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1.
J Orthop Surg Res ; 16(1): 550, 2021 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-34488826

RESUMO

BACKGROUND: Lumbar spinal stenosis (LSS) is a common degenerative condition of the spine that causes back pain radiating to the lower extremity. Surgical treatment is indicated to treat progressive radical symptoms. Obesity has been associated with inferior results in the domains of quality of life (QoL) following an LSS operation, but the research findings have been limited. This paper aims to identify whether obesity affects QoL due to back pain among patients who underwent an operation for LSS. METHODS: This study is based on a series of patients operated on for LSS between 2012 and 2018. Operated patients who returned for follow-up forms within the first or second years were included. A total of 359 patients were selected, 163 males (45%) and 196 females (55%). The mean age was 68.9 years. The EuroQol five-dimension scale (EQ-5D) questionnaire was chosen to measure QoL and the Oswestry Disability Index (ODI) for functional disability. RESULTS: QoL, as measured by EQ-5D, was preoperatively lower in those patients with a BMI ≥ 30. One year after the operation, all groups had a similar trend of improved QoL. At the second year, the results in all groups levelled off even though there was no statistical difference in clinical outcomes (p = 0.92). The ODI was preoperatively statistically higher in patients with a BMI ≥ 30 (p < 0.001). Two years after the surgery, all groups had improved ODI scores, but there was no statistical difference in ODI between the BMI groups (p = 0.54). CONCLUSION: Surgical intervention for debilitating or longstanding symptoms of LSS should be considered as a treatment option for suitable patients in spite of an elevated BMI.

2.
Age Ageing ; 2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34473831

RESUMO

BACKGROUND: oral frailty (OFr) may be called a syndrome lacking a consensus on its definition. OBJECTIVE: the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care. DESIGN: the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition. SETTING: participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs). SUBJECTS: the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland. METHODS: frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination. RESULTS: a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties. CONCLUSIONS: OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.

3.
Scand J Prim Health Care ; 39(3): 382-388, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34474641

RESUMO

OBJECTIVE: Overweight and obesity are increasing globally. General practitioners (GP's) are at the first point of contact for medical support and consequently have a major role in resolving this overwhelming problem. The aim of this study was to assess the effectiveness of a brief lifestyle counselling on weight management and on the participants' quality of life (QoL). DESIGN: A cohort study with a one-year follow-up. SETTING: Occupational health care, city of Pori in southwestern Finland. PARTICIPANTS: Female municipal employees (n = 625) with a mean age of 48 (SD 9) years. INTERVENTION: A nurse and a physiotherapist gave lifestyle counselling to all the participants; however, only the overweight/obese subjects were recommended to lose at least 5% of their initial weight. MAIN OUTCOME MEASURE: Success in weight management and quality of life. RESULTS: At the follow-up visit, 10.4% (95% CI: 7.5-14.0) of the overweight/obese subjects had lost at least 5% of their weight, but 10.0% (95% CI: 6.7-14.3) of the normal-weight participants had become overweight. The mean weight change was +0.1 kg (95% CI: -0.3-0.5) in the overweight/obese group and +0.5 kg (95% CI: 0.2-0.8) in the normal weight group. The change in QoL was inversely correlated with relative weight change in overweight/obese subjects, albeit the effect size was small. CONCLUSION: Weight management counselling should also be directed to individuals with a normal weight. Even with brief lifestyle counselling it may be possible to stabilize weight gain. Successful weight loss may improve the QoL of overweight/obese individuals.KEY POINTSPrimary health care has to deal with the increasing problem of overweight and obesity.Brief lifestyle counselling performed by a nurse and a physiotherapist seems to be quite effective in weight stabilization, considering the effort needed.People with normal weight tend to gain weight and weight management counselling should also be directed to them. Successful weight management may improve the quality of life of overweight/obese people.


Assuntos
Sobrepeso , Qualidade de Vida , Estudos de Coortes , Aconselhamento , Feminino , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Sobrepeso/terapia
4.
Mil Med ; 2021 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-34480793

RESUMO

INTRODUCTION: Back pain is a major reason for sick leaves and disability pension in primary health care. The prevalence of back pain among adolescents and young adults is believed to be increasing, and back pain during military service predicts unspecified back pain during later life. The aim of this study was to investigate the prevalence and risk factors of back pain among conscripts in compulsory Finnish military service during the period 1987-2005. MATERIALS AND METHODS: The Finnish Defence Forces recruit all men aged 18 years for compulsory military service, and new conscripts enter the service twice a year. Before entering the service, all conscripts must pass a medical examination and conscripts entering the service are generally healthy.Health care in Finnish military service is organized by the public Garrison Health Center, and all medical records are stored as part of the Finnish health care operation plan. For this study, we randomly selected 5,000 men from the Finnish Population Register Centre, according to their year of birth from five different age categories (1969, 1974, 1979, 1984, and 1989). RESULTS: We gathered 4,029 documents for the analysis.The incidence of back pain varied between 18% and 21% and remained unchanged during the examination period.The risk factors for back pain were smoking (risk ratio 1.35,P-value <.001),elementary school only as education (risk ratio 1.55, P-value <.001), and back problems reported before military service (risk ratio 2.03,P-value.002).Half of the back pain incidences occurred during the first months of service. CONCLUSIONS: The prevalence of back pain among male Finnish military service conscripts has not changed in the last 25 years. Twenty percent of conscripts suffer from back-related problems during their military service. The majority of the visits to health centers occurred in the first service months. The risk factors for back pain include smoking, low education level, and musculoskeletal disorders in general. Educating the young people about harms of tobacco and supporting education is a way to influence the back pain prevalence. Strength of this study is a good generalized population sample of young Finnish adult males because of the fact that the Finnish military service is compulsory for all men. All medical records of all visits to the Garrison Health Care Centre were available, and all the conscripts filled the same pre-service questionnaire, minimizing the possibility of selection bias. The sample size was also large. Weakness of this study is that the service time changed during the study period and in the latest conscript group born in 1989, data collection and the data available for this cohort was limited, because nearly half of the conscripts had not yet started their service. The Finnish military service is compulsory only for men and because of the low number of female conscripts, they were excluded from this study. Diagnoses were also missing from 70% of the back-related visits, and these visits were recorded as back pain-related visits according to the reason for seeking care.

5.
BMC Cardiovasc Disord ; 21(1): 444, 2021 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-34530733

RESUMO

BACKGROUND: Effective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year. METHODS: In this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months. RESULTS: We found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year. CONCLUSIONS: Our study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life. Trial registration ClinicalTrials NCT02377960 (Date of registration: 04/03/2015).

6.
Nutrients ; 13(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34371901

RESUMO

BACKGROUND: Burnout is an undesirable mental condition, which may have a negative impact on individuals' health and work ability. This study aimed to evaluate the relationship between diet and burnout symptoms among female public sector employees. METHODS: A cross-sectional study was conducted in 2015 among 630 female employees from 10 municipal work units of the city of Pori, Finland. Burnout symptoms were assessed with the Bergen Burnout Indicator (BBI). The consumption of food items was determined using the food frequency questionnaire (FFQ). The main food groups were categorized into healthy and unhealthy foods based on the Nordic Nutrition Recommendations for a healthy and balanced diet. RESULTS: In multivariate linear regression analysis, consumption of healthy food items had an inverse relationship with the severity of burnout symptoms independently of age, education years, physical activity, and depressive symptoms. De-tailed analysis revealed that subjects with lower BBI score consumed more often low-fat dairy produce, vegetables, fruit and berries, vegetable food, and white meat. CONCLUSIONS: Frequent consumption of healthy food items is associated with low level of burnout symptoms. Our results emphasize the importance of diverse and balanced healthy diet to promote work well-being.


Assuntos
Esgotamento Profissional/prevenção & controle , Dieta Saudável , Saúde do Trabalhador , Setor Público , Comportamento de Redução do Risco , Saúde da Mulher , Adulto , Esgotamento Profissional/diagnóstico , Esgotamento Profissional/epidemiologia , Estudos Transversais , Feminino , Finlândia/epidemiologia , Humanos , Pessoa de Meia-Idade , Estado Nutricional , Valor Nutritivo , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Fatores Sexuais
7.
Artigo em Inglês | MEDLINE | ID: mdl-34283997

RESUMO

OBJECTIVES: To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty. DESIGN: A randomized controlled trial with a 1:1 allocation. SETTING: Home-based. PARTICIPANTS: Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria. INTERVENTIONS: A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149). MAIN OUTCOME MEASURES: FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months. RESULTS: FIM deteriorated in both groups over 12 months, -4.1 points (95% confidence interval [CI], -5.6 to -2.5) in the exercise group and -6.9 (95% CI, -8.4 to -2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, -0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity. CONCLUSIONS: One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.

8.
Breast ; 59: 110-116, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34225091

RESUMO

OBJECTIVE: To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial. METHODS: Survivors (aged 35-68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors. RESULTS: The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference -0.017, 95% CI: -0.031 to -0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference -0.019, 95% CI: -0.031 to -0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up. CONCLUSIONS: HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.

9.
Ann N Y Acad Sci ; 2021 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-34273130

RESUMO

Many people enjoy sad music, and the appeal for tragedy is widespread among the consumers of film and literature. The underlying mechanisms of such aesthetic experiences are not well understood. We tested whether pleasure induced by sad, unfamiliar instrumental music is explained with a homeostatic or a reward theory, each of which is associated with opposite patterns of changes in the key hormones. Sixty-two women listened to sad music (or nothing) while serum was collected for subsequent measurement of prolactin (PRL) and oxytocin (OT) and stress marker (cortisol and adrenocorticotropic hormone) concentrations. Two groups of participants were recruited on the basis of low and high trait empathy. In the high empathy group, PRL and OT levels were significantly lower with music compared with no music. And compared to the low empathy group, the high empathy individuals reported an increase of positive mood and higher ratings of being moved with music. None of the stress markers showed any changes across the conditions or the groups. These hormonal changes, inconsistent with the homeostatic theory proposed by Huron, exhibit a pattern expected of general reward. Our findings illuminate how unfamiliar and low arousal music may give rise to pleasurable experiences.

10.
Eur Geriatr Med ; 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34313976

RESUMO

PURPOSE: We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. METHODS: This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants' background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. RESULTS: Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. CONCLUSIONS: Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents' oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups.

11.
Nutr Metab Cardiovasc Dis ; 31(9): 2678-2684, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34218989

RESUMO

BACKGROUND AND AIMS: Current guidelines on prediabetes and diabetes (T2D) recommend to regularly perform an oral glucose tolerance test (OGTT) on subjects at risk of T2D. However, it is not known why women tend to have relatively higher 2-h post-load plasma (2hPG) glucose concentrations during OGTT than men. The aim of the present study is to investigate if there are sex differences in fasting plasma glucose (FPG) and 2hPG concentrations in relation to body size in apparently healthy non-diabetic subjects with normal glucose tolerance. We hypothesized that sex differences in glucose tolerance are physiological and related to different body surface area (BSA) in men and women. METHODS AND RESULTS: A 2-h 75 g OGTT was performed on 2010 subjects aged 45-70 years. Their BSA was calculated using the Mosteller formula. Men and women were separately divided into five BSA levels. Within the normal 2hPG range, women had higher mean 2hPG concentrations during the OGTT than men in all BSA levels estimated by sex-standardized BSA (p for linearity < 0.001). BSA adjusted for age, waist circumference, leisure-time physical activity, and smoking, showed an inverse association with 2hPG concentration in both sexes. Mean FPG concentrations were higher in men than in women. CONCLUSIONS: Body size has a negative inverse association with 2hPG concentration in an OGTT even within a physiological plasma glucose range. This may cause underestimation of glucose disorders in individuals with larger BSA and overestimation in individuals with smaller BSA when using an OGTT.


Assuntos
Glicemia/metabolismo , Superfície Corporal , Teste de Tolerância a Glucose , Disparidades nos Níveis de Saúde , Idoso , Biomarcadores/sangue , Estudos Transversais , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores Sexuais , Fatores de Tempo
12.
BMC Health Serv Res ; 21(1): 715, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34284783

RESUMO

BACKROUND: Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension. METHODS: The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017-2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up. RESULTS: A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes. CONCLUSIONS: During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02992431 . Registered 14/12/2016.


Assuntos
Planejamento de Assistência ao Paciente , Qualidade de Vida , Idoso , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Assistência ao Paciente , Atenção Primária à Saúde
13.
Pediatr Rheumatol Online J ; 19(1): 105, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215280

RESUMO

BACKGROUND: Chronic illness, such as juvenile idiopathic arthritis (JIA), appears to have an impact on the mental health of children and adolescents. The aim of this study was to explore the incidence of mental and behavioural disorders according to age at JIA onset and gender in JIA patients compared to a control population. METHODS: Information on all incident patients with JIA in 2000-2014 was collected from the nationwide register, maintained by the Social Insurance Institution of Finland. The National Population Registry identified three controls (similar regarding age, sex and residence) for each case. They were followed up together until 31st Dec. 2016. ICD-10 codes of their psychiatric diagnoses (F10-F98) were obtained from the Care Register of the National Institute for Health and Welfare. The data were analysed using generalized linear models. RESULTS: The cumulative incidence of psychiatric morbidity was higher among the JIA patients than the controls, hazard ratio 1.70 (95% Cl 1.57 to 1.74), p < 0.001. Phobic, anxiety, obsessive-compulsive, stress-related and somatoform disorders (F40-48) and mood (affective) disorders (F30-39) were the most common psychiatric diagnoses in both the JIA patients (10.4 and 8.2%) and the control group (5.4 and 5.1%), respectively. Female patients were more prone to mental and behavioural disorders than males were, and the risk seemed to be higher in patients who developed JIA in early childhood or adolescence. CONCLUSION: Patients with JIA are diagnosed with mental and behavioural disorders more often than controls, and the age at onset of JIA could have implications for future mental health.

14.
Scand J Prim Health Care ; 39(2): 157-165, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34092186

RESUMO

OBJECTIVE: There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up. DESIGN: A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006. SETTING: A public health care centre in the town of Harjavalta, Finland. SUBJECTS: All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes. MAIN OUTCOME MEASURES: All-cause and CVD mortality. RESULTS: Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention. CONCLUSIONS: Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.Key PointsPreviously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality.With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community.Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons.Subjects not willing to participate in health surveys have the worst prognosis.


Assuntos
Doenças Cardiovasculares , Idoso , Doenças Cardiovasculares/prevenção & controle , Estudos de Viabilidade , Humanos , Estilo de Vida , Pessoa de Meia-Idade , Prevenção Primária , Fatores de Risco
15.
Clin Nutr ; 40(6): 3793-3797, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34134002

RESUMO

BACKGROUND & AIMS: The temporal trends in protein and other nutrient intakes among older long-term care residents have not been studied. The aim of this study was to explore the changes in energy, protein, and other nutrient intakes between 2007 and 2017-8 in two cross-sectional samples of older long-term care residents in the Helsinki metropolitan area. We also studied how the residents' disability and stage of cognition modified the association between observation year and protein intake (g/body weight kg). METHODS: Two cross-sectional samples were collected in 2007 (n = 350) and 2017-8 (n = 476) in long-term care settings. Residents' nutrient intake was determined by a one- or two-day food record. Residents' disability was determined by the Clinical Dementia Rating (CDR) "personal care" question and stage of cognition was determined by the CDR "memory" item. RESULTS: There was no significant difference in energy intake between the observation years. Carbohydrates, total protein, and protein (g/body weight kg) intakes were significantly lower in 2017-8 than in 2007. Fat intake was higher in 2017-8 than in 2007. In 2017-8, the intake of some vitamins and minerals was lower (thiamine, calcium) but some higher (vitamins A, D, C, E) compared to 2007. Residents' disability (p = 0.049) and observation year (p = 0.037) were significantly associated with protein intake (g/body weight kg), but the interaction was not significant (p = 0.35). Furthermore, residents' stage of cognition was not associated with protein intake (p = 0.22) but observation year was (p < 0.001). The interaction was not significant (p = 0.30). CONCLUSIONS: Whereas the energy intake remained at the same level in the observation years, the ratio of macronutrient intake changed in an unfavorable way. The intake of protein and some vitamins were lower whereas the relative proportion of fat was higher in 2017-8 compared to 2007. As long-term care residents become more disabled in the future, more attention should be paid to diet quality.

16.
J Am Med Dir Assoc ; 22(8): 1699-1705.e1, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34133971

RESUMO

OBJECTIVES: This trial examines the effects of end-of-life training on long-term care facility (LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital services. DESIGN: A single-blind, cluster randomized (at facility level) controlled trial (RCT). Our training intervention included 4 small-group 4-hour educational sessions on the principles of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff. Education was based on constructive learning methods and included resident cases, role-plays, and small-group discussions. SETTING AND PARTICIPANTS: We recruited 324 residents with possible need for end-of-life care due to advanced illness from 20 LTCF wards in Helsinki. METHODS: Primary outcome measures were HRQoL and hospital inpatient days per person-year during a 2-year follow-up. Secondary outcomes were number of emergency department visits and cost of all hospital services. RESULTS: HRQoL according to the 15-Dimensional Health-Related Quality-of-Life Instrument declined in both groups, and no difference was present in the changes between the groups (P for group .75, adjusted for age, sex, do-not-resuscitate orders, need for help, and clustering). Neither the number of hospital inpatient days (1.87 vs 0.81 per person-year) nor the number of emergency department visits differed significantly between intervention and control groups (P for group .41). The total hospital costs were similar in the intervention and control groups. CONCLUSIONS AND IMPLICATIONS: Our rigorous RCT on end-of-life care training intervention demonstrated no effects on residents' HRQoL or their use of hospitals. Unsupported training interventions alone might be insufficient to produce meaningful care quality improvements.

17.
Scand J Pain ; 21(4): 716-723, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34114388

RESUMO

OBJECTIVES: This 10-year follow-up study aimed to examine the persistence of SF-36 pain intensity and pain-related interference and to identify baseline factors that may relate to pain experience among community-dwelling aging adults. METHODS: Questionnaire and clinical data on a total of 1,954 participants (mean age at baseline 63 years) were collected in 2002, 2005, 2008, and 2012. Based on pain reports, four pain intensity, pain interference (PIPI) groups were formed at each time point: PIPI group I: none to mild pain intensity and interference; II: moderate to extreme pain intensity, none to mild pain-related interference; III: None to mild pain intensity, moderate to extreme pain-related interference, IV: Moderate to extreme pain intensity and interference. RESULTS: Participants with the most pain at baseline improved their pain situation the most during the follow-up. Higher BMI was associated with pain interference, and metabolic syndrome (MetS) and musculoskeletal diseases with both pain intensity and interference (p<0.05, statistically significant interaction between pain intensity and pain interference) at baseline. According to multivariate logistic regression analysis the following baseline characteristics were associated with remaining in PIPI group I throughout the follow-up: presence of musculoskeletal disease (OR 0.22 [95% CI 0.16-0.30]), high BMI (OR 0.93 [95% CI 0.90-0.97]), high household income (OR 1.46 [95% CI 1.07-1.98]), good childhood home environment (OR 1.03 [95% CI 1.00-1.05]). CONCLUSIONS: Multiple factors may affect pain persistence in late adulthood with varying effect on pain intensity and pain-related interference. Pain situation of even those with most pain may be improved.

19.
Arch Phys Med Rehabil ; 102(9): 1692-1699, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33939973

RESUMO

OBJECTIVE: To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures. DESIGN: Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up. SETTING: Home-based intervention. PARTICIPANTS: Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups. INTERVENTIONS: Supervised physical exercise twice a week. MAIN OUTCOME MEASURES: The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months. RESULTS: Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group. CONCLUSIONS: Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.


Assuntos
Terapia por Exercício/economia , Terapia por Exercício/métodos , Estado Funcional , Fraturas do Quadril/reabilitação , Serviços de Assistência Domiciliar/economia , Aceitação pelo Paciente de Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Feminino , Humanos , Masculino
20.
Eur J Intern Med ; 91: 40-44, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33994250

RESUMO

High body mass index (BMI) is known to be associated with elevated blood pressure (BP). The present study aims to determine the relative importance of the two components of BMI, fat mass and lean body mass index, on BP levels. We assessed body composition with bioimpedance and performed 24 hour ambulatory BP measurements in 534 individuals (mean age 61 ± 3 years) who had no cardiovascular medication. Fat mass index and lean mass index were calculated analogously to BMI as fat mass or lean body mass (kg) divided by the square of height (m2). Both fat mass index and lean mass index showed a positive, small to moderate relationship with all 24 hour BP components independently of age, sex, smoking, and leisure-time physical activity. There were no interaction effects between fat mass index and lean mass index on the mean BP levels. Adult lean body mass is a significant determinant of BP levels with an equal, albeit small to moderate magnitude as fat mass. Relatively high amount of muscle mass may not be beneficial to cardiovascular health.

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