belg 2023; 89:634-638. [PMID: 38205753 DOI: 10.52628/89.4.9832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
We aimed to investigate the national trends in the incidence and management of slipped capital femoral epiphysis (SCFE) and to report the need for reoperations. We included all <19-year-old patients hospitalised for SCFE in 2004-2014 in mainland Finland (n=159). Data from the Finnish Care Register for Health Care, Statistics Finland, and Turku University Hospital patient charts were analyse for the incidence of SCFE in 2004-2012, the length of stay, and the type of surgery with respect to age, gender, study year, and season. The reoperations and rehospitalisations in 2004-2014 for SCFE were analysed for 2-10 years after surgery. In 2004 to 2012, primary surgery for SCFE was performed for 126 children. The average annual incidence of SCFE was 1.06/100 000 (95% confidence interval [CI], 0.81-1.38) in girls and 1.35/100 000 (95% CI 1.07-1.70) in boys. The median age at surgery was lower in girls than in boys (11 and 13 years, respectively, p<0.0001). During the study period, there was no significant change in the incidence of SCFE (p=0.9330), the type of primary procedures performed (p=0.9988), or the length of stay after the primary procedure (p=0.2396). However, the length of stay after percutaneous screw fixation was shorter compared with open reduction and fixation (mean 3.4 and 7.9 days, respectively, p<0.0001). There was no significant difference in the rate of reoperations according to the type of primary surgery. In conclusion, the incidence of SCFE and the proportion of different primary surgeries have recently remained stable in Finland.
Collapse
|
8
|
Lipasti M, Jalava-Broman J, Sillanmäki L, Mäkinen J, Rautava P. Increasing climacteric symptoms in untreated perimenopausal Finnish women: a 10-year cohort study. Climacteric 2023; 26:472-478. [PMID: 37158148 DOI: 10.1080/13697137.2023.2202810] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/06/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aimed to examine changes over a 10-year period in experiencing climacteric symptoms and their associations with sociodemographic and health-related background factors in a birth cohort of Finnish women who have never used menopausal hormone therapy (MHT). METHODS This nationwide population-based follow-up study consists of 1491 women who during the follow-up period moved from the age group 42-46 years to the age group 52-56 years. The experience of climacteric symptoms was assessed by 12 symptoms commonly associated with the climacterium. The data were analyzed using statistical techniques. RESULTS Both the intensity, expressed as a symptom score of four symptoms associated with a decrease in estrogen production (sweating, hot flushes, vaginal dryness, sleeping problems), and the prevalence of the five most common symptoms (sweating, hot flushes, sleeping problems, lack of sexual desire, depressive symptoms) increased clearly during the follow-up period. The examined sociodemographic and health-related variables did not explain the changes in experiencing the symptoms. CONCLUSIONS The results of this study can be considered in primary and occupational health care and in gynecological settings when working with symptomatic women or women with hidden climacteric problems and carrying out health promotion and counseling for them.
Collapse
Affiliation(s)
- M Lipasti
- Department of Public Health, University of Turku, Turku, Finland
| | - J Jalava-Broman
- Department of Public Health, University of Turku, Turku, Finland
| | - L Sillanmäki
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Mäkinen
- Department of Obstetrics and Gynaecology, University of Turku, Turku, Finland
- Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
| | - P Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
| |
Collapse
|
9
|
Saarinen T, Ylijoki M, Lehtonen L, Munck P, Stolt S, Lapinleimu H, Rautava P, Haataja L, Setänen S, Leppänen M, Huhtala M, Saarinen K, Grönroos L, Korja R. Web-based follow-up tool (ePIPARI) of preterm infants-study protocol for feasibility and performance. BMC Pediatr 2023; 23:413. [PMID: 37612695 PMCID: PMC10463747 DOI: 10.1186/s12887-023-04226-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/02/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Preterm infants have a risk of health and developmental problems emerging after discharge. This indicates the need for a comprehensive follow-up to enable early identification of these problems. In this paper, we introduce a follow-up tool "ePIPARI - web-based follow-up for preterm infants". Our future aim is to investigate whether ePIPARI is a feasible tool in the follow-up of preterm infants and whether it can identify children and parents in need of clinical interventions. METHODS ePIPARI includes eight assessment points (at term age and at 1, 2, 4, 8, 12, 18, and 24 months of corrected age) when the child´s health and growth, eating and feeding, neurodevelopment, and parental well-being are evaluated. ePIPARI consists of several widely used, standardized questionnaires, in addition to questions typically presented to parents in clinical follow-up visits. It also provides video guidance and written information about age-appropriate neurodevelopment for the parents. Parents of children born before 34 weeks of gestation during years 2019-2022 are being invited to participate in the ePIPARI study, in which web-based follow-up with ePIPARI is compared to clinical follow-up. In addition, the parents of children born before 32 weeks of gestation, who reached the corrected age of two years during 2019-2021 were invited to participate for the assessment point of 24 months of ePIPARI. The parents are asked to fill in the online questionnaires two weeks prior to each clinical follow-up visit. DISCUSSION The web-based tool, ePIPARI, was developed to acquire a sensitive and specific tool to detect infants and parents in need of further support and clinical interventions. This tool could allow individualized adjustments of the frequency and content of the clinical visits. TRIAL REGISTRATION ClinicalTrials.cov, NCT05238168 . Registered 11 April 2022 - Retrospectively registered.
Collapse
Affiliation(s)
- Tiina Saarinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
| | - Milla Ylijoki
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Paediatric Neurology, Turku University Hospital and University of Turku, Turku, Finland
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Petriina Munck
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Suvi Stolt
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Helena Lapinleimu
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
| | - Leena Haataja
- Department of Pediatric Neurology, Children's Hospital and Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sirkku Setänen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
- Department of Paediatric Neurology, Turku University Hospital and University of Turku, Turku, Finland
| | - Marika Leppänen
- Department of Public Health and Psychiatry, and University of Turku, Turku, Finland
| | - Mira Huhtala
- Department of Public Health, University of Turku, Turku, Finland
| | - Katriina Saarinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Linda Grönroos
- Department of Paediatric Neurology, Turku University Hospital and University of Turku, Turku, Finland
| | - Riikka Korja
- Department of Psychology, and Speech Pathology, University of Turku, Turku, Finland
| |
Collapse
|
10
|
Helin M, Karukivi M, Rautava P, Hirvonen M, Huhtala M, Setänen S. Pre-notifications increase retention in a 17-year follow-up of adolescents born very preterm. Trials 2023; 24:477. [PMID: 37496017 PMCID: PMC10373294 DOI: 10.1186/s13063-023-07390-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/18/2023] [Indexed: 07/28/2023] Open
Abstract
OBJECTIVE Retention is essential in follow-up studies to reduce missing data, which can cause bias and limit the generalizability of the results. We investigated whether pre-notification letters would increase the response rates of approval forms and questionnaires and reduce the need for post-notifications in a prospective follow-up study of 17-year-old adolescents. STUDY DESIGN and settings This long-term follow-up study included 269 adolescents were randomized (1:1) into a pre-notification group (n = 132) and a no pre-notification group (n = 137). The pre-notification letter was sent prior to the approval form and questionnaires. The outcome measures were the response rates to the approval forms and questionnaires and the rate of post-notifications required. RESULTS The adolescents who received the pre-notifications were more likely to return approval forms (n = 88/132, 67%) than the adolescents who did not receive the pre-notifications (n = 79/137, 58%) (OR 1.5, 95% CI 0.9-2.4). The rates of returned questionnaires were higher in the pre-notification group (n = 82/88, 93%) than in the no pre-notification group (n = 68/79, 86%) (OR 2.2, 95% CI 0.8-6.3). The adolescents who did not receive the pre-notifications were more likely to need the post-notifications than the adolescents who received the pre-notifications (OR 3.0, 95% CI 1.4 to 6.5). CONCLUSIONS Pre-notifications decreased the need for post-notifications and may increase retention in 17-year-old adolescents. Based on our findings, pre-notification letters are recommended in future follow-up studies in adolescents. TRIAL REGISTRATION The Ethics Review Committee of the Hospital District of South-West Finland approved the 17-year PIPARI Study protocol in January 2018 (23.1.2018; 2/180/2012). The study has been registered to the SWAT repository as SWAT 179. Filetoupload,1457904,en.pdf (qub.ac.uk).
Collapse
Affiliation(s)
- Minttu Helin
- Department of Pediatric Neurology, Turku University Hospital and the University of Turku, Savitehtaankatu 5, 20521, Turku, Finland.
| | - Max Karukivi
- Department of Adolescent Psychiatry, Turku University Hospital and the University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Päivi Rautava
- Turku Clinical Research Center, Turku University Hospital, poBOX 52, 20521, Turku, Finland
- Public Health, University of Turku, 20014 Turun yliopisto, Turku, Finland
| | - Milka Hirvonen
- The Faculty of Medicine, the University of Turku, Kiinamyllynkatu 10, 20520, Turku, Finland
| | - Mira Huhtala
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and the University of Turku, Savitehtaankatu 5, 20521, Turku, Finland
| | - Sirkku Setänen
- Department of Pediatric Neurology, Turku University Hospital and the University of Turku, Savitehtaankatu 5, 20521, Turku, Finland
| |
Collapse
|
11
|
Stenlund S, Mâsse LC, Stenlund D, Sillanmäki L, Appelt KC, Koivumaa-Honkanen H, Rautava P, Suominen S, Patrick DM. Do Patients' Psychosocial Characteristics Impact Antibiotic Prescription Rates? Antibiotics (Basel) 2023; 12:1022. [PMID: 37370341 DOI: 10.3390/antibiotics12061022] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients' psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient's psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004-2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients' adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients' adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients.
Collapse
Affiliation(s)
- Säde Stenlund
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC V5Z 4H4, Canada
| | - David Stenlund
- Department of Mathematics, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
- Faculty of Science and Engineering, Åbo Akademi University, 20500 Turku, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
| | - Kirstin C Appelt
- Sauder School of Business, University of British Columbia, Vancouver, BC V6T 1Z2, Canada
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, 70029 Kuopio, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20520 Turku, Finland
- School of Health Sciences, University of Skövde, 54128 Skövde, Sweden
| | - David M Patrick
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
| |
Collapse
|
12
|
Mäkilä E, Ekblad MO, Rautava P, Lapinleimu H, Setänen S. Five-to-Fifteen-Parental Perception of Developmental Profile from Age 5 to 8 Years in Children Born Very Preterm. J Pers Med 2023; 13:jpm13050819. [PMID: 37240989 DOI: 10.3390/jpm13050819] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Children born very preterm have increased risk of developmental difficulties. We examined the parental perception of developmental profile of children born very preterm at 5 and 8 years by using the parental questionnaire Five-to-Fifteen (FTF) compared to full-term controls. We also studied the correlation between these age points. The study included 168 and 164 children born very preterm (gestational age < 32 weeks and/or birth weight ≤ 1500 g) and 151 and 131 full-term controls. The rate ratios (RR) were adjusted for sex and the father's educational level. At 5 and 8 years, children born very preterm were more likely to have higher scores (more difficulties) compared to controls in motor skills (RR = 2.3, CI 95% = 1.8-3.0 at 5 years and RR = 2.2, CI 95% = 1.7-2.9 at 8 years), executive function (1.7, 1.3-2.2 and 1.5, 1.2-2.0), perception (1.9, 1.4-2.5 and 1.9, 1.5-2.5), language (1.5, 1.1-1.9 and 2.2, 1.7-2.9), and social skills (1.4, 1.1-1.8 and 2.1, 1.6-2.7), and at 8 years in learning (1.9, 1.4-2.6) and memory (1.5, 1.2-2.0). There were moderate-to-strong correlations (r = 0.56-0.76, p < 0.001) in all domains between 5 and 8 years in children born very preterm. Our findings suggest that FTF might help to earlier identify children at the greatest risk of incurring developmental difficulties persisting to school-age.
Collapse
Affiliation(s)
- Eeva Mäkilä
- Department of Pediatric Neurology, University of Turku, 20014 Turku, Finland
- Salo Health Centre, 24240 Salo, Finland
| | - Mikael O Ekblad
- Department of General Practice, Institute of Clinical Medicine, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Päivi Rautava
- Public Health, Turku Clinical Research Centre, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Helena Lapinleimu
- Department of Pediatrics, Turku University Hospital, University of Turku, 20014 Turku, Finland
| | - Sirkku Setänen
- Department of Pediatric Neurology, University of Turku, 20014 Turku, Finland
- Department of Pediatrics, Turku University Hospital, University of Turku, 20014 Turku, Finland
| |
Collapse
|
13
|
Sundqvist P, Rautava P, Kautiainen H, Korhonen PE. Cardiac symptoms and yield of diagnostic tests among primary care patients with and without diabetes. Prim Care Diabetes 2023; 17:195-199. [PMID: 36746712 DOI: 10.1016/j.pcd.2023.01.010] [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: 06/14/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
AIMS To compare the symptoms, diagnostic tests used, and clinical diagnoses made among diabetic and non-diabetic patients. METHODS This is a register-based study of 704 primary care patients referred electively to cardiology specialists in the city of Turku, Finland, during the year 2016. The patient's medical history, cardiovascular medication use, risk factors, cardiac symptoms, diagnostic tests applied, and diagnoses made were gathered from the medical records. The angiography data was derived from the Hospital District of Southwest Finland data pool. RESULTS Of the cohort, 120 (17 %) patients had diabetes mellitus. They were on average older (67 vs. 63 years, p = 0.009) and more often females (62 % vs. 38 %, p = 0.042) than the non-diabetic patients. Chest pain or discomfort was the most prevalent symptom in the diabetic patients and a sense of arrhythmia in the non-diabetic subjects. Ischemic heart disease was diagnosed more often in the person with diabetes (15 %) than in the non-diabetic (6 %) patients (p = 0.004). Cardiac arrhythmias were diagnosed in 26 % of the non-diabetic and 20 % of the diabetic subjects (p = 0.021). CONCLUSIONS Symptoms that might indicate heart disease, especially chest pain/discomfort, are common in both the diabetic and the non-diabetic patients in primary care. Several diagnostic tests are applied, possibly not to miss a life-threatening disease. However, many patients do not get a specific diagnosis for their concerns.
Collapse
Affiliation(s)
- Pieta Sundqvist
- Institute of Clinical Medicine, Department of General Practice, University of Turku and Turku University Hospital, Medisiina A 2 krs, Kiinamyllynkatu 10, 20520 Turku, Finland; Wellbeing services county of Southwest Finland.
| | - Päivi Rautava
- Department of Public Health, University of Turku and Turku University Hospital, Medisiina A 2 krs, Kiinamyllynkatu 10, 20520 Turku, Finland; Turku Clinical Research Centre, PL 52 20521, Kiinanmyllynkatu 4-8, Turku, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Päivi E Korhonen
- Institute of Clinical Medicine, Department of General Practice, University of Turku and Turku University Hospital, Medisiina A 2 krs, Kiinamyllynkatu 10, 20520 Turku, Finland
| |
Collapse
|
14
|
Åivo J, Ruuskanen JO, Tornio A, Rautava P, Kytö V. Lack of Statin Therapy and Outcomes After Ischemic Stroke: A Population-Based Study. Stroke 2023; 54:781-790. [PMID: 36748465 PMCID: PMC10561684 DOI: 10.1161/strokeaha.122.040536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 07/05/2022] [Revised: 12/22/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND Statin treatment is effective at preventing adverse vascular events after ischemic stroke (IS). However, many patients fail to use statins after IS. We studied the impact of not using statins after IS on adverse outcomes. METHODS IS patients (n=59 588) admitted to 20 Finnish hospitals were retrospectively studied. Study data were combined from national registries on hospital admissions, mortality, cancer diagnoses, prescription medication purchases, and permissions for special reimbursements for medications. Usage of prescription medication was defined as drug purchase within 90 days after hospital discharge. Ongoing statin use during follow-up was analyzed in 90-day intervals. Differences in baseline features, comorbidities, other medications, and recanalization therapies were balanced with inverse probability of treatment weighting. Median follow-up was 5.7 years. RESULTS Statin therapy was not used by 27.1% of patients within 90 days after IS discharge, with women and older patients using statins less frequently. The average proportion of patients without ongoing statin during the 12-year follow-up was 36.0%. Patients without early statins had higher all-cause mortality at 1 year (7.5% versus 4.4% in patients who did use statins; hazard ratio [HR], 1.74 [CI, 1.61-1.87]) and 12 years (56.8% versus 48.6%; HR, 1.37 [CI, 1.33-1.41]). Cumulative incidence of major adverse cerebrovascular or cardiovascular event was higher at 1 year (subdistribution HR, 1.36 [CI, 1.29-1.43]) and 12 years (subdistribution HR, 1.21 [CI, 1.18-1.25]) without early statin use. Cardiovascular death, recurrent IS, and myocardial infarction were more frequent without early statin use. Early statin use was not associated with hemorrhagic stroke during follow-up. Lack of ongoing statin during follow-up was associated with risk of death in time-dependent analysis (adjusted HR, 3.03 [CI, 2.96-3.23]). CONCLUSIONS Lack of statin treatment after IS is associated with adverse long-term outcomes. Measures to further improve timely statin use after IS are needed.
Collapse
Affiliation(s)
- Julia Åivo
- Neurocenter, Department of Neurology, Turku University Hospital and University of Turku, Finland (J.Å., J.O.R.)
| | - Jori O. Ruuskanen
- Neurocenter, Department of Neurology, Turku University Hospital and University of Turku, Finland (J.Å., J.O.R.)
| | - Aleksi Tornio
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Finland (A.T.)
- Unit of Clinical Pharmacology, Turku University Hospital, Finland (A.T.)
| | - Päivi Rautava
- Department of Public Health, University of Turku, Finland (P.R.)
- Turku Clinical Research Centre, Turku University Hospital, Finland (P.R., V.K.)
| | - Ville Kytö
- Turku Clinical Research Centre, Turku University Hospital, Finland (P.R., V.K.)
- Heart Center, Turku University Hospital and University of Turku, Finland (V.K.)
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland (V.K.)
- Center for Population Health Research, Turku University Hospital and University of Turku, Finland (V.K.)
| |
Collapse
|
15
|
Halme M, Rautava P, Sillanmäki L, Sumanen M, Suominen S, Vahtera J, Virtanen P, Salo P. Educational level and the use of mental health services, psychotropic medication and psychotherapy among adults with a history of physician diagnosed mental disorders. Int J Soc Psychiatry 2023; 69:493-502. [PMID: 35819228 PMCID: PMC9983050 DOI: 10.1177/00207640221111091] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The prevalence of mental disorders is increased among people of low socioeconomic status or educational level, but it remains unclear whether their access to treatment matches their increased need. AIMS Our objective was to examine whether educational level as an indicator of socioeconomic status is associated with use of mental health services, psychotropic medication and psychotherapy in Finland. METHOD Cross-sectional data from a follow-up survey of a longitudinal, population-based cohort study were used to form a sample of 3,053 men and women aged 24 to 68 with a current or previous physician diagnosed mental disorder. The prevalence of mental disorders, mental health service use and educational level were assessed with self-report questionnaire. Educational level was determined by the highest educational attainment and grouped into three levels: high, intermediate and low. The associations between educational level and mental health service -related outcomes were assessed with binary logistic regression. Covariates in the fully adjusted model were age, gender and number of somatic diseases. RESULTS Compared to high educational level, low educational level was associated with higher odds of using antidepressants (OR 1.35, 95% CI [1.09, 1.66]), hypnotics (OR 1.33, 95% CI [1.07, 1.66]) and sedatives (OR 2.17, 95% CI [1.69, 2.78]), and lower odds of using mental health services (OR 0.80, 95% CI [0.65, 0.98]). No associations were found between educational level and use of psychotherapy. CONCLUSIONS The results do not suggest a general socioeconomic status related mismatch. A pharmacological emphasis was observed in the treatment of low educational background participants, whereas overall mental health service use was emphasized among high educational background participants.
Collapse
Affiliation(s)
- Marie Halme
- Department of Psychology, University of
Turku, Finland
- Marie Halme, Department of Psychology,
University of Turku, Turku 20014, Finland.
| | - Päivi Rautava
- Department of Public Health, University
of Turku, Finland
- Turku Clinical Research Centre, Turku
University Hospital, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University
of Turku, Finland
- Turku Clinical Research Centre, Turku
University Hospital, Finland
- Department of Public Health, University
of Helsinki, Finland
| | - Markku Sumanen
- Faculty of Medicine and Health
Technology, Tampere University, Finland
| | - Sakari Suominen
- Department of Public Health, University
of Turku, Finland
- Turku Clinical Research Centre, Turku
University Hospital, Finland
- School of Health Sciences, University
of Skövde, Sweden
| | - Jussi Vahtera
- Department of Public Health and Centre
for Population Health Research, University of Turku, Finland
| | | | - Paula Salo
- Department of Psychology, University of
Turku, Finland
- Finnish Institute of Occupational
Health, Helsinki, Finland
| |
Collapse
|
16
|
Karukivi J, Leino-Kilpi H, Kuokkanen L, Kuusisto H, Rautava P, Seppänen L, Sulosaari V, Stolt M. Association between work empowerment and interprofessional collaboration among health care professionals working in cancer care settings. J Interprof Care 2023; 37:21-28. [PMID: 34979858 DOI: 10.1080/13561820.2021.1997949] [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: 01/10/2023]
Abstract
This study aimed to analyze work-related empowerment and interprofessional collaboration and to identify possible associations among healthcare professionals working in cancer care settings. A cross-sectional survey design was employed in this study. Healthcare professionals (n = 175) in one Finnish Cancer Center participating in the care of patients with cancer at least on a monthly basis took part in the study. The data were collected with three instruments: Interprofessional Collaboration and Leadership, Performance of an Empowered Personnel (PEN), and Work-related Empowerment Promoting Factors (WEP). The data were analyzed with descriptive statistics, Pearson and Spearman's correlation coefficients and multivariate analysis using generalized liner models. Healthcare professionals rated their work empowerment as rather high. Performance of an Empowered Personnel (PEN) was perceived as high (mean 4.08, SD 0.47). Promoting factors for Work Empowerment (WEP) were also assessed as high (mean 3.98, SD 0.61). Interprofessional collaboration in the cancer care setting was perceived as moderate (mean 2.94, SD 0.36). Managerial position explained work empowerment based on multivariate analysis. Work empowerment and interprofessional collaboration had a strong correlation. The results can be used in the leadership and management of interprofessional collaboration and in developing new structures to support health professionals' work empowerment. In the future, work empowerment needs to be promoted by constructing solutions and practices that support interprofessional collaboration and thus improve the quality of cancer care.
Collapse
Affiliation(s)
- Johanna Karukivi
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| | - Liisa Kuokkanen
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Hannele Kuusisto
- Environmental and Energy Engineering, Turku University of Applied Sciences, Turku, Finland
| | - Päivi Rautava
- Public Health, University of Turku, Turku, Finland.,Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Laura Seppänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Virpi Sulosaari
- Department of Nursing Science, University of Turku, Turku, Finland.,Health and Well-being, Turku University of Applied Sciences, Turku, Finland
| | - Minna Stolt
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland
| |
Collapse
|
17
|
Ripatti L, Puustinen L, Rautava P, Koivisto M, Haataja L. Impact of epilepsy on the risk of hospital-treated injuries in Finnish children. Epilepsy Behav Rep 2023; 21:100587. [PMID: 36935841 PMCID: PMC10015441 DOI: 10.1016/j.ebr.2023.100587] [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: 11/11/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Objectives To study the effect of epilepsy on the risk of injury in children. Methods All first-born singleton children (n = 133055) born in 2001 - 2006 in Finland were included. Data was collected from national registers up to the first hospital-treated injury during the five years following the onset of epilepsy. Four matched controls were chosen for every subject. Results Epilepsy had been diagnosed in 0.66 % of children. During follow-up, 12 % of 884 children with epilepsy and 9 % of 3536 controls were hospitalized for injuries (HR 1.387 [95 % CI 1.115 - 1.725]; p = 0.0033). Risk for injuries was higher in boys than girls (p = 0.0057). Mean age at the first injury was 6.8 years (SD 3.3, median 7, range 0-13) in subjects and 7.2 years (SD 3.2, median 8, range 1-13) in controls (p = 0.272). The rate of hospitalization did not differ according to the type of epilepsy. The risks of subjects compared to controls were not significantly different concerning the nature of injury or survival. Conclusions Children with epilepsy are at increased risk for hospital-treated injuries. The spectrum of injuries and the risk for death due to injuries are not different in children with and without epilepsy.
Collapse
Affiliation(s)
- Liisi Ripatti
- Department of Pediatric Surgery, Turku University Hospital and University of Turku, Turku, Finland
- Corresponding author at: Department of Pediatric Surgery, Turku University Hospital, Savitehtaankatu 5, PL 52, FI-20520 Turku, Finland.
| | - Laura Puustinen
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Leena Haataja
- Children's Hospital, Pediatric Research Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| |
Collapse
|
18
|
Bergman E, Löyttyniemi E, Myllyntausta S, Rautava P, Korhonen PE. Temporal changes in self-reported sleep quality, sleep duration and sleep medication use in relation to temporal changes in quality of life and work ability over a 1-year period among Finnish municipal employees. J Sleep Res 2022; 31:e13605. [PMID: 35429092 PMCID: PMC9787037 DOI: 10.1111/jsr.13605] [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: 10/22/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 12/30/2022]
Abstract
In this prospective follow-up study, we aimed to examine whether changes in self-reported sleep quality, sleep duration, and sleep medication use are temporally associated with changes in quality of life and work ability in municipal employees when several confounding factors are considered. The study was conducted in Finland among 637 municipal employees (88% women, mean [SD] age 48 [10] years) in 2014 and 2015. Information about the participants was collected by self-administered questionnaire and from medical history. Predicting variables were changes in self-reported sleep quality, sleep duration, and sleep medication use. Outcome variables were changes in the EUROHIS-QOL eight-item index and the Work Ability Score. Improved or unchanged sleep quality compared to worse sleep quality were associated with a preferable change in quality of life (both p < 0.001). No change in sleep duration compared to a decrease and no change in sleep medication use compared to increased use were also associated with favourable changes in quality of life. Increased use of sleep medication was associated with a decline in work ability, and the change in Work Ability Score also differed significantly between improved and worsened sleep quality. In this study, changes in sleep were widely associated with changes in quality of life and work ability of municipal employees. Programmes aiming for better sleep health would probably be beneficial both from a health-oriented and an economical point of view. Special attention should be paid to employees with a need for sleep medication.
Collapse
Affiliation(s)
- Elina Bergman
- Department of General Practice, Institute of Clinical MedicineUniversity of Turku and Turku University HospitalTurkuFinland
| | | | - Saana Myllyntausta
- Department of Psychology and Speech‐Language PathologyUniversity of TurkuTurkuFinland
| | - Päivi Rautava
- Department of Public HealthUniversity of TurkuTurkuFinland,Turku University Hospital, Clinical Research CentreTurkuFinland
| | - Päivi E. Korhonen
- Department of General Practice, Institute of Clinical MedicineUniversity of Turku and Turku University HospitalTurkuFinland
| |
Collapse
|
19
|
Kytö V, Rautava P, Tornio A. Initial statin dose after myocardial infarction and long-term cardiovascular outcomes. Eur Heart J Cardiovasc Pharmacother 2022; 9:156-164. [PMID: 36385668 PMCID: PMC9892868 DOI: 10.1093/ehjcvp/pvac064] [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] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
AIMS Effective statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). Real-life statin dosing is nevertheless suboptimal and largely determined early after MI. We studied long-term outcome impact of initial statin dose after MI. METHODS AND RESULTS Consecutive MI patients treated in Finland who used statins early after index event were retrospectively studied (N = 72 401; 67% men; mean age 68 years) using national registries. High-dose statin therapy was used by 26.3%, moderate dose by 69.2%, and low dose by 4.5%. Differences in baseline features, comorbidities, revascularisation, and usage of other evidence-based medications were adjusted for with multivariable regression. The primary outcome was major adverse cardiovascular or cerebrovascular event (MACCE) within 10 years. Median follow-up was 4.9 years. MACCE was less frequent in high-dose group compared with moderate dose [adjusted hazard ratio (HR) 0.92; P < 0.0001; number needed to treat (NNT) 34.1] and to low dose [adj.HR 0.81; P < 0.001; NNT 13.4] as well as in moderate-dose group compared with low dose (adj.HR 0.88; P < 0.0001; NNT 23.4). Death (adj.HR 0.87; P < 0.0001; NNT 23.6), recurrent MI (adj.sHR 0.91; P = 0.0001), and stroke (adj.sHR 0.86; P < 0.0001) were less frequent with a high- vs. moderate-dose statin. Higher initial statin dose after MI was associated with better long-term outcomes in subgroups by age, sex, atrial fibrillation, dementia, diabetes, heart failure, revascularisation, prior statin usage, or usage of other evidence-based medications. CONCLUSION Higher initial statin dose after MI is dose-dependently associated with better long-term cardiovascular outcomes. These results underline the importance of using a high statin dose early after MI.
Collapse
Affiliation(s)
- Ville Kytö
- Corresponding author. Tel: +358 2 3130000,
| | - Päivi Rautava
- Turku Clinical Research Center, Turku University Hospital, Turku, Finland,Department of Public Health, University of Turku, Turku, Finland
| | - Aleksi Tornio
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| |
Collapse
|
20
|
Kerola AM, Semb AG, Juonala M, Palomäki A, Rautava P, Kytö V. Long-term cardiovascular prognosis of patients with type 1 diabetes after myocardial infarction. Cardiovasc Diabetol 2022; 21:177. [PMID: 36068573 PMCID: PMC9450422 DOI: 10.1186/s12933-022-01608-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background To explore long-term cardiovascular prognosis after myocardial infarction (MI) among patients with type 1 diabetes. Methods Patients with type 1 diabetes surviving 90 days after MI (n = 1508; 60% male, mean age = 62.1 years) or without any type of diabetes (n = 62,785) in Finland during 2005–2018 were retrospectively studied using multiple national registries. The primary outcome of interest was a combined major adverse cardiovascular event (MACE; cardiovascular death, recurrent MI, ischemic stroke, or heart failure hospitalization) studied with a competing risk Fine-Gray analyses. Median follow-up was 3.9 years (maximum 12 years). Differences between groups were balanced by multivariable adjustments and propensity score matching (n = 1401 patient pairs). Results Cumulative incidence of MACE after MI was higher in patients with type 1 diabetes (67.6%) compared to propensity score-matched patients without diabetes (46.0%) (sub-distribution hazard ratio [sHR]: 1.94; 95% confidence interval [CI]: 1.74–2.17; p < 0.0001). Probabilities of cardiovascular death (sHR 1.81; p < 0.0001), recurrent MI (sHR 1.91; p < 0.0001), ischemic stroke (sHR 1.50; p = 0.0003), and heart failure hospitalization (sHR 1.98; p < 0.0001) were higher in patients with type 1 diabetes. Incidence of MACE was higher in diabetes patients than in controls in subgroups of men and women, patients aged < 60 and ≥ 60 years, revascularized and non-revascularized patients, and patients with and without atrial fibrillation, heart failure, or malignancy. Conclusions Patients with type 1 diabetes have notably poorer long-term cardiovascular prognosis after an MI compared to patients without diabetes. These results underline the importance of effective secondary prevention after MI in patients with type 1 diabetes. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01608-3.
Collapse
Affiliation(s)
- Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Helsinki, Finland. .,Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
21
|
Bergman E, Vepsäläinen H, Erkkola M, Laaksonen M, Kautiainen H, Penttinen MA, Rautava P, Korhonen PE. Healthy and Unhealthy Food Consumption in Relation to Quality of Life among Finnish Female Municipal Employees: A Cross-Sectional Study. Nutrients 2022; 14:nu14173630. [PMID: 36079887 PMCID: PMC9460930 DOI: 10.3390/nu14173630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/09/2022] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 12/16/2022] Open
Abstract
Aspects of good quality of life (QoL) have been found to motivate people to make lifestyle changes. There is also evidence that certain dietary patterns are associated with QoL. The aim of this work was to examine whether consumption frequencies of healthy and unhealthy food items are associated with QoL in female employees. A cross-sectional study was conducted among 631 Finnish female employees (mean age 49 years, SD = 10) from 10 municipal work units in 2015. Information about the participants was collected by physical examination, laboratory tests, self-administered questionnaires, including the Food Frequency Questionnaire (FFQ), and from medical history. QoL was assessed with the EUROHIS-Quality of Life 8-item index. A significant positive association was seen between consumption frequency of healthy foods and the EUROHIS-QOL mean score (p = 0.002). The association was small but comprehensive, also involving most dimensions of QoL. The consumption frequency of unhealthy foods was not associated with QoL. These findings are relevant when designing diet counselling, since QoL is an outcome that has been found to motivate people to change their health habits. Recommending abundant use of healthy foods could be a simple and convenient way of diet counselling at many health care appointments, where time consuming approaches are difficult to conduct.
Collapse
Affiliation(s)
- Elina Bergman
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, 20014 Turku, Finland
- Correspondence:
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland
| | | | - Hannu Kautiainen
- Unit of Primary Health Care, Kuopio University Hospital, 70210 Kuopio, Finland
- Folkhälsan Research Centre, University of Helsinki, 00290 Helsinki, Finland
| | - Markus A. Penttinen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, 20014 Turku, Finland
- Suomen Terveystalo, 20520 Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku and Turku University Hospital, 20014 Turku, Finland
- Clinical Research Centre, Turku University Hospital, 20521 Turku, Finland
| | - Päivi E. Korhonen
- Department of General Practice, Institute of Clinical Medicine, University of Turku and Turku University Hospital, 20014 Turku, Finland
| |
Collapse
|
22
|
Kerola AM, Juonala M, Palomäki A, Semb AG, Rautava P, Kytö V. Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction. Diabetes Care 2022; 45:1657-1665. [PMID: 35679070 PMCID: PMC9274223 DOI: 10.2337/dc22-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching. RESULTS Case fatality was higher in patients with type 1 diabetes than in propensity score-matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32-1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar. CONCLUSIONS Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.
Collapse
Affiliation(s)
- Anne M Kerola
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
23
|
Posti JP, Ruuskanen JO, Sipilä JOT, Luoto TM, Rautava P, Kytö V. Effect of Oral Anticoagulation and Adenosine Diphosphate Inhibitor Therapies on Short-term Outcome of Traumatic Brain Injury. Neurology 2022; 99:e1122-e1130. [PMID: 35764401 DOI: 10.1212/wnl.0000000000200834] [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] [Received: 11/22/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Usage of oral anticoagulants (OAC) or adenosine diphosphate inhibitors (ADPi) is known to increase the risk of bleeding. We aimed to investigate the impact of OAC and ADPi therapies on short-term outcomes after traumatic brain injury (TBI). METHODS All adult patients hospitalized for TBI in Finland during 2005-2018 were retrospectively studied using a combination of national registries. Usage of pharmacy-purchased OACs and ADPis at the time of TBI was analyzed with the pill-counting method (Social Insurance Institution of Finland). The primary outcome was 30-day case-fatality (Finnish Cause of Death Registry). The secondary outcomes were acute neurosurgical operation (ANO) and admission duration (Finnish Care Register for Health Care). Baseline characteristics were adjusted with multivariable regression including age, sex, comorbidities, skull or facial fracture, OAC/ADPi treatment, initial admission location, and the year of TBI admission. RESULTS The study population included 57,056 persons (mean age 66 years) of whom 0.9% used direct oral anticoagulants (DOAC), 7.1% Vitamin K antagonists (VKA), and 2.3% ADPis. Patients with VKAs had higher case-fatality than patients without OAC (15.4% vs. 7.1%; adjHR 1.35, CI 1.23-1.48; p<0.0001). Case-fatality was lower with DOACs (8.4%) than with VKAs (adjHR 0.62, CI 0.44-0.87; p=0.005) and was not different from patients without OACs (adjHR 0.93, CI 0.69-1.26; p=0.634). VKA usage was associated with higher neurosurgical operation rate compared to non-OAC patients (9.1% vs. 8.3%; adjOR 1.33, CI 1.17-1.52; p<0.0001). There was no difference in operation rate between DOAC and VKA. ADPi was not associated with case-fatality or operation rate in the adjusted analyses. VKAs and DOACs were not associated with longer admission length compared with the non-OAC group, whereas the admissions were longer in the ADPi group compared with the non-ADPi group. CONCLUSION Preinjury use of VKA is associated with increases in short-term mortality and in need for ANOs after TBI. DOACs are associated with lower fatality than VKAs after TBI. ADPis were not independently associated with the outcomes studied. These results point to relative safety of DOACs or ADPis in patients at risk of head trauma and encourage to choose DOACs when oral anticoagulation is required. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that among adults with TBI, mortality was significantly increased in those using VKAs but not in those using DOACs or ADPis.
Collapse
Affiliation(s)
- Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Finland
| | - Jori O Ruuskanen
- Neurocenter, Department of Neurology, Turku University Hospital and University of Turku, Finland
| | - Jussi O T Sipilä
- Clinical neurosciences, University of Turku, Turku, Finland; Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
24
|
Salo-Tuominen K, Teros-Jaakkola T, Toivonen L, Ollila H, Rautava P, Aromaa M, Lahti E, Junttila N, Peltola V. Parental socioeconomic and psychological determinants of the 2009 pandemic influenza A(H1N1) vaccine uptake in children. Vaccine 2022; 40:3684-3689. [PMID: 35595660 PMCID: PMC9112036 DOI: 10.1016/j.vaccine.2022.05.012] [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: 09/21/2021] [Revised: 04/12/2022] [Accepted: 05/04/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Before COVID-19, the previous pandemic was caused by influenza A(H1N1)pdm09 virus in 2009. Identification of factors behind parental decisions to have their child vaccinated against pandemic influenza could be helpful in planning of other pandemic vaccination programmes. We investigated the association of parental socioeconomic and psychosocial factors with uptake of the pandemic influenza vaccine in children in 2009-2010. METHODS This study was conducted within a prospective birth-cohort study (STEPS Study), where children born in 2008-2010 are followed from pregnancy to adulthood. Demographic and socioeconomic factors of parents were collected through questionnaires and vaccination data from electronic registers. Before and after the birth of the child, the mother's and father's individual and relational psychosocial well-being, i.e. depressive symptoms, dissatisfaction with the relationship, experienced social and emotional loneliness, and maternal anxiety during pregnancy, were measured by validated questionnaires (BDI-II, RDAS, PRAQ, and UCLA). RESULTS Of 1020 children aged 6-20 months at the beginning of pandemic influenza vaccinations, 820 (80%) received and 200 (20%) did not receive the vaccine against influenza A(H1N1)pdm09. All measures of parents' psychosocial well-being were similar between vaccinated and non-vaccinated children. Children of younger mothers had a higher risk of not receiving the influenza A(H1N1)pdm09 vaccine than children of older mothers (OR 2.59, 95% CI 1.52-4.43, for mothers < 27.7 years compared to ≥ 33.6 years of age). Children of mothers with lower educational level had an increased risk of not receiving the vaccine (OR 1.46, 95% CI 1.00-2.14). CONCLUSIONS Mother's younger age and lower education level were associated with an increased risk for the child not to receive the 2009 pandemic influenza vaccine, but individual or relational psychosocial well-being of parents was not associated with children's vaccination. Our findings suggest that young and poorly educated mothers should receive targeted support in order to promote children's vaccinations during a pandemic.
Collapse
Affiliation(s)
- Krista Salo-Tuominen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland,Turku University of Applied Sciences, Turku, Finland
| | - Tamara Teros-Jaakkola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Laura Toivonen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Helena Ollila
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland,Department of Public Health, University of Turku, Turku, Finland
| | - Minna Aromaa
- Department of Public Health, University of Turku, Turku, Finland,Outpatient Clinic for Children and Adolescents, City of Turku, Turku, Finland
| | - Elina Lahti
- Outpatient Clinic for Children and Adolescents, City of Turku, Turku, Finland
| | - Niina Junttila
- Department for Teacher Education, University of Turku, Turku, Finland
| | - Ville Peltola
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland,Corresponding author at: Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, 20521, Finland
| |
Collapse
|
25
|
Carlén K, Suominen S, Augustine L, Saarinen MM, Aromaa M, Rautava P, Sourander A, Sillanpää M. Teenagers' mental health problems predict probable mental diagnosis 3 years later among girls, but what about the boys? Child Adolesc Psychiatry Ment Health 2022; 16:41. [PMID: 35681228 PMCID: PMC9185898 DOI: 10.1186/s13034-022-00473-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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of mental disorders is increasing, and there seems to be a gender difference in prevalence, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Early detection of mental disorders is essential for successful treatment, which is not always happening. The study aimed to estimate to what extent teenagers' self-reports predict probable mental diagnosis as they enter adulthood, particularly regarding gender differences. METHODS Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (range 3-110, n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. RESULTS One unit's increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03-1.04), p < 0.001]. In gender-specific analysis, the findings applied, particularly to girls. CONCLUSIONS Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly in girls. Further research is needed to explain the lower sensitivity of YSR among boys.
Collapse
Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Box 408, 54128, Skövde, Sweden. .,The Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sakari Suominen
- grid.412798.10000 0001 2254 0954School of Health Sciences, University of Skövde, Box 408, 54128 Skövde, Sweden ,grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Lilly Augustine
- grid.118888.00000 0004 0414 7587CHILD, School of Learning and Communication, Jönköping University, Jönköping, Sweden
| | - Maiju M. Saarinen
- grid.1374.10000 0001 2097 1371Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland ,City of Turku Welfare Division, Turku, Finland
| | - Päivi Rautava
- grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland ,grid.410552.70000 0004 0628 215XClinical Research Centre, Turku University Hospital, Turku, Finland
| | - André Sourander
- grid.1374.10000 0001 2097 1371Department of Child Psychiatry, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Matti Sillanpää
- grid.1374.10000 0001 2097 1371Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
26
|
Malmberg M, Anttila V, Rautava P, Gunn J, Kytö V. Long-term outcomes of mechanical versus biological valve prosthesis in native mitral valve infective endocarditis. SCAND CARDIOVASC J 2022; 56:132-137. [PMID: 35652503 DOI: 10.1080/14017431.2022.2079712] [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: 10/18/2022]
Abstract
Objectives. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. Desing. We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve infective endocarditis in Finland between 2004 and 2017. Results. The endpoints were all-cause mortality, ischemic stroke, major bleeding, and mitral valve reoperations. The results were adjusted for baseline features (age, gender, comorbidities, history of drug abuse, concomitant surgeries, operational urgency, and surgical center). The median follow-up time was 6.1 years. The 12-year cumulative mortality rates were 36% for mechanical prostheses and 74% for biological prostheses (adj. HR 0.40; CI: 0.17-0.91; p = 0.03). At follow-up, the ischemic stroke had occurred in 19% of patients with mechanical prosthesis and 33% of those with a biological prosthesis (adj. p = 0.52). The major bleeding rates within the 12-year follow-up period were 30% for mechanical prosthesis and 13% for a biological prosthesis (adj. p = 0.29). The mitral valve reoperation rates were 13% for mechanical prosthesis and 12% for a biological prosthesis (adj. p = 0.50). Drug abuse history did not have a significant modifying impact on the results (interaction p = 0.51 for mortality and ≥0.13 for secondary outcomes). Conclusion. The use of mechanical mitral valve prosthesis is associated with lower long-term mortality compared to the biological prosthesis in non-elder native mitral valve infective endocarditis patients. The routine choice of biological mitral valve prostheses for this patient group is not supported by the results.
Collapse
Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Vesa Anttila
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
27
|
Kytö V, Saraste A, Rautava P, Tornio A. Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation. Basic Clin Pharmacol Toxicol 2022; 130:655-665. [PMID: 35420260 PMCID: PMC9321089 DOI: 10.1111/bcpt.13733] [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: 02/07/2022] [Revised: 03/27/2022] [Accepted: 04/11/2022] [Indexed: 12/04/2022]
Abstract
Digoxin is used for rate control in atrial fibrillation (AF), but evidence for its efficacy and safety after myocardial infarction (MI) is scarce and mixed. We studied post‐MI digoxin use effects on AF patient outcomes in a nationwide registry follow‐up study in Finland. Digoxin was used by 18.6% of AF patients after MI, with a decreasing usage trend during 2004–2014. Baseline differences in digoxin users (n = 881) and controls (n = 3898) were balanced with inverse probability of treatment weight adjustment. The median follow‐up was 7.4 years. Patients using digoxin after MI had a higher cumulative all‐cause mortality (77.4% vs. 72.3%; hazard ratio [HR]: 1.19; confidence interval [CI]: 1.07–1.32; p = 0.001) during a 10‐year follow‐up. Mortality differences were detected in a subgroup analysis of patients without baseline heart failure (HF) (HR: 1.23; p = 0.019) but not in patients with baseline HF (HR: 1.05; p = 0.413). Cumulative incidences of HF hospitalizations, stroke and new MI were similar between digoxin group and controls. In conclusion, digoxin use after MI is associated with increased mortality but not with HF hospitalizations, new MI or stroke in AF patients. Increased mortality was detected in patients without baseline HF. Results suggest caution with digoxin after MI in AF patients, especially in the absence of HF.
Collapse
Affiliation(s)
- Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Antti Saraste
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Aleksi Tornio
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland.,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
| |
Collapse
|
28
|
Laitinen L, Nurmi M, Kulovuori N, Koivisto M, Ojala E, Rautava P, Polo-Kantola P. Usability of Pregnancy-Unique Quantification of Emesis questionnaire in women hospitalised for hyperemesis gravidarum: a prospective cohort study. BMJ Open 2022; 12:e058364. [PMID: 35589345 PMCID: PMC9121481 DOI: 10.1136/bmjopen-2021-058364] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Pregnancy-Unique Quantification of Emesis (PUQE) questionnaire is mainly used in outpatient care to assess the severity of nausea and vomiting of pregnancy (NVP). Our aim was to evaluate the usability of the Finnish-translated PUQE in hospitalised women with hyperemesis gravidarum (HG). DESIGN Prospective cohort study. SETTING University hospital in Finland. PARTICIPANTS Ninety-five women admitted due to HG for at least overnight. PRIMARY AND SECONDARY OUTCOME MEASURES Categorised and continuous PUQE scores, physical and mental quality of life (QoL) and urine ketones at admission and at discharge, analysing the first admission and readmissions separately. RESULTS The most common PUQE categories at admission were 'moderate' and 'severe', whereas at discharge they were 'mild' and 'moderate'. Likewise, continuous PUQE scores improved between admission and discharge (p<0.0001). At admission, women rating worse physical QoL (first admission adjusted OR (AOR) 1.09; 95% CI 1.03 to 1.16; readmissions AOR 1.13; 95% CI 1.02 to 1.25) and women with ketonuria of +++ (first admission AOR 16.00; 95% CI 1.44 to 177.82) fell into higher PUQE score category. On discharge day, women with better physical QoL had lower PUQE score category (first admission AOR 0.94; 95% CI 0.91 to 0.98; readmissions AOR 0.93; 95% CI 0.90 to 0.97). The results between physical QoL and continuous PUQE scores were similar. Concerning readmissions, better mental QoL was associated with lower PUQE score category at discharge (AOR 0.93; 95% CI 0.89 to 0.97). As for continuous PUQE score, worse mental QoL was associated with higher score at admission (readmissions, p=0.007) and better mental QoL with lower score at discharge (readmissions, p=0.007). CONCLUSIONS PUQE scores reflected alleviation of NVP severity in women hospitalised due to HG. Further, the decrease in PUQE score was associated with improved physical QoL and partly also with improved mental QoL. We therefore suggest PUQE as a complementary instrument for inpatient setting.
Collapse
Affiliation(s)
- Linda Laitinen
- Central Finland Health Care District, Department of Obstetrics and Gynecology, Jyväskylä, Finland
- Department of Obstetrics and Gynecology, University of Turku Faculty of Medicine, Turku, Finland
| | - Miina Nurmi
- Department of Obstetrics and Gynecology, University of Turku Faculty of Medicine, Turku, Finland
- Department of Public Health, University of Turku Faculty of Medicine, Turku, Finland
| | | | - Mari Koivisto
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Elina Ojala
- Department of Obstetrics and Gynecology, Turku University Hospital (TYKS), Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku Faculty of Medicine, Turku, Finland
- Clinical Research Centre, Turku University Hospital (TYKS), Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, University of Turku Faculty of Medicine, Turku, Finland
- Department of Obstetrics and Gynecology, Turku University Hospital (TYKS), Turku, Finland
| |
Collapse
|
29
|
Posti JP, Luoto TM, Sipilä JOT, Rautava P, Kytö V. Prognosis of patients with operated chronic subdural hematoma. Sci Rep 2022; 12:7020. [PMID: 35488040 PMCID: PMC9054845 DOI: 10.1038/s41598-022-10992-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 04/14/2022] [Indexed: 12/11/2022] Open
Abstract
Chronic subdural hematoma (cSDH), previously considered fairly benign and easy to treat, is now viewed a possible sign of incipient clinical decline. We investigated case-fatality, excess fatality and need for reoperations following operated cSDH in a nationwide setting focusing on patient-related characteristics. Finnish nationwide databases were searched for all admissions with operated cSDH as well as later deaths in adults (≥ 16 years) during 2004–2017. There were 8539 patients with an evacuated cSDH (68% men) with a mean age of 73.0 (± 12.8) years. During the follow-up, 3805 (45%) patients died. In-hospital case-fatality was 0.7% (n = 60) and 30-day case-fatality 4.2% (n = 358). The 1-year case-fatality was 14.3% (95% CI = 13.4–15.2%) among men and 15.3% (95% CI = 14.0–16.7%) among women. Comorbidity burden, older age, and alcoholism were significantly associated with fatality. One-year excess fatality rate compared to general Finnish population was 9.1% (95% CI = 8.4–9.9) among men and 10.3% (95% CI = 9.1–11.4) among women. Highest excess fatality was observed in the oldest age group in both genders. Reoperation was needed in 19.4% (n = 1588) of patients. Older age but not comorbidity burden or other patient-related characteristics were associated with increased risk for reoperation. The overall case-fatality and need for reoperations declined during the study era. Comorbidities should be considered when care and follow-up are planned in patients with cSDH. Our findings underpin the perception that the disease is more dangerous than previously thought and causes mortality in all exposed age groups: even a minor burden of comorbidities can be fatal in the post-operative period.
Collapse
Affiliation(s)
- Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, P.O. Box 52, 20521, Turku, Finland.
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jussi O T Sipilä
- Clinical Neurosciences, University of Turku, Turku, Finland.,Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
30
|
Stenlund S, Koivumaa-Honkanen H, Sillanmäki L, Lagström H, Rautava P, Suominen S. Changed health behavior improves subjective well-being and vice versa in a follow-up of 9 years. Health Qual Life Outcomes 2022; 20:66. [PMID: 35449057 PMCID: PMC9027415 DOI: 10.1186/s12955-022-01972-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/24/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Previous research on health behavior and subjective well-being has mainly focused on interindividual differences or explored certain domains of health behavior. Good health behavior and subjective well-being at baseline can predict each other after a follow-up. In the present cohort study, we explored the outcomes of change for an individual i.e., how changed health behavior is reflected in subsequent subjective well-being and vice versa. Methods Data (n = 10,855) originates from a population-based Health and Social Support (HeSSup) study on working-age Finns in 2003 and 2012. A composite measure of health behavior included physical activity, dietary habits, alcohol consumption, and smoking status (range 0–4, worst–best) and a composite measure of subjective well-being (with reversed scoring) included three life assessments, i.e., interest, happiness, and ease in life, and perceived loneliness (range 4–20, best–worst). Different multiple linear regression models were used to study how changes in health behavior predict subjective well-being and the opposite, how changes in subjective well-being predict health behavior. Results A positive change in health behavior from 2003 to 2012 predicted better subjective well-being (i.e., on average 0.31 points lower subjective well-being sum score), whereas a negative change predicted poorer subjective well-being (i.e., 0.37 points higher subjective well-being sum score) (both: p < 0.001) compared to those study subjects who had no change in health behavior. Similarly, when a positive and negative change in subjective well-being was studied, these figures were 0.071 points better and 0.072 points worse (both: p < 0.001) health behavior sum score, respectively. When the magnitude of the effect of change was compared to the range of scale of the outcome the effect of health behavior change appeared stronger than that of subjective well-being. Conclusion Changes in health behavior and subjective well-being have long-term effects on the level of the other, the effect of the first being slightly stronger than vice versa. These mutual long-term benefits can be used as a motivator in health promotion on individual and societal levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01972-4.
Collapse
Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, 20014, Turku, Finland. .,Research Services, Turku University Hospital, 20014, Turku, Finland.
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, 70211, Kuopio, Finland.,Mental Health and Wellbeing Center, Kuopio University Hospital, 70029, Kuopio, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Research Services, Turku University Hospital, 20014, Turku, Finland.,Department of Public Health, University of Helsinki, 00014, Helsinki, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Centre for Population Health Research, University of Turku and Turku University Hospital, 20014, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Research Services, Turku University Hospital, 20014, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, 20014, Turku, Finland.,Research Services, Turku University Hospital, 20014, Turku, Finland.,School of Health Sciences, University of Skövde, 54128, Skövde, Sweden
| |
Collapse
|
31
|
Sipilä JOT, Ruuskanen JO, Heervä E, Posti JP, Rautava P, Kytö V. Cancer Occurrence After a Cerebral Venous Thrombosis: A Nationwide Registry Study. Stroke 2022; 53:e189-e191. [PMID: 35380049 PMCID: PMC9022683 DOI: 10.1161/strokeaha.122.038685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jussi O T Sipilä
- Department of Neurology, North Karelia Central Hospital, Joensuu, Finland (J.O.T.S.).,Clinical Neurosciences, University of Turku, Finland (J.O.T.S., J.O.R., J.P.P.)
| | - Jori O Ruuskanen
- Clinical Neurosciences, University of Turku, Finland (J.O.T.S., J.O.R., J.P.P.).,Neurocenter, Department of Neurology, Turku University Hospital, Finland.(J.O.R.)
| | - Eetu Heervä
- Department of Oncology, Turku University Hospital and University of Turku, Finland. (E.H.)
| | - Jussi P Posti
- Clinical Neurosciences, University of Turku, Finland (J.O.T.S., J.O.R., J.P.P.).,Department of Neurosurgery, Turku University Hospital and University of Turku, Finland. (J.P.P.)
| | - Päivi Rautava
- Department of Public Health, University of Turku and Turku Clinical Research Centre, Turku University Hospital, Finland. (P.R.)
| | - Ville Kytö
- Heart Center and Center for Population Health Research, Turku University Hospital and University of Turku, Finland. (V.K.)
| |
Collapse
|
32
|
Carlén K, Suominen S, Augustine L, Saarinen MM, Aromaa M, Rautava P, Sourander A, Sillanpää M. Parental distress rating at the child's age of 15 years predicts probable mental diagnosis: a three-year follow-up. BMC Pediatr 2022; 22:177. [PMID: 35379223 PMCID: PMC8978369 DOI: 10.1186/s12887-022-03248-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/04/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Mental health in adolescence is an increasing global public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, underlining the significance of early detection. The study aimed to investigate whether parental distress rating at the child’s age of 15 predicts a probable mental diagnosis in a three-year follow-up. Methods All data was derived from the Finnish Family Competence (FFC) Study. The analysis focused on whether parental CBCL (Child Behavior Checklist) rating (n = 441) at the child’s age of 15 years predicted the outcome of the child’s standardised DAWBA (Development and Well-Being Assessment) interview at offspring’s 18 years. Results Multivariable analysis showed that a one-unit increase in the total CBCL scores increased the relative risk of a DAWBA-based diagnosis by 3% (RR [95% CI] 1.03 [1.02–1.04], p < 0.001). Conclusions Parental CBCL rating in a community sample at the adolescent’s age of 15 contributes to early identification of adolescents potentially at risk and thus benefitting from early interventions.
Collapse
Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Skövde, Box 408, 54128, Skövde, Sweden. .,The Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sakari Suominen
- School of Health Sciences, University of Skövde, Skövde, Box 408, 54128, Skövde, Sweden.,Department of Public Health, University of Turku, Turku, Finland
| | - Lilly Augustine
- CHILD, School of Learning and Communication, Jönköping University, Jönköping, Sweden
| | - Maiju M Saarinen
- Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- Department of Public Health, University of Turku, Turku, Finland.,City of Turku Welfare Division, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku University Hospital, Clinical Research Centre, Turku, Finland
| | - André Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Matti Sillanpää
- Department of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
33
|
Posti JP, Luoto TM, Sipilä JOT, Rautava P, Kytö V. Changing epidemiology of traumatic brain injury among the working-aged in Finland: Admissions and neurosurgical operations. Acta Neurol Scand 2022; 146:34-41. [PMID: 35257358 DOI: 10.1111/ane.13607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/02/2022] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies from Finland have highlighted an increase in the incidence of traumatic brain injuries (TBI) in older age groups and high overall mortality. We performed a comprehensive study on the changing epidemiology of TBI focusing on the acute events in the Finnish working-age population. METHODS Nationwide databases were searched for all emergency ward admissions with a TBI diagnosis for persons of 16-69 years of age during 2004-2018. RESULTS In the Finnish working-age population, there were 52,487,099 person-years, 38,810 TBI-related hospital admissions, 4664 acute neurosurgical operations (ANO), and 2247 cases of in-hospital mortality (IHM). The TBI-related hospital admission incidence was 94/100,000 person-years in men, 44/100,000 in women, and 69/100,000 overall. The incidence rate of admissions increased in women, while in men and overall, the rate decreased. The incidence rate increased in the group of 60-69 years in both genders. Lowest incidence rates were observed in the age group of 30-39 years. Occurrence risk for TBI admission was higher in men in all age groups. Trends of ANOs decreased overall, while decompressive craniectomy was the only operation type in which a rise in incidence was found. Evacuation of acute subdural hematoma was the most common ANO. Mean length of stay and IHM rate halved during the study years. CONCLUSIONS In Finland, the epidemiology of acute working-aged TBI has significantly changed. The rates of admission incidences, ANOs, and IHM nowadays represent the lower end of the range of these acute events reported in the western world.
Collapse
Affiliation(s)
- Jussi P. Posti
- Neurocenter Department of Neurosurgery and Turku Brain Injury Center Turku University Hospital and University of Turku Turku Finland
| | - Teemu M. Luoto
- Department of Neurosurgery Tampere University Hospital and Tampere University Tampere Finland
| | - Jussi O. T. Sipilä
- Clinical Neurosciences University of Turku Turku Finland
- Department of Neurology Siun Sote North Karelia Central Hospital Joensuu Finland
| | - Päivi Rautava
- Clinical Research Center Turku University Hospital and University of Turku Turku Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research Turku University Hospital and University of Turku Turku Finland
- Research Center of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland
- Administrative Center Hospital District of Southwest Finland Turku Finland
- Department of Public Health Faculty of Medicine University of Helsinki Helsinki Finland
| |
Collapse
|
34
|
Kallio M, Korkeila J, Malmberg M, Gunn J, Rautava P, Korhonen P, Kytö V. Impaired long-term outcomes of patients with schizophrenia spectrum disorder after coronary artery bypass surgery: nationwide case-control study. BJPsych Open 2022; 8:e48. [PMID: 35144708 PMCID: PMC8867870 DOI: 10.1192/bjo.2022.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Patients with schizophrenia spectrum disorder have increased risk of coronary artery disease. AIMS To investigate long-term outcomes of patients with schizophrenia spectrum disorder and coronary artery disease after coronary artery bypass grafting surgery (CABG). METHOD Data from patients with schizophrenia spectrum disorder (n = 126) were retrospectively compared with propensity-matched (1:20) control patients without schizophrenia spectrum disorder (n = 2520) in a multicentre study in Finland. All patients were treated with CABG. The median follow-up was 7.1 years. The primary outcome was all-cause mortality. RESULTS Patients with diagnosed schizophrenia spectrum disorder had an elevated risk of 10-year mortality after CABG, compared with control patients (42.7 v. 30.3%; hazard ratio 1.56; 95% CI 1.13-2.17; P = 0.008). Schizophrenia spectrum diagnosis was associated with a higher risk of major adverse cardiovascular events during follow-up (49.9 v. 32.6%, subdistribution hazard ratio 1.59; 95% CI 1.18-2.15; P = 0.003). Myocardial infarction (subdistribution hazard ratio 1.86; P = 0.003) and cardiovascular mortality (subdistribution hazard ratio 1.65; P = 0.017) were more frequent in patients with versus those without schizophrenia spectrum disorder, but there was no difference for stroke. Psychiatric ward admission, antipsychotic medication, antidepressant use and benzodiazepine use before CABG were not associated with outcome differences. After CABG, patients with schizophrenia spectrum disorder received statin therapy less often and had lower doses; the use of other cardiovascular medications was similar between schizophrenia spectrum and control groups. CONCLUSIONS Patients with schizophrenia spectrum disorder have higher long-term risks of death and major adverse cardiovascular events after CABG. The results underline the vulnerability of these patients and highlight the importance of intensive secondary prevention and risk factor optimisation.
Collapse
Affiliation(s)
- Mika Kallio
- Department of Psychiatry, University of Turku and Turku University Hospital, Finland
| | - Jyrki Korkeila
- Department of Psychiatry, University of Turku and Turku University Hospital, Finland; and Department of Psychiatry, Hospital District of Satakunta, Finland
| | - Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Finland; and Turku Clinical Research Centre, Turku University Hospital, Finland
| | - Päivi Korhonen
- Turku Clinical Research Centre, Turku University Hospital, Finland; and Department of General Practice, University of Turku and Turku University Hospital, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Center for Population Health Research, Turku University Hospital and University of Turku, Finland; Administrative Center, Hospital District of Southwest Finland, Finland; and Department of Public Health, Faculty of Medicine, University of Helsinki, Finland
| |
Collapse
|
35
|
Rautava S, Turta O, Vahtera J, Pentti J, Kivimäki M, Pearce J, Kawachi I, Rautava P, Lagström H. Neighborhood Socioeconomic Disadvantage and Childhood Body Mass Index Trajectories From Birth to 7 Years of Age. Epidemiology 2022; 33:121-130. [PMID: 34669629 PMCID: PMC8614531 DOI: 10.1097/ede.0000000000001420] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/06/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The epidemic of increasing childhood overweight and obesity is a major global health concern, with local contextual factors identified as possible contributors. Robust research is needed to establish an evidence base supporting health policy decisions to reverse the trend. We aimed to examine the association between neighborhood socioeconomic disadvantage and trajectories of body mass index (BMI) from birth to age 7. METHODS The present study included 11,023 children born within the Southwest Finland Birth Cohort who were free of severe conditions affecting growth with adequate exposure and growth data. We obtained child growth data until school age from municipal follow-up clinics. We based cumulative childhood neighborhood socioeconomic disadvantage on the average annual income, unemployment, and level of education in a residential area defined using a geographic grid at a spatial resolution of 250 m by 250 m. RESULTS Cumulative neighborhood socioeconomic disadvantage was associated with distinct childhood BMI z score trajectories from birth to age 7. Despite being born in the lowest BMI z scores, children growing up in disadvantaged neighborhoods subsequently exhibited a trajectory of increasing BMI z scores starting at 4 years of age, ending up with a higher risk of overweight at the end of the follow-up (30%) as compared with children living in more affluent neighborhoods (22%). The corresponding risk of obesity was 5 % for those in affluent neighborhoods and 9 % and those in disadvantaged neighborhoods. CONCLUSION Cumulative exposure to neighborhood socioeconomic disadvantage is independently associated with unfavorable BMI development and obesity in childhood.
Collapse
Affiliation(s)
- Samuli Rautava
- From the Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Helsinki and New Children’s Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Olli Turta
- From the Department of Pediatrics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Clinicum, Faculty of Medicine and Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
| | - Jamie Pearce
- Centre for Research on Environment, Society & Health, School of GeoSciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Päivi Rautava
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- Turku University Hospital, Research Services, Turku, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| |
Collapse
|
36
|
Malmberg M, Gunn J, Rautava P, Sipilä J, Kytö V. Outcome of acute myocardial infarction versus stable coronary artery disease patients treated with coronary bypass surgery. Ann Med 2021; 53:70-77. [PMID: 32875916 PMCID: PMC7877950 DOI: 10.1080/07853890.2020.1818118] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 08/28/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To study the long-term outcome differences between acute myocardial infarction (MI) and stable coronary artery disease (CAD) patients treated with coronary artery bypass grafting (CABG). METHODS We studied retrospectively patients with MI (n = 1882) or stable CAD (n = 13117) treated with isolated CABG between 2004 and 2014. Inverse propensity probability weight adjustment for baseline features was used. Median follow-up was 7.9 years. RESULTS In-hospital mortality (8.6% vs. 1.6%; OR 5.94; p < .0001) and re-sternotomy (5.5% vs. 2.7%; OR 2.07; p < .0001) were more common in MI patients compared to stable CAD patients. Hospital surviving MI patients had higher all-cause mortality (28.2% vs. 22.2%; HR 1.37; p = .002) and MACE rate (34.4% vs. 27.4%; HR 1.22; CI 1.00-1.50; p = .049) at 10-year follow-up. Cardiovascular mortality (15.9% vs. 12.7%; HR 1.36; p = .017) and rate of new myocardial infarction (12.0% vs. 9.8%; HR 1.40; p = .034) were also higher in MI patients during follow-up. In follow-up of stabilized first-year survivors, the difference in all-cause (26.5% vs. 20.7%; HR 1.40; p = .003) and cardiovascular (14.2% vs. 11.4%; HR 1.37; p = .027) mortality continued to increase between MI and stable CAD patients. CONCLUSION MI patients have poorer short- and long-term outcomes compared to stable CAD patients after CABG and risk difference continues to increase with time. Key Messages Patients with myocardial infarction have poorer short- and long-term outcomes compared to stable coronary artery disease patients after coronary artery bypass grafting (CABG). Higher risk of death continues also in stabilized first-year myocardial infarct survivors. The importance of efficient secondary prevention and follow-up highlights in post-myocardial infarct population after CABG.
Collapse
Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Jussi Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland
- Department of Neurology, University of Turku, Turku, Finland
| | - Ville Kytö
- Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Administative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
37
|
Stenlund S, Koivumaa-Honkanen H, Sillanmäki L, Lagström H, Rautava P, Suominen S. Subjective well-being predicts health behavior in a population-based 9-years follow-up of working-aged Finns. Prev Med Rep 2021; 24:101635. [PMID: 34976687 PMCID: PMC8684019 DOI: 10.1016/j.pmedr.2021.101635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/10/2021] [Accepted: 11/12/2021] [Indexed: 11/26/2022] Open
Abstract
Subjective well-being predicts subsequent health behavior in a 9-years of follow-up. Neither direction of influence was stronger as compared to the other one. Enhancing subjective well-being could serve as an additional support for health behavior change.
The cross-sectional association between measures of subjective well-being (SWB) and various health behaviors is well-established. In this 9-year (2003–2012) follow-up study, we explored how a composite indicator of SWB (range 4–20) with four items (interest, happiness, and ease in life, as well as perceived loneliness) predicts a composite health behavior measure (range 0–4) including dietary habits, physical activity, alcohol consumption, and smoking status. Study subjects (n = 10,855) originated from a population-based random sample of working-age Finns in the Health and Social Support study (HeSSup). According to linear regression analysis, better SWB predicted better health behavior sum score with a β = 0.019 (p < 0.001) with a maximum effect of 0.3 points after adjusting for age (p = 0.038), gender (p < 0.001), education (p = 0.55), baseline self-reported diseases (p = 0.020), baseline health behavior (β = 0.49, p < 0.001), and the interaction between SWB and education (p < 0.001). The results suggest that SWB has long-term positive effect on health behavior. Thus, interventions aiming at health behavioral changes could benefit from taking into account SWB and its improvement in the intervention.
Collapse
|
38
|
Malmberg M, Palomäki A, Sipilä JOT, Rautava P, Gunn J, Kytö V. Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis. Ann Med 2021; 53:1512-1519. [PMID: 34461789 PMCID: PMC8409967 DOI: 10.1080/07853890.2021.1969591] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). METHODS Patients with RA (n = 378) were retrospectively compared to patients without RA (n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. RESULTS Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28-1.77; p < .0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28-2.04; p < .0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients (p = .060). Duration of RA before CABG (p = .011) and preoperative corticosteroid usage in RA (p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. CONCLUSIONS RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality.Key messagesPatients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG).Glucocorticoid use before CABG and duration of RA are associated with higher mortality.Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.
Collapse
Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Palomäki
- Centre of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Jussi O. T. Sipilä
- Department of Neurology, North Karelia Central Hospital, Siun Sote, Joensuu, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland
- Administrative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
39
|
Abstract
Background Evidence on the impact of sex on prognoses after myocardial infarction (MI) among older adults is limited. We evaluated sex differences in long-term cardiovascular outcomes after MI in older adults. Methods and Results All patients with MI ≥70 years admitted to 20 Finnish hospitals during a 10-year period and discharged alive were studied retrospectively using a combination of national registries (n=31 578, 51% men, mean age 79). The primary outcome was combined major adverse cardiovascular event within 10-year follow-up. Sex differences in baseline features were equalized using inverse probability weighting adjustment. Women were older, with different comorbidity profiles and rarer ST-segment-elevation MI and revascularization, compared with men. Adenosine diphosphate inhibitors, anticoagulation, statins, and high-dose statins were more frequently used by men, and renin-angiotensin-aldosterone inhibitors and beta blockers by women. After balancing these differences by inverse probability weighting, the cumulative 10-year incidence of major adverse cardiovascular events was 67.7% in men, 62.0% in women (hazard ratio [HR], 1.17; CI, 1.13-1.21; P<0.0001). New MI (37.0% in men, 33.1% in women; HR, 1.16; P<0.0001), ischemic stroke (21.1% versus 19.5%; HR, 1.10; P=0.004), and cardiovascular death (56.0% versus 51.1%; HR, 1.18; P<0.0001) were more frequent in men during long-term follow-up after MI. Sex differences in major adverse cardiovascular events were similar in subgroups of revascularized and non-revascularized patients, and in patients 70 to 79 and ≥80 years. Conclusions Older men had higher long-term risk of major adverse cardiovascular events after MI, compared with older women with similar baseline features and evidence-based medications. Our results highlight the importance of accounting for confounding factors when studying sex differences in cardiovascular outcomes.
Collapse
Affiliation(s)
- Anne M Kerola
- Department of Internal Medicine Päijät-Häme Joint Authority for Health and Wellbeing Lahti Finland.,Preventive Cardio-Rheuma Clinic Division of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway.,Faculty of Medicine University of Helsinki Helsinki Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology Division of Medicine Turku University Hospital Turku Finland.,Department of Medicine University of Turku Turku Finland
| | - Päivi Rautava
- Department of Public Health University of Turku Turku Finland.,Turku Clinical Research Center Turku University Hospital Turku Finland
| | - Maria Nuotio
- Research Services and Department of Clinical Medicine Turku University Hospital Turku Finland.,Division of Geriatric Medicine University of Turku Turku Finland
| | - Ville Kytö
- Heart Center Turku University Hospital and University of Turku Turku Finland.,Research Center of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Center for Population Health Research Turku University Hospital and University of Turku Turku Finland.,Administrative Center Hospital District of Southwest Finland Turku Finland.,Department of Public Health Faculty of Medicine University of Helsinki Helsinki Finland
| |
Collapse
|
40
|
Lipasti M, Jalava-Broman J, Sillanmäki L, Mäkinen J, Rautava P. Climacteric symptoms more severe in 2010 than in 2000 - experience of Finnish women aged 52-56 years not now or previously on menopausal hormone therapy. Maturitas 2021; 154:20-24. [PMID: 34736576 DOI: 10.1016/j.maturitas.2021.09.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/15/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyze and compare the experience of climacteric symptoms and their associations with sociodemographic and health-related characteristics in two cohorts of Finnish women aged 52-56 years, born ten years apart and not now or previously on menopausal hormone therapy (MHT). STUDY DESIGN Nationwide population-based time-trend study with a large number of participants (n = 1986 + 1988). MAIN OUTCOME MEASURES The experience of climacteric symptoms was assessed by 12 commonly used menopause-related symptoms. RESULTS Women aged 52-56 experienced more moderate or severe symptoms and fewer mild symptoms in 2010 than in 2000. Being unemployed or inactive was associated with more severe symptoms (P = 0.007), but employment status had no effect on the relative odds estimates. CONCLUSIONS The influence of the birth cohort and time-period effects as well as work-related factors on the experience of climacteric symptoms in women not now or previously on MHT needs further research, particularly since the change in the experience of symptoms found in this study occurred within only ten years.
Collapse
Affiliation(s)
- Maija Lipasti
- Department of Public Health, University of Turku, Turku, Finland.
| | | | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku, Finland; Research Services, Turku University Hospital, Turku, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Juha Mäkinen
- Department of Obstetrics and Gynaecology, University of Turku, Turku, Finland; Department of Obstetrics and Gynaecology, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland; Research Services, Turku University Hospital, Turku, Finland
| |
Collapse
|
41
|
Stenlund S, Junttila N, Koivumaa-Honkanen H, Sillanmäki L, Stenlund D, Suominen S, Lagström H, Rautava P. Longitudinal stability and interrelations between health behavior and subjective well-being in a follow-up of nine years. PLoS One 2021; 16:e0259280. [PMID: 34714864 PMCID: PMC8555827 DOI: 10.1371/journal.pone.0259280] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The bidirectional relationship between health behavior and subjective well-being has previously been studied sparsely, and mainly for individual health behaviors and regression models. In the present study, we deepen this knowledge focusing on the four principal health behaviors and using structural equation modeling with selected covariates. METHODS The follow-up data (n = 11,804) was derived from a population-based random sample of working-age Finns from two waves (2003 and 2012) of the Health and Social Support (HeSSup) postal survey. Structural equation modeling was used to study the cross-sectional, cross-lagged, and longitudinal relationships between the four principal health behaviors and subjective well-being at baseline and after the nine-year follow-up adjusted for age, gender, education, and self-reported diseases. The included health behaviors were physical activity, dietary habits, alcohol consumption, and smoking status. Subjective well-being was measured through four items comprising happiness, interest, and ease in life, and perceived loneliness. RESULTS Bidirectionally, only health behavior in 2003 predicted subjective well-being in 2012, whereas subjective well-being in 2003 did not predict health behavior in 2012. In addition, the cross-sectional interactions in 2003 and in 2012 between health behavior and subjective well-being were statistically significant. The baseline levels predicted their respective follow-up levels, the effect being stronger in health behavior than in subjective well-being. CONCLUSION The four principal health behaviors together predict subsequent subjective well-being after an extensive follow-up. Although not particularly strong, the results could still be used for motivation for health behavior change, because of the beneficial effects of health behavior on subjective well-being.
Collapse
Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
| | - Niina Junttila
- Department of Teacher Education, University of Turku, Turku, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, University of Eastern Finland, Kuopio, Finland
- Mental Health and Wellbeing Center, Kuopio University Hospital, Kuopio, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - David Stenlund
- Faculty of Science and Engineering, Åbo Akademi University, Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Hanna Lagström
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland
- Research Services, Turku University Hospital, Turku, Finland
| |
Collapse
|
42
|
Stenlund S, Koivumaa-Honkanen H, Sillanmäki L, Lagström H, Rautava P, Suominen S. Health behavior of working-aged Finns predicts self-reported life satisfaction in a population-based 9-years follow-up. BMC Public Health 2021; 21:1815. [PMID: 34625042 PMCID: PMC8501556 DOI: 10.1186/s12889-021-11796-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/29/2020] [Accepted: 09/15/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Previous studies have shown positive association between health behavior and life satisfaction, but the studies have mostly been cross-sectional, had follow-up times up to 5 years or focused on only one health behavior domain. The aim of the study was to explore how principal health behavior domains predict life satisfaction as a composite score in a previously unexplored longitudinal setting. METHODS The present study tested whether a health behavior sum score (range 0-4) comprising of dietary habits, smoking, alcohol consumption, and physical activity predicted subsequent composite score of life satisfaction (range 4-20). Data included responses from 11,000 working-age Finns who participated in the Health and Social Support (HeSSup) prospective population-based postal survey. RESULTS Protective health behavior in 2003 predicted (p < .001) better life satisfaction 9 years later when sex, age, education, major diseases, and baseline life satisfaction were controlled for. The β in the linear regression model was - 0.24 (p < .001) corresponding to a difference of 0.96 points in life satisfaction between individuals having the best and worst health behavior. CONCLUSION Good health behavior has a long-term beneficial impact on subsequent life satisfaction. This knowledge could strengthen the motivation for improvement of health behavior particularly on an individual level but also on a policy level.
Collapse
Affiliation(s)
- Säde Stenlund
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, 70211 Kuopio, Finland
- Mental health & Wellbeing Center, Kuopio University Hospital, 70029 Kuopio, Finland
| | - Lauri Sillanmäki
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
| | - Hanna Lagström
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, 20014 Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
| | - Sakari Suominen
- Department of Public Health, University of Turku, 20014 Turku, Finland
- Research Services, Turku University Hospital, 20014 Turku, Finland
- School of Health Sciences, University of Skövde, 54128 Skövde, Sweden
| |
Collapse
|
43
|
Anttila V, Malmberg M, Gunn J, Rautava P, Kytö V. Infective endocarditis and outcomes of mitral valve replacement. Eur J Clin Invest 2021; 51:e13577. [PMID: 33931874 DOI: 10.1111/eci.13577] [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: 02/09/2021] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the long-term outcomes of mitral valve replacement (MVR) in native mitral valve infective endocarditis (IE). METHODS Multicentre, population-based cohort register study consisted of 1233 consecutive adult patients treated with first-time MVR in Finland. Mitral valve IE was diagnosed in 170 of these patients. Propensity score matching resulted in 134 pairs with balanced baseline characteristics. The median follow-up was 6.1 years. RESULTS Pre-operative native mitral valve IE was associated with an increased hazard of 10-year mortality (38.8% vs 30.5%; HR 2.13; CI 1.17-3.85; P = .013) after MVR. Occurrence of major bleeding was higher in IE patients (26.0%) vs non-IE patients (23.4%) during the 10-year follow-up (HR 2.80; CI 1.01-7.77; P = .048). Hospital admission duration after MVR was longer in IE patients (median 28 vs 11 days; P < .0001). Cumulative ischaemic stroke rate was similar between patient groups (12.1% in IE vs 15.1% in non-IE; P = .493). Re-sternotomy was performed in 13.4% of IE patients and 9.0% of non-IE patients (P = .261). CONCLUSIONS Patients with native mitral valve IE have a higher risk of death and major bleeding after MVR than matched patients without IE. Results highlight the importance of complication prevention in these patients.
Collapse
Affiliation(s)
- Vesa Anttila
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
44
|
Ahtela E, Oksi J, Vahlberg T, Sipilä J, Rautava P, Kytö V. Short- and long-term outcomes of infective endocarditis admission in adults: A population-based registry study in Finland. PLoS One 2021; 16:e0254553. [PMID: 34265019 PMCID: PMC8282023 DOI: 10.1371/journal.pone.0254553] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/28/2021] [Indexed: 02/06/2023] Open
Abstract
Infective endocarditis (IE) is associated with high mortality. However, data on factors associated with length of stay (LOS) in hospital due to IE are scarce. In addition, long-term mortality of more than 1 year is inadequately known. In this large population-based study we investigated age and sex differences, temporal trends, and factors affecting the LOS in patients with IE and in-hospital, 1-year, 5-year and 10-year mortality of IE. Data on patients (≥18 years of age) admitted to hospital due to IE in Finland during 2005–2014 were collected retrospectively from nationwide obligatory registries. We included 2166 patients in our study. Of the patients 67.8% were men. Women were older than men (mean age 63.3 vs. 59.5, p<0.001). The median LOS was 20.0 days in men and 18.0 in women, p = 0.015. In the youngest patients (18–39 years) the median LOS was significantly longer than in the oldest patients (≥80 years) (24.0 vs. 16.0 days, p = 0.014). In-hospital mortality was 10% with no difference between men and women. Mortality was 22.7% at 1 year whereas 5- and 10-year mortality was 37.5% and 48.5%, respectively. The 5-year and 10-year mortality was higher in women (HR 1.18, p = 0.034; HR 1.18, p = 0.021). Both in-hospital and long-term mortality increased significantly with aging and comorbidity burden. Both mortality and LOS remained stable over the study period. In conclusion, men had longer hospital stays due to IE compared to women. The 5- and 10-year mortality was higher in women. The mortality of IE or LOS did not change over time.
Collapse
Affiliation(s)
- Elina Ahtela
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jarmo Oksi
- Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi Sipilä
- Department of Neurology, Siun sote, North Karelia Central Hospital, Joensuu, Finland.,Clinical Neurosciences, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
45
|
Santalahti A, Luutonen S, Vahlberg T, Moen H, Salanterä S, Rautava P. How GPs can Recognize Persistent Frequent Attenders at Finnish Primary Health Care Using Electronic Patient Records. J Prim Care Community Health 2021; 12:21501327211024417. [PMID: 34109878 PMCID: PMC8202266 DOI: 10.1177/21501327211024417] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: The proportion of patients who are frequent attenders (FAs) varies from few percent to almost 30% of all patients. A small group of patients continued to visit GPs year after year. In previous studies, it has been reported that over 15% of all 1-year FAs were persistent frequent attenders (pFAs). Objectives: This study aimed to identify typical features of pFAs from the textual content in their medical entries, which could help GPs to recognize pFAs easily and facilitated treatment.Methods: A retrospective register study was done, using 10 years of electronic patient records. The data were collected from Finnish primary health care centers and used to analyze chronic symptoms and diagnoses of pFAs and to calculate the inverse document frequency weight (IDF) of words used in the patient records. IDF was used to determine which words, if any, are typical for pFAs. The study group consisted of the 5-year pFAs and control group of 1-year FAs. The main background variables were age, gender, occupation, smoking habits, use of alcohol, and BMI. Results: Out of 4392 frequent attenders, 6.6% were pFAs for 3 years and 1.1% were pFAs for 5 years. Of the pFAs, 65% were female and 35% were male. The study group had significantly more depressive episodes (P = .004), heart failure (P = .019), asthma (P = .032), COPD (P = .036), epilepsy (P = .035), and lumbago (P = .046) compared to the control group. GPs described their 5-year pFAs by words related to lung and breathing issues, but there was no statistical difference to the 1-year FAs’ descriptions. Conclusion: A typical pFA seems to be a woman, aged about 55 years with depressive episodes, asthma or COPD, and lower back pain. Physicians describe pFAs with ordinary words in patient records. It was not possible to differentiate pFAs from 1-year FAs in this way.
Collapse
Affiliation(s)
- Anne Santalahti
- Turku City Healthcare Center, Turku, Finland.,University of Turku, Turku, Finland
| | - Sinikka Luutonen
- University of Turku and Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | | | | | - Sanna Salanterä
- University of Turku and Turku University Hospital, Turku, Varsinais-Suomi, Finland
| | - Päivi Rautava
- University of Turku and Turku University Hospital, Turku, Varsinais-Suomi, Finland
| |
Collapse
|
46
|
Posti JP, Luoto TM, Rautava P, Kytö V. Mortality After Trauma Craniotomy Is Decreasing in Older Adults-A Nationwide Population-Based Study. World Neurosurg 2021; 152:e313-e320. [PMID: 34082165 DOI: 10.1016/j.wneu.2021.05.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/19/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE No evidence-based guidelines are available for operative neurosurgical treatment of older patients with traumatic brain injuries (TBIs), and no population-based results of current practice have been reported. The objective of the present study was to investigate the rates of trauma craniotomy operations and later mortality in older adults with TBI in Finland. METHODS Nationwide databases were searched for all admissions with a TBI diagnosis and after trauma craniotomy, and later deaths for persons aged ≥60 years from 2004 to 2018. RESULTS The study period included 2166 patients (64% men; mean age, 70.3 years) who had undergone TBI-related craniotomy. The incidence rate of operations decreased with a concomitant decrease in adjusted mortality (30-day mortality, P < 0.001; 1-year mortality, P < 0.001) and increase in mean patient age (R2 = 0.005; P < 0.001) during the study period. The cumulative mortality was 25% at 30 days and 38% at 1 year. The comorbidities increasing the hazard for 30-day mortality were diabetes, a history of malignancy, peripheral vascular disease, and a history of myocardial infarction. For 1-year mortality, the comorbidities were heart failure and a history of myocardial infarction. Evacuation of an epidural hematoma decreased the hazard for mortality. In contrast, evacuation of an intracerebral hematoma and decompressive craniectomy increased the risk at both 30 days and 1 year. CONCLUSIONS Among older adults in Finland, the rate of trauma craniotomy and later mortality has been decreasing although the mean age of operated patients has been increasing. This can be expected to be related to an improved understanding of geriatric TBIs and, consequently, improved selection of patients for targeted therapy.
Collapse
Affiliation(s)
- Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Centre, Turku University Hospital and University of Turku, Turku, Finland.
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Päivi Rautava
- Clinical Research Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Centre and Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland; Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland; Administative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
47
|
Malmberg M, Ahtela E, Sipilä JOT, Gunn J, Rautava P, Kytö V. Surgical aortic valve replacement and infective endocarditis. Eur J Clin Invest 2021; 51:e13476. [PMID: 33326602 DOI: 10.1111/eci.13476] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/01/2020] [Accepted: 12/13/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND We wanted to investigate the influence of native-valve infective endocarditis (IE) on long-term outcomes of surgical aortic valve replacement (SAVR). METHODS Native-valve patients with IE (n = 191) were compared to propensity score-matched patients without IE (n = 191), all treated with SAVR, in a multicentre, population-based cohort register study in Finland. The median follow-up was 6.2 years. RESULTS Infective endocarditis as the indication for SAVR was associated with an increased hazard of 10-year mortality (37.1% vs 24.2%; HR 1.83; CI 1.03-3.26; P = .039). Ischaemic stroke was also more frequent in IE patients during 10-year follow-up (15.8% vs 7.5%; HR 3.80; CI 1.42-10.18; P = .008). Major bleeding within first year after SAVR was more frequent in patients with IE (7.0% vs 2.9%; P = .038). Ten-year major bleeding rate was 32.4% in IE vs 24.5% in non-IE groups (P = .174). Aortic valve re-operation rate was 4.3% in IE vs 8.4% in non-IE groups (P = .975). Admission duration after SAVR was longer in IE (median 29 vs 9 days; P < .0001). There was no difference in 30-day mortality after SAVR. CONCLUSIONS Patients with native-valve IE have a higher risk of death, ischaemic stroke, and early major bleeding after SAVR than matched patients without IE. Results confirm the high risk for complications of IE patients after SAVR and highlight the importance of vigorous prevention of both stroke and bleeding after SAVR in these patients.
Collapse
Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Elina Ahtela
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi O T Sipilä
- Department of Neurology, Siun Sote, North Karelia Central Hospital, Joensuu, Finland.,Clinical Neurosciences, University of Turku, Turku, Finland.,Neuro Center, Turku University Hospital, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administative Center, Hospital District of Southwest Finland, Turku, Finland
| |
Collapse
|
48
|
Abstract
Background The female sex is associated with poorer outcomes after myocardial infarction (MI), although current evidence in older patients is limited and mixed. We sought to evaluate sex-based differences in outcome after MI in older patients. Method Consecutive older (≥70 years) all-comer patients with out-of-hospital MI admitted to 20 hospitals in Finland between 2005 and 2014 were studied using national registries (n = 40 654, mean age 80 years, 50% women). The outcome of interest was death within 1 year after MI. Differences between sexes (age, baseline features, medication, comorbidities, revascularization, and treating hospital) were balanced by inverse probability weighting. Results Adjusted all-cause case fatality was lower in women than in men at 30 days (16.0% vs 19.0%, respectively) and at 1 year (27.7% vs 32.4%, respectively) after MI (hazard ratio: 0.83; confidence interval [CI]: 0.80–0.86; p < .0001). Excess 1-year case fatality after MI compared to the corresponding general population was 22.1% (CI: 21.4%–22.8%) in women and 24.1% (CI: 23.4%–24.9%) in men. Women had a lower adjusted hazard of death after MI in subgroups of patients aged 70–79 years and ≥80 years, patients with and without ST elevation MI, revascularized and non-revascularized patients, patients with and without atrial fibrillation, and patients with and without diabetes. The sex difference in case fatality remained similar during the study period. Conclusions Older women were found to have a lower hazard of death after an out-of-hospital MI when compared to older men with similar features and treatments. This finding was consistent in several subgroups.
Collapse
Affiliation(s)
- Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Maria Nuotio
- Research Services and Department of Clinical Medicine, Turku University Hospital, Turku, Finland.,Division of Geriatric Medicine, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| |
Collapse
|
49
|
Siekkinen M, Kuokkanen L, Kuusisto H, Leino-Kilpi H, Rautava P, Rekunen M, Seppänen L, Stolt M, Walta L, Sulosaari V. Work empowerment among cancer care professionals: a cross-sectional study. BMC Health Serv Res 2021; 21:502. [PMID: 34034734 PMCID: PMC8146678 DOI: 10.1186/s12913-021-06528-8] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/13/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND There is a growing understanding that empowerment of interprofessional personnel is linked to job satisfaction levels and quality of care, but little is known about empowerment in the context of cancer care. This study describes how interprofessional cancer care personnel perceive their performance and factors that promote work empowerment. METHODS This cross-sectional study enrolled 475 (45.2%) of the 1050 employees who work at a regional cancer centre. The participants used two self-administered questionnaires - the Performance of an Empowered Personnel (PEN) questionnaire and Work Empowerment Promoting Factors (WEP) questionnaire - to report perceptions of work empowerment. Both questionnaires' categories comprise moral principles, personal integrity, expertise, future orientation, and sociality. The data were analyzed using IBM SPSS Statistics, Versions 24 and 25. RESULTS Overall, the performance of work empowerment was evaluated as being rather high (overall sum score mean: 4.05; range: 3.51-4.41; scale: 1-5). The category that rated highest was moral principles (4.41), and the one rated lowest was the social category (3.51). The factors that promoted work empowerment also ranked high (3.93; range: 3.55-4.08; scale: 1-5), with personal integrity (4.08) the highest and future orientation (3.55) the lowest. Performance and factors that promoted work empowerment correlated positively, moderately, and highly statistically significantly (r = 0.531; p < 0.001). Statistically significant associations also were found between empowered performance of personnel and empowerment promoting factors (sex, education, leadership position, belonging to an interprofessional team, and time elapsed since training in interprofessional cooperation). CONCLUSION The personnel rated their performance and the factors perceived to promote work empowerment rather highly. Personal empowerment can be promoted through teamwork training and supportive management in interprofessional cancer care.
Collapse
Affiliation(s)
- Mervi Siekkinen
- Turku University Hospital, FICAN West Cancer Centre, P.O. Box 52, FI-20521, Turku, Finland.
| | | | | | - Helena Leino-Kilpi
- University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland
| | - Päivi Rautava
- University of Turku, Public Health and Turku University Hospital, Clinical Research Services, Turku, Finland
| | - Maijastiina Rekunen
- Turku University Hospital, FICAN West Cancer Centre, P.O. Box 52, FI-20521, Turku, Finland
| | - Laura Seppänen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Minna Stolt
- University of Turku, Department of Nursing Science, Turku University Hospital, Turku, Finland
| | - Leena Walta
- Turku University of Applied Sciences, Turku, Finland
| | | |
Collapse
|
50
|
Salomäki S, Rautava P, Junttila N, Huhtala M, Leppänen MH, Nyman A, Koivisto M, Haataja L, Lehtonen L, Korja R. Social functioning questionnaires of adolescents born preterm show average profiles and attenuated sex differences. Acta Paediatr 2021; 110:1490-1497. [PMID: 33341096 DOI: 10.1111/apa.15728] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/24/2020] [Accepted: 12/16/2020] [Indexed: 11/28/2022]
Abstract
AIM Prematurity has been shown to affect social competence in children and adults. Our aim was to evaluate profiles of self-reported social behaviours and loneliness in preterm- and term-born adolescents. METHODS Preterm (≤1500 g and, or, <32 gestational weeks)- and term-born infants were recruited in Turku University Hospital from 2001 to 2006. The Multisource Assessment of Children's Social Competence Scale and the Peer Network and Dyadic Loneliness Scale were completed at the age of 11. Profiles of social competence and loneliness were labelled as low, average or high. RESULTS A total of 172 preterm-born and 134 term-born adolescents returned the questionnaires. Most frequently, preterm adolescents reported a profile of average social competence and average levels of loneliness. Preterm-born boys reported a profile of low social functioning less often (preterm-born 36% vs. term-born 54%), and preterm-born girls reported a profile of high social functioning less frequently (preterm-born 26% vs. term-born 37%) than same-sex controls. Sex differences in social functioning profiles were smaller in preterm than term-born adolescents. CONCLUSION The majority of young adolescents born preterm reported a high or average social functioning profile irrespective of sex. Prematurity seems to level out differences between the sexes.
Collapse
Affiliation(s)
| | - Päivi Rautava
- Department of Public Health University of Turku Turku Finland
- Clinical Research Center Turku University Hospital Turku Finland
| | - Niina Junttila
- Department for Teacher Education University of Turku Turku Finland
| | - Mira Huhtala
- Department of Oncology and Radiotherapy University of Turku and Turku University Hospital Turku Finland
| | - Marika H. Leppänen
- Clinic of Child Psychiatry University of Turku and Turku University Hospital Turku Finland
| | - Anna Nyman
- Department of Psychology University of Turku Turku Finland
| | - Mari Koivisto
- Clinical Research Center Turku University Hospital Turku Finland
| | - Leena Haataja
- Children's Hospital Pediatric Research Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Liisa Lehtonen
- Department of Pediatrics University of Turku and Turku University Hospital Turku Finland
| | - Riikka Korja
- Department of Psychology University of Turku Turku Finland
| | | |
Collapse
|