1H NMR Urinary Metabolomic Analysis in Older Adults after Hip Fracture Surgery May Provide Valuable Information for Patient Profiling-A Preliminary Investigation.

In these times of precision and personalized medicine, profiling patients to identify their needs is crucial to providing the best and most cost-effective treatment. In this study, we used urine metabolomics to explore the characterization of older adults with hip fractures and to explore the forecasting of patient outcomes. Overnight urine specimens were collected from 33 patients (mean age 80 ± 8 years) after hip fracture surgery during their stay at a rehabilitation hospital. The specimens were analyzed with 1H NMR spectroscopy. We performed a metabolomics study regarding assessments of frailty status, Functional Independence Measure (FIM), and Short Physical Performance Battery (SPPB). The main metabolic variations concerned 10 identified metabolites: paracetamol derivatives (4 peaks: 2.15 ppm; 2.16 ppm; 7.13 ppm and 7.15 ppm); hippuric acid; acetate; acetone; dimethylamine; glycine; alanine; lactate; valine; TMAO. At baseline, the urinary levels of these metabolites were significantly higher (i) in frail compared with non-frail patients, (ii) in persons with poorer FIM scores, and (iii) in persons with poorer compared SPPB scores. Our findings suggested that patients with increased levels of urine metabolites associated with metabolic, inflammatory, and renal disorders presented clear signs of frailty, impaired functional independence, and poor physical performance. Metabolomics could be a valuable tool to further characterize older adults, especially after major medical events.

Lifestyle counseling in overweight truck and bus drivers - Effects on dietary patterns and physical activity.

UNLABELLED: We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. TRIAL REGISTRATION: Clinical Trials NCT00893646.

[Update on Current Care Guideline: Physical activity and exercise training for adults in sickness and in health]. / KÄYPÄ HOITO -SUOSITUS (Päivitystiivistelmä). Liikunta.

The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.

[Update on Current Care Guideline: Insomnia]. / KÄYPÄ HOITO-SUOSITUS (Päivitystiivistelmä). Unettomuus.

Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. Treatment of acute insomnia with hypnotics should not exceed two weeks. In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.

Associations of physical activity with self-rated health and well-being in middle-aged Finnish men.

AIMS: We examined the associations of physical activity (PA) frequency with self-rated health (SRH), self-rated well-being (SRW) and depressive symptoms, in middle-aged men in Finland. METHODS: The cross-sectional study comprised 665 men (mean age 41 ± 3 SD years; body mass index (BMI) 26.8 ± 4.2 SD kg/m(2)), who had completed the screening questionnaire of an intervention for men with cardiovascular risk factors. Their weekly frequency of PA was assessed by a questionnaire, SRH and SRW by visual analog scales (VAS), and depressive symptoms by the Patient Health Questionnaire-2 (PHQ-2). RESULTS: The mean SRH ± SD (range of scale 0-100) by PA frequency categories was 56.2 ± 18.5 for PA sometimes or never, 63.8 ± 16.2 for PA about 1-2 times/week, and 71.1 ± 15.5 for PA at least 3 times/week. The mean SRW ± SD (range of scale 0-100) was 59.0 ± 20.4, 65.6 ± 17.6, and 68.9 ± 17.1, respectively. The mean PHQ-2 score ± SD (range of scale 0-6) by PA categories was 1.83 ± 1.40 for PA sometimes or never, 1.68 ± 1.28 for PA about 1-2 times/week, and 1.60 ± 1.31 for the PA at least 3 times/week group. SRH and SRW improved linearly with increasing PA frequency (both p < 0.001), and the results remained similar after adjustment for BMI, education and smoking status. No association existed between PA frequency and PHQ-2. CONCLUSIONS: More frequent PA was linearly associated with better SRH and SRW, but not with depressive symptoms that were measured by a brief depression screening tool.

Hysteroscopic tubal sterilization: a systematic review of the Essure system.

OBJECTIVE: To update the evidence of the efficacy and safety of the Essure system. Female sterilization has undergone changes in the last decade. Besides laparoscopic tubal occlusion, the Essure system is now a viable option, with about 200,000 women sterilized using this method. DESIGN: The review is based on the report of the Alberta Heritage Foundation for Medical Research and completed with systematic literature searches up to April 8, 2008. SETTING: The Managed Uptake of Medical Methods program of the Finnish National Research and Development Center for Health and Welfare. PATIENT(S): Women over 30 years, who had been sterilized by the Essure method. INTERVENTION(S): Hysteroscopic tubal sterilization using Essure system. MAIN OUTCOME MEASURE(S): Efficacy/effectiveness, adverse events, costs. RESULT(S): Sterilization by Essure can be performed under local anesthesia or with oral analgesics in ambulatory settings. However, sterilization is not immediate and women must use additional contraception for 3 months until permanent tubal occlusion is verified by transvaginal ultrasound, hysterosalpingosonography, hysterosalpingography, or pelvic radiography. The evidence on efficacy and safety is mainly available from short follow-up case series but shows good efficacy and safety of the Essure system. Only a few small risks are associated with the procedure. Two economic studies, one of which implemented Essure as an in-office procedure, suggest that Essure could be more cost-effective than laparoscopic sterilization, but more information on the total cost is needed. CONCLUSION(S): The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.

Effects of concurrent strength and endurance training on physical fitness and symptoms in postmenopausal women with fibromyalgia: a randomized controlled trial.

OBJECTIVE: To examine the effectiveness of concurrent strength and endurance training on muscle strength, aerobic and functional performance, and symptoms in postmenopausal women with fibromyalgia (FM). DESIGN: Randomized controlled trial. SETTING: Local gym and university research laboratory. PARTICIPANTS: Twenty-six women with FM. INTERVENTION: Progressive and supervised 21-week concurrent strength and endurance training. MAIN OUTCOME MEASURES: Muscle strength of leg extensors, upper extremities, and trunk; peak oxygen uptake (Vo(2)peak), maximal workload (Wmax), and work time; 10-m walking and 10-step stair-climbing time and self-reported functional capacity (Health Assessment Questionnaire); and symptoms of FM. RESULTS: After concurrent strength and endurance training, the groups differed significantly in Wmax (P=.001), work time (P=.001), concentric leg extension force (P=.043), walking (P=.001) and stair-climbing (P<.001) time, and fatigue (P=.038). The training led to an increase of 10% (P=.004) in Wmax and 13% (P=.004) in work time on the bicycle but no change in Vo(2)peak. CONCLUSIONS: Concurrent strength and endurance training in low to moderate volume improves the muscle strength of leg extensors, Wmax, work time, and functional performance as well as perceived symptoms, fatigue in particular. Concurrent strength and endurance training is beneficial to postmenopausal women with FM without adversities, but more extensive studies are needed to confirm the results.

Association of the IL6-174(G/C) polymorphism with C-reactive protein concentration after weight loss in obese men.

Elevated plasma concentration of C-reactive protein has emerged as an important predictor of future cardiovascular diseases and metabolic abnormalities in apparently healthy individuals. Obese individuals tend to have elevated C-reactive protein concentrations. Weight loss induces a change in this protein, and single nucleotide polymorphisms in regulating genes might affect this change, since C-reactive protein concentration is known to be approximately 40-50% heritable. Our aim was to study the association between the IL6 -174(G/C), IL1B +3,954(C/T) and CRP +1,059(G/C) single nucleotide polymorphisms, and CRP concentrations in obese men during a weight reduction program. We genotyped 72 obese men who had participated in a weight reduction program. Their C-reactive protein concentrations, interleukin-6 levels and fat mass were determined at two time points: at baseline and after weight reduction (after 2 months). After weight reduction, the mean weight loss was 14.3 kg. Median C-reactive protein concentrations decreased, after weight reduction, from 1.72 to 1.22 mg/l (p < 0.02). The baseline C-reactive protein concentration did not differ between the IL6-174(G/C) genotypes, but after weight loss, concentrations differed (p = 0.03 Kruskal-Wallis test); the highest concentration was found in the CC genotype (CC 1.01 versus GG 1.93 mg/l, p = 0.007 ANOVA post-hoc test). This change in concentration was associated with the IL6-174(G/C) genotype (p = 0.01, Kruskal-Wallis test), being least in the CC genotype. The other single nucleotide polymorphisms studied were not associated with CRP concentrations. Our results show that, at baseline, there is no difference in C-reactive protein concentrations among the different IL6-174(G/C) genotypes, but after weight loss the CC genotype is associated with highest C-reactive protein concentrations, resulting from the fact that C-reactive protein seems not to decrease with weight loss in this genotype.

Gender differences in the treatment and secondary prevention of CHD at population level.

OBJECTIVES: Treatment and secondary prevention measures, received by persons with coronary heart disease (CHD), are insufficiently known at the moment. The aim of this study was to investigate the state of treatment and secondary prevention of CHD in a population-based sample and to analyze possible gender differences in different age groups. DESIGN: 300 men and 300 women with CHD were identified from a nationally representative health examination survey with 88% participation rate, carried out in Finland in 2000-2001. RESULTS: Revascularization had been performed on 34% (95% confidence interval 29, 40%) of men and 13% (8, 18%) of women. Moreover, 76% (71, 81%) of the men and 63% (57, 69%) of the women used antithrombotic medications. Two thirds of both men and women used beta-blockers and one third lipid-lowering medication. Smoking was more common among men, whereas obesity and high total cholesterol concentration were more common among women. CONCLUSIONS: Secondary prevention of CHD is far from optimal and there are gender differences in the care of CHD.