Unlocking the Dietary Puzzle: How Macronutrient Intake Shapes the Relationship between Visfatin and Atherosclerosis in Type 2 Diabetes.

Background and Objectives. Optimal nutrition for type 2 diabetes (T2DM) aims to improve glycemic control by promoting weight loss and reducing adipose tissue, consequently improving cardiovascular health. Dietary alterations can influence adipose tissue metabolism and potentially impact adipocytokines like visfatin, thereby affecting atherosclerosis development. This study aimed to investigate dietary habits and adherence to recommendations among individuals with T2DM and to examine how dietary adherence influences the association between visfatin and subclinical atherosclerosis. Materials and Methods: This cross-sectional multicenter study involved 216 adults (30-70 years) with T2DM, assessing dietary habits, adherence to recommendations (carbohydrates, fats, protein, fiber, saturated fatty acid, polyunsaturated and monounsaturated fatty acid (PUFA and MUFA) and salt), and the association between visfatin and subclinical atherosclerosis. Participants completed 24 h dietary recalls; dietary misreporting was assessed using the Goldberg cut-off method. Carotid intima-media thickness (IMT) and plaque occurrence were evaluated with ultrasound, while visfatin levels were measured using Luminex's xMAP technology. Results: Three of the eight recommendations were followed in 31% of subjects, two in 26%, and four in 20%, with the highest adherence to MUFA and protein intake. Significant correlations between IMT and visfatin were observed in individuals with specific dietary patterns. The association between IMT and visfatin persisted when PUFA and MUFA intake aligned with recommendations. PUFA intake ≤ 10% and MUFA ≤ 20% of total energy significantly correlated with carotid artery IMT (p = 0.010 and p = 0.006, respectively). Visfatin's associations with IMT remained significant (p = 0.006) after adjusting for common risk factors, medication use, and dietary nonadherence. No association was observed with carotid artery plaque. Conclusions: Dietary compliance was limited, as only 31% adhered even to three of eight recommendations. A common dietary pattern characterized by low carbohydrate and fiber but high fat, total fat, saturated fat, and salt intake was identified. This pattern amplifies the statistical association between visfatin and subclinical atherosclerosis.

Visfatin and Subclinical Atherosclerosis in Type 2 Diabetes: Impact of Cardiovascular Drugs.

Background and Objectives: The role of adipokines in the development of atherosclerosis in type 2 diabetes (T2DM) has not yet been fully elucidated. The effects of drugs on adipokine concentrations have only been evaluated in very few studies, although they may be of clinical importance. This study aimed to assess whether the concentrations of circulating adipokines could predict subclinical atherosclerosis in patients with T2DM, as well as their interactions with commonly used cardiovascular drugs. Materials and Methods: Our population-based cross-sectional multicentric study included 216 participants with T2DM but without previously diagnosed atherosclerosis. The carotid artery intima-media thickness (IMT), plaque and ankle-brachial index (ABI) metrics were measured. Resistin, visfatin, retinol-binding protein 4, high molecular weight adiponectin and leptin levels were evaluated using Luminex's xMAP technology. Results: Visfatin and resistin concentrations correlated positively with IMT (p = 0.002 and p = 0.009, respectively). The correlation of visfatin to IMT ≥ 1.0 mm was significant in males (p < 0.001). Visfatin had a positive correlation with IMT ≥ 1.0 mm or plaque (p = 0.008) but resistin only correlated with plaque (p = 0.049). Visfatin predicted IMT ≥ 1.0 mm or plaque in patients on ß-blocker monotherapy (p = 0.031). Visfatin lost its ability to predict subclinical atherosclerosis in patients taking angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers or statins. After adjustments for risk factors for atherosclerosis and cardiovascular drugs, visfatin maintained an independent association with mean IMT (p = 0.003), IMT ≥ 1.0 mm or plaque (p = 0.005) and ABI ≤ 0.9 (p = 0.029). Conclusions: Visfatin could be used as a marker of subclinical atherosclerosis in patients with T2DM, especially in males. The assessment of visfatin concentration could aid in identifying individuals who could benefit from implementing preventive measures against atherosclerosis.

Changes in adipokine levels and metabolic profiles following bariatric surgery.

BACKGROUND: Bariatric surgery is considered to be the most effective treatment option for weight reduction in obese patients. Abdominal obesity is frequently accompanied by metabolic syndrome (MS). Adipokines are cell signaling proteins that have direct impact upon the metabolic homeostasis. The purpose of this analysis was to evaluate the effect of bariatric surgery, including laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric bypass (LRYGB) on the adipokine levels and metabolic profile as well as MS and status of type 2 diabetes (T2D). METHODS: We analyzed anthropometric parameters, blood levels of adipokines, vitamins, lipids and inflammatory markers in 30 bariatric surgery patients with obesity of class II or III 1 month before and 1 year after surgery as well as in 60 obese patients from general practice (GP) and 15 patients with normal body mass (control). RESULTS: The BMI was significantly higher among patients before surgery and GP patients in comparison to control and post-surgery patients. The levels of glucose, cholesterol and LDL-cholesterol, triglyceride and hs-CRP were the highest in patients before surgery but decreased significantly after surgery, while the level of HDL-cholesterol increased after surgery. The levels of adiponectin increased and that of leptin decreased after surgery. The significant difference in the concentration of resistin was revealed between LSG and LRYGB methods. The relationship between resistin and vitamin D was also found. The patients with MS and T2D displayed significantly greater reduction in lipid markers and adipokine levels than the rest of patients. CONCLUSION: Remarkable changes in levels of adipokines after bariatric surgery appear like increase in adiponectin and decrease in leptin levels. Significant improvement in anthropometric parameters, metabolic and inflammatory markers occurs, suggesting high potential for reduction of metabolic syndrome and risk for type 2 diabetes. We have shown for the first time ever that level of vitamin D may be involved in resistin regulation.

Impact of obesity on vascular calcification in patients with chronic kidney disease.

AIM: The aim of this study was to compare vascular calcification (VC) in obese and non-obese chronic kidney disease (CKD) patients, using three methods for measuring VC. MATERIALS AND METHODS: The study included 168 consecutive patients with CKD. Patients were divided into two groups by body mass index (BMI) - group 1 (BMI ≥ 30 kg/m2) and group 2 (BMI < 30 kg/m2), and according to estimated glomerular filtration rate (eGFR) - subgroup A (eGFR < 45 mL/min/1.73m2) and subgroup B (eGFR < 45 mL/min/1.73m2). VC was assessed by measuring abdominal aortic calcification (AAC), ankle-brachial index (ABI) and echocardiography. RESULTS: Group 1 patients were older (p = 0.03). There was a relatively low number of diabetics in our study cohort: 41 patients, (24%). The number of diabetics was similar in both groups. The presence of AAC was more common in 1B and 2B than in 1A and 2A groups (p = 0.005 and p = 0.02) and in 1B group compared to 2B group (p = 0.05). In both groups, ABI ≥ 1.3 and ABI < 0.9 were more common in B subgroups. The presence of heart valvular lesions was very high in both groups. Spearman rank-order analysis of every cohort demonstrated significant correlation between AAC and heart valve lesions (Spearman R = 0.3; p = 0.01) and also between AAC and LVH (Spearman R = 0.3; p = 0.004). Analysis of variance of every cohort showed that in patients with ABI ≥ 1.3 and heart valve lesions, Kauppila score was significantly higher than in those with normal heart valves. CONCLUSION: Our study shows that obesity is not an independent predictor of VC in CKD patients. VC, assessed by three different methods, was more pronounced in obese patients with lower kidney function.

Significant associations between bone mineral density and vascular calcification in patients with different stages of chronic kidney disease.

INTRODUCTION: Chronic kidney disease-mineral and bone disorders (CKD-MBD) is characterised by generalised vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in CKD patients. METHODS: We performed a cross-sectional study of patients with different stages of CKD. For assessment of VC of abdominal aorta lateral lumbar X-rays (Kauppila score), the ankle-brachial index (ABI) and echocardiography were used. Total body densitometry provided BMD. RESULTS: Ninety patients (41% male, median age 64 years (range 29-87)) were included, of whom 41.1% had a Kauppila score > 1. Evidence of peripheral VC as measured by ABI was detected in 23.3% of cases. Lesions of the heart valves were found in 46.7% of patients. There was a significant association between high ABI and lesions of the heart valves. In the multivariate regression model to analyse the independent determinants of abdominal aorta calcification (AAC) and ABI, the BMD of the femoral neck was identified as significant for both (p = 0.001, p = 0.001). The total spine BMD was found to be significant for AAC (p = 0.001), and the BMD of spine L1-L4 and the ribs were found to be significant for ABI (p = 0.01, p = 0.002 respectively). In factorial regression analysis, where BMD was independent determinant, valvular calcification was significant for BMD of femur, femoral neck and total BMD. Age and tALP were inversely correlated with the BMD of femur and femoral neck. CONCLUSIONS: Our work highlighted clinically important relationships between VC and bone mineral density (BMD) in CKD patients. We detected inverse relationships between AAC, high ABI and BMD. Secondly, BMD at certain bone sites (femur, femoral neck) and total BMD were associated with important lesions of heart valves. Thirdly, a significant association between a high ABI and lesions of the heart valves. We believe that the results of our study will help in the planning of future research and in current clinical practice for the early diagnosis, further monitoring and management of CKD-MBD. Additionally, these results may have treatment implications on use of different CKD-MBD medications.

Subclinical atherosclerosis in the carotid artery: can the ankle-brachial index predict it in type 2 diabetes patients?

Atherosclerosis is a progressive asymmetrical systemic disease that progresses faster in patients with diabetes comorbidity. Therefore, type 2 diabetic (T2DM) patients who have a high risk of, or have already detected, early atherosclerosis should be treated aggressively to prevent premature mortality. We hypothesised that subclinical atherosclerosis is predictable with the ankle-brachial index (ABI). There are currently only a few studies to indicate which specific value of ABI can predict atherosclerosis in the carotid artery. Our study aimed to examine ABI ≤ 1.1 ability to predict ultrasound-visualised atherosclerosis in carotid arteries in patients with T2DM, who had not been previously diagnosed with atherosclerosis. A population-based cross-sectional multicentric study was performed in 216 participants (mean age 59 ± 8 years). Carotid artery intima-medial thickness (IMT) ≥1 mm ± plaque was defined as a marker for subclinical atherosclerosis and was compared with ABI. Mean duration of T2DM was 7.05 ± 6.0 years. Atherosclerosis in the carotid artery was found in 96 (44%) patients, with no significant differences between genders (47 vs 53%, p = .206). ABI ≤1.1 was associated with the carotid artery mean IMT ≥1 mm (p = .037), plaque (p = .027) and IMT ≥1 mm ± plaque (p = .037). The association between ABI ≤ 1.1 and IMT ≥ 1 mm ± plaque remained significant after adjustment for risk factors and age >50 years. Observations demonstrated that ABI ≤ 1.1 could be an indicator of subclinical atherosclerosis for T2DM male patients over 50 years old.

Structural and Functional Changes of Hands and Legs in Early Rheumatoid Arthritis.

Background and Objectives: The aim of this study was to assess if there are structural and functional changes of hands and legs already in early rheumatoid arthritis (ERA), compared with the population-based control group. Additionally, we aimed to identify if the changes are symmetrical in hands and legs and if there are factors that are associated with these changes. The study was conducted, and, thus far, the results have been controversial. Materials and Methods: The study group consisted of 83 consecutive patients with ERA and 321 control subjects. Dual-Energy X-Ray Absorptiometry (DXA) machine was used to measure bone, lean and fat mass. Inflammation and bone markers, smoking and nutritional habits were assessed, to evaluate the effects of different factors. The 30-Second Chair Stand Test (30-CST) and the Handgrip Strength Test (HST) were used to estimate muscle strength. Results: The presence of ERA was associated with lower arm, leg lean mass and higher fat mass of arm, compared with control subjects. ERA was also associated with lower mean handgrip in HST and worse muscle strength of legs in the 30-CST. Bone mass changes were not so evident both in arms and legs. Smoking habits did not seem to have relevant effect on bone mass, muscle structural and functional changes, both on hands and legs. In ERA, lean mass of arm and leg was negatively associated with C-reactive protein (CRP). The intake of proteins in ERA was not associated with lean mass changes both in hands and legs. Conclusions: Structural and functional changes of hands and legs are different in ERA. ERA patients had higher fat mass of arm, lower lean mass of arm and leg and, accordingly, decreased muscle function. The lowering of lean mass of arm and leg in ERA was associated with the elevation of CRP.

Factors Associated With Low Lean Mass in Early Rheumatoid Arthritis: A Cross- Sectional Study.

Background and Objectives: The aim of the study was to evaluate body composition (BC) of rheumatoid arthritis (RA) patients at disease onset compared to population controls focusing on the associations between low lean mass and disease specific parameters, nutritional factors and physical activity. Materials and Methods: 91 patients with early rheumatoid arthritis (ERA) (72% female) and 328 control subjects (54% female) were studied. BC- lean and fat mass parameters were measured with a Lunar Prodigy Dual Energy X-Ray Absorptiometry (DXA) machine. The prevalence, age and gender adjusted odds ratios of having low lean mass and overfat, associations between nutrition, physical activity, and ERA disease specific parameters and the presence of low lean mass were evaluated. Results: We found that the BC of patients with recent onset RA differs from control subjects-ERA patients had a higher mean body fat percentage (BFP) and lower appendicular lean mass (ALM). 41.8% of the ERA patients and 19.8% of the controls were classified as having low lean mass adjusted OR 3.3 (95% C.I. 1.9-5.5, p < 0.001). 68.1% of the ERA subjects and 47.3% of the controls were overfat (adjusted OR 1.9 (95% C.I. 1.1-3.3, p = 0.02)) and the adjusted odds of having both low lean mass and overfat were 4.4 times higher (26.4% vs. 7.0% 95% C.I. 2.3-8.4, p < 0.001) among the ERA group. Higher ESR (OR 1.03, C.I.1.002-1.051, p = 0.03), CRP (OR 1.03, C.I. 1.002-1.061, p = 0.04), lower protein intake (OR 0.98 C.I. 0.96-0.99, p = 0.04), corticosteroid usage (OR 3.71 C.I. 1.4-9.9, p < 0.01) and lower quality of life (higher HAQ score OR 2.41 C.I. 1.24-4.65, p < 0.01) were associated with having low lean mass in the ERA group (adjusted to age and gender). Conclusions: Patients with early RA have lower appendicular lean mass and higher body fat percentage compared to healthy controls. Loss of lean mass in early RA is associated with elevated inflammatory markers inducing catabolism, lower protein intake and also with GCS treatment.

Quality of life after hip, vertebral, and distal forearm fragility fractures measured using the EQ-5D-3L, EQ-VAS, and time-trade-off: results from the ICUROS.

INTRODUCTION: The International Costs and Utilities Related to Osteoporotic fractures Study is a multinational observational study set up to describe the costs and quality of life (QoL) consequences of fragility fracture. This paper aims to estimate and compare QoL after hip, vertebral, and distal forearm fracture using time-trade-off (TTO), the EuroQol (EQ) Visual Analogue Scale (EQ-VAS), and the EQ-5D-3L valued using the hypothetical UK value set. METHODS: Data were collected at four time-points for five QoL point estimates: within 2 weeks after fracture (including pre-fracture recall), and at 4, 12, and 18 months after fracture. Health state utility values (HSUVs) were derived for each fracture type and time-point using the three approaches (TTO, EQ-VAS, EQ-5D-3L). HSUV were used to estimate accumulated QoL loss and QoL multipliers. RESULTS: In total, 1410 patients (505 with hip, 316 with vertebral, and 589 with distal forearm fracture) were eligible for analysis. Across all time-points for the three fracture types, TTO provided the highest HSUVs, whereas EQ-5D-3L consistently provided the lowest HSUVs directly after fracture. Except for 13-18 months after distal forearm fracture, EQ-5D-3L generated lower QoL multipliers than the other two methods, whereas no equally clear pattern was observed between EQ-VAS and TTO. On average, the most marked differences between the three approaches were observed immediately after the fracture. CONCLUSIONS: The approach to derive QoL markedly influences the estimated QoL impact of fracture. Therefore the choice of approach may be important for the outcome and interpretation of cost-effectiveness analysis of fracture prevention.

The metabolic profile in early rheumatoid arthritis: a high prevalence of metabolic obesity.

The aim of the study was to compare the prevalence of metabolic syndrome (MetS) in early RA patients with age-gender-matched population controls focusing on the presence of MetS in different weight categories. The study group consisted of 91 consecutive patients with early RA and 273 age- and gender-matched controls subjects. MetS was diagnosed according to the National Cholesterol Education Program (NCEP-ATP III) criteria. Mean age in both groups was 52 years, and 72.5 % were female. The prevalence of MetS did not differ between the two groups (35.2 % in RA, 34.1 % in control group). Mean systolic blood pressure in the RA group was 137 mmHg, in control group 131 mmHg, P = 0.01, and diastolic blood pressure 85 versus 81 mmHg, respectively (P < 0.01). We found that 20 of 65 (30.8 %) of RA patients compared to 80 of 152 (52.6 %) of the control subjects with elevated blood pressure received antihypertensive treatment (P < 0.01). When comparing subgroups with normal BMI, the odds of having MetS (being metabolically obese) were higher among early RA subjects (OR 5.6, CI 1.3-23.8). Of the individual components of metabolic syndrome, we found increased prevalence of hypertension (OR 2.8, CI 1.3-6.0) and hyperglycemia (OR 2.9, CI 1.0-8.0) in the RA group. Recognition of abnormal metabolic status among normal-weight RA patients who have not yet developed CVD could provide a valuable opportunity for preventative intervention.

The impact of hip fracture on mortality in Estonia: a retrospective population-based cohort study.

BACKGROUND: Estimates of hip fracture mortality in Eastern Europe are scarce. We aimed to estimate the magnitude and duration of excess mortality after hip fracture in Estonia. METHODS: Retrospective, population-based 10-year study of persons aged ≥50 in two cohorts: with hip fracture and an age- and sex-matched (in a 1:4 ratio) random sample from the national health insurance fund database for comparison. Cumulative risks, excess risks and relative risks of death were estimated using Poisson regression with 95% bootstrap confidence intervals (CI). Risks were adjusted for age and Charlson comorbidity index. RESULTS: We identified 8298 (2383 men, 5915 women) incident hip fracture patients from 2005 to 2013 and 33,191 (9531 men, 23,660 women) individuals for the reference group. 5552 (1564 men, 3988 women) cases and 14,037 (3514 men, 10,523 women) reference individuals died during the 10-year follow-up period. Among hip fracture patients we observed a pronounced and durable excess risk of death that was highest within 3-6 months after fracture and persisted for the full 10-year follow-up period. After adjustment for age and Charlson index, hip fracture was associated with a 21.1% (95% CI 20.0-22.5%) 10-year cumulative excess risk of death (RR 1.37, 95% CI 1.35-1.40). We found a high immediate excess risk of death in older age groups (≥80 years) and gradually accumulating excess risk in younger age groups (50-79 years). The excess risk was more pronounced among men than women. CONCLUSIONS: By the end of the 10-year follow-up, 1 in 4 deaths in the hip fracture group was attributable to the hip fracture. The results indicate a high attributable impact of hip fracture as an independent risk factor for death.

Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study.

AIM: To determine the detection rates, clinical features, and risk factors for lack of registration of alcohol use in medical patients admitted in European hospitals. METHODS: A point-prevalence, cross-sectional, multicenter survey involving 2100 medical inpatients from 43 hospitals from 8 European countries. Patients were screened for current alcohol use, using standardized questionnaires. Alcohol use recording in medical records was assessed. RESULTS: Of the 2100, more than a half reported alcohol use. Significant differences were shown in the prevalence of drinking and the recording rates of alcohol use among the hospitals and countries involved. Overall, 346 patients (16%) fulfilled criteria for alcohol use disorder. Alcohol use was registered in 909 (43%) of medical records, with quantification in 143 (7%). Multivariate analysis showed that women (OR 1.49), older age patients (OR 1.23), patients from the Northern European countries (OR 4.79) and from hospitals with high local alcohol prevalence (OR 1.59) were more likely to have lack of alcohol use registration in their medical files. CONCLUSIONS: A considerable proportion of medical patients admitted in European hospitals fulfill criteria for alcohol use disorders. These patients are frequently overlooked during hospitalization and not appropriately registered in medical records. Women, older patients, and inpatients from European areas with high local alcohol use prevalence are at higher risk associated with a non-recording of alcohol use.

Adverse lifestyle and health-related quality of life: gender differences in patients with and without chronic conditions.

OBJECTIVES: The aim was to investigate the relationship between the main lifestyle-related factors and health-related quality of life (HRQoL) in a sample of patients with and without chronic conditions (CCs) with respect to the gender differences in both groups. METHODS: A cross-sectional study was conducted on 1061 patients (of which 308 had no CCs and 753 of those had one or more CCs) recruited at primary health care centres and the Internal Medicine Clinic at Tartu University Hospital in Estonia. Data were collected during 2012-2014. The patient's age, self-reported smoking status, alcohol consumption (assessed by Alcohol Use Disorders Identification Test) and body mass index were used as independent variables to predict the physical component scores (PCS) and mental component scores (MCS) of HRQoL (assessed by SF-36). RESULTS: Smoking had a negative association with both physical and mental components of HRQoL only in women with CCs. Further, the PCS of chronically ill women was negatively associated with the higher body mass index. Harmful drinking had a negative association with the HRQoL in all patient groups, except with the PCS in women with CC. Light alcohol consumption without symptoms of harmful use or dependency had a positive association with the physical and mental HRQoL in all patient groups, except with the MCS in women without CCs. CONCLUSION: Adverse lifestyle had the most expressed association with HRQoL in women with CCs. Light alcohol consumption had a positive association, but harmful use of alcohol had an inverse association with HRQoL irrespective of patients' gender or health status.

Level of knowledge and sources of information about the rheumatoid arthritis in Estonian patients.

The objective of this paper was to find out how many patients with rheumatoid arthritis (RA) know about several aspects of disease, to explain the associations between the level of self-rated knowledge and patients' background and health status and to compare the importance of the main sources of information. A random sample (n = 1,259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, use of health services, information about the disease, and sources of information. Regression analysis was used to calculate the associations between the independent variables and level of self-rated knowledge about several aspects of RA. The results of the study indicated that the self-reported ratings of knowledge about the disease in Estonian RA patients were rather low. Health professionals were mentioned as the primary sources of information, but the longer disease history and more frequent use of health services as considerable predictors of higher ratings of knowledge refer to role of personal experience in obtaining knowledge about the disease as well.

Collaborative learning linking nursing practice and education - Interview study with master's students and teachers.

BACKGROUND: Collaborative and innovative educational approaches are essential to building nurses' competencies in responding to healthcare challenges and to enhance high-quality nursing practice. Nurses are increasingly learning in various contexts, and thus, the understanding and organising of collaborative learning needs further exploration. AIM: To describe collaborative learning in nursing practice and education from the point of view of nurses, involved as students and teachers in master's education in nursing. DESIGN AND METHODS: Qualitative study using semi-structured focus groups involving 33 nurses as master's students and teachers from Estonia and Norway. The data were analysed using inductive content analysis. FINDINGS: The essence of collaborative learning in the context of nursing practice and education was identified as the aggregation of diverse learners' skills and reflections while working towards shared aims. This fostered the development of workplace competencies, professional attitudes, and personal growth. Organising collaborative learning requires careful planning and synchronisation between clinical and educational organisations. CONCLUSIONS: Collaborative learning is an inclusive method, aiding nurses at different phases of their career to gain knowledge and enhance their soft skills, and potentially reducing professional hierarchies. Further research is needed to develop methods for evaluating the outcomes of collaborative learning.

Does Dietary Polyunsaturated Fatty Acid Intake Associate With Bone Mineral Density and Limb Structural Changes in Early Rheumatoid Arthritis?

Background: Rheumatoid arthritis (RA) is an inflammatory disease that can result in bone erosion, lean mass lowering, and increase of fat mass without changes in body weight. The dietary consumption of polyunsaturated fatty acids (PUFAs) has been assessed in many studies due to their potential anti-inflammatory effect. Aim: The aim of this research was to identify if dietary intake of PUFAs associates with bone mineral density (BMD) and limb structural changes in early rheumatoid arthritis (ERA) compared to a population-based control group. The study was conducted because previous results have been insufficient. Methods: The study group consisted of 83 ERA patients and 321 control subjects. A dual-energy X-Ray absorptiometry (DXA) machine was used to measure hip, lumbar spine, and radius BMD, as well as arm and leg fat, lean, and bone mass. Dietary habits and inflammatory markers were assessed to evaluate the effects to BMD and limb structural changes. Results: In ERA subjects, higher dietary consumption of PUFAs was associated with a decrease in arm fat mass (b -28.17, P = .02) and possibly with higher lumbar BMD (b 0.008, P = .058). Limb bone and lean mass changes were not associated with dietary intake of PUFAs. Conclusion: Balanced nutrition is essential. Consuming PUFAs could be beneficial in ERA preventing structural changes to hands, but additional research is needed.

Planned improvement actions based on patient safety incident reports in Estonian hospitals: a document analysis.

AIM: Aim of this study was to describe and analyse associations of incidents and their improvement actions in hospital setting. METHODS: It was a retrospective document analysis of incident reporting systems' reports registered during 2018-2019 in two Estonian regional hospitals. Data were extracted, organised, quantified and analysed by statistical methods. RESULTS: In total, 1973 incident reports were analysed. The most commonly reported incidents were related to patient violent or self-harming behaviour (n=587), followed by patient accidents (n=379), and 40% of all incidents were non-harm incidents (n=782). Improvement actions were documented in 83% (n=1643) of all the reports and they were focused on (1) direct patient care, (2) staff-related actions; (3) equipment and general protocols and (4) environment and organisational issues. Improvement actions were mostly associated with medication and transfusion treatment and targeted to staff. The second often associated improvement actions were related to patient accidents and were mostly focused on that particular patient's further care. Improvement actions were mostly planned for incidents with moderate and mild harm, and for incidents involving children and adolescents. CONCLUSION: Patient safety incidents-related improvement actions need to be considered as a strategy for long-term development in patient safety in organisations. It is vital for patient safety that the planned changes related to the reporting will be documented and implemented more visibly. As a result, it will boost the confidence in managers' work and strengthens all staff's commitment to patient safety initiatives in an organisation.

Estonian adverse events study for multimorbid patients using Estonian Trigger Tool (MUPETT-MUltimorbid Patients-Estonian Trigger Tool). Development of Estonian trigger tool for multimorbid patients. A study protocol for mixed-methods study.

INTRODUCTION: It is widely recognized that providing healthcare may produce harm to the patient. Different approaches have been developed to measure the burden of adverse events (AEs) to plan and measure the effects of interventions. One of the most widely used instruments is the Trigger Tool, which has previously been modified to be used on various settings and translated into many languages. Multimorbidity complicates care and may increase the number of AEs patients experience. Currently there is no instrument designed to measure AEs in multimorbid patients. In Estonia, there is currently no validated instrument to measure the burden of AEs. AIMS: The aim of this study will be evaluating the characteristics and ocurrence of AEs in multimorbid patients in hospitalised internal medicine patients of Estonia, and describes the development of a trigger tool for this purpose. METHODS AND ANALYSIS: We will search for the evidence on measuring AEs in the population of multimorbid patients focusing on trigger tools, and synthesize the data. Data collection of the triggers from the literature will be followed by translating triggers from English to Estonian. An expert multidisciplinary panel will select the suitable triggers for this population. Trigger tool will be pre-tested to assess agreement among professionals and usability of the tool. Validation will be done using 90 medical records. A cross-sectional study in internal medicine departments of two Estonian tertiary care hospitals will be performed to identify the frequency and characteristics of AEs in 960 medical records. We will also provide preventability potential and influencing factors. DISSEMINATION: Results will be disseminated to healthcare providers and stakeholders at national and international conferences, and as a doctoral medical thesis.

Factors associated with hand bone changes in early rheumatoid arthritis.

BACKGROUND: The aim of this research was to assess if hand bone mineral density (HBMD) changes associated with the appearance of erosions in early rheumatoid arthritis (ERA), compared with the population-based control group. Additionally, we tried to identify if there are novel factors that associate with HBMD and erosive changes (EC), and if they are dissimilar. The study was conducted as the data are limited. METHODS: The study group consisted of 83 ERA patients and 321 controls. Dual-Energy X-Ray Absorptiometry (DXA) machine was used to measure HBMD. EC of RA (rheumatoid arthritis) were assessed in X-rays of hands using Sharp scores. Life-style habits, inflammation markers were assessed to evaluate the effects of different factors. RESULTS: The presence of ERA was associated with lower HBMD compared with controls (adjusted for age, gender, height and weight; b -0.01, p = 0.045). 76% (95% CI 65.3-84.6) of ERA patients had EC in hand X-ray. Smoking habits and higher BMI (body mass index) were associated with an increased likelihood of having RA specific EC. In ERA, decreasing of HBMD was associated with the elevation of interleukin-6 (IL-6) and rheumatoid factor (RF) positivity. CONCLUSIONS: In ERA, HBMD changes were not associated with the appearance of erosions. Factors that associate in ERA with HBMD changes and appearance of erosions differ. HBMD assessment together with serum IL-6 level could be useful in everyday clinical practice for better surveillance of ERA patients who do not have EC in hand X-rays.

Autoantibodies Neutralizing Type III Interferons Are Uncommon in Patients with Severe Coronavirus Disease 2019 Pneumonia.

Autoantibodies (AABs) neutralizing type I interferons (IFN) underlie about 15% of cases of critical coronavirus disease 2019 (COVID-19) pneumonia. The impact of autoimmunity toward type III IFNs remains unexplored. We included samples from 1,002 patients with COVID-19 (50% with severe disease) and 1,489 SARS-CoV-2-naive individuals. We studied the prevalence and neutralizing capacity of AABs toward IFNλ and IFNα. Luciferase-based immunoprecipitation method was applied using pooled IFNα (subtypes 1, 2, 8, and 21) or pooled IFNλ1-IFNλ3 as antigens, followed by reporter cell-based neutralization assay. In the SARS-CoV-2-naive cohort, IFNλ AABs were more common (8.5%) than those targeting IFNα2 (2.9%) and were related with older age. In the COVID-19 cohort the presence of autoreactivity to IFNλ did not associate with severe disease [odds ratio (OR) 0.84; 95% confidence interval (CI) 0.40-1.73], unlike to IFNα (OR 4.88; 95% CI 2.40-11.06; P < 0.001). Most IFNλ AAB-positive COVID-19 samples (67%) did not neutralize any of the 3 IFNλ subtypes. Pan-IFNλ neutralization occurred in 5 patients (0.50%), who all suffered from severe COVID-19 pneumonia, and 4 of them neutralized IFNα2 in addition to IFNλ. Overall, AABs to type III IFNs are rarely neutralizing, and do not seem to predispose to severe COVID-19 pneumonia on their own.