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2.
Skeletal Radiol ; 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501959

RESUMO

OBJECTIVE: The purpose of this study was to assess if ultra-low-dose CT is a useful clinical alternative to digital radiographs in the evaluation of acute wrist and ankle fractures. MATERIALS AND METHODS: An ultra-low-dose protocol was designed on a 256-slice multi-detector CT. Patients from the emergency department were evaluated prospectively. After initial digital radiographs, an ultra-low-dose CT was performed. Two readers independently analyzed the images. Also, the radiation dose, examination time, and time to preliminary report was compared between digital radiographs and CT. RESULTS: In 207 extremities, digital radiography and ultra-low-dose CT detected 73 and 109 fractures, respectively (p < 0.001). The odds ratio for fracture detection with ultra-low-dose CT vs. digital radiography was 2.0 (95% CI, 1.4-3.0). CT detected additional fracture-related findings in 33 cases (15.9%) and confirmed or ruled out suspected fractures in 19 cases (9.2%). The mean effective dose was comparable between ultra-low-dose CT and digital radiography (0.59 ± 0.33 µSv, 95% CI 0.47-0.59 vs. 0.53 ± 0.43 µSv, 95% CI 0.54-0.64). The mean combined examination time plus time to preliminary report was shorter for ultra-low-dose CT compared to digital radiography (7.6 ± 2.5 min, 95% CI 7.1-8.1 vs. 9.8 ± 4.7 min, 95% CI 8.8-10.7) (p = 0.002). The recommended treatment changed in 34 (16.4%) extremities. CONCLUSIONS: Ultra-low-dose CT is a useful alternative to digital radiography for imaging the peripheral skeleton in the acute setting as it detects significantly more fractures and provides additional clinically important information, at a comparable radiation dose. It also provides faster combined examination and reporting times.

4.
Qual Life Res ; 28(12): 3225-3236, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31401749

RESUMO

PURPOSE: The impact of visual acuity (VA) on Health-Related Quality of Life (HRQoL) and the cross-sectional and longitudinal differences in HRQoL during the 11-year follow-up were investigated. The aim was to examine the impact declining vision has on HRQoL and to provide comparable data to facilitate the allocation of health-care resources. METHODS: We utilized nationwide health examination surveys carried out by the National Institute for Health and Welfare in 2000 and 2011, providing a representative sampling of the Finnish adult population aged 30 and older. VA was assessed through Snellen E test, and HRQoL scores were evaluated using EQ-5D and 15D questionnaires. Multiple imputations with Markov chain Monte Carlo method was used to utilize the data more effectively. Regression analyses were conducted to assess the impact of declining VA on HRQoL, adjusted for incident comorbidities. RESULTS: Lower VA status was associated with significantly lower HRQoL at both time points, most clearly observable below the VA level of 0.5. Declining VA resulted in statistically significant decline in HRQoL during the follow-up, greater with distance than near VA. 15D impairment associated with decline in the distance VA was also clinically meaningful and greater than that associated with any of the examined comorbidities. CONCLUSIONS: HRQoL was significantly and meaningfully impaired even before the threshold of severe vision loss or blindness was reached. The results encourage the improvement of available treatment options aiming to postpone the onset of visual impairment or declining VA, to maintain better quality of life among the population.

5.
Emotion ; 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31259585

RESUMO

Little is known about how retirement and the time use redistribution that comes with it relate to experiential wellbeing, especially in low- and middle-income countries (LAMICs). This study aims to determine whether there are differences in experiential wellbeing between retired and working older adults; whether time use accounts for a portion of these differences; and whether these potential relationships differ across LAMICs and high-income countries. We used data from 2 multicountry studies conducted in countries at different levels of economic development: SAGE (China, Ghana, India, Mexico, and South Africa) and COURAGE in Europe (Finland, Poland, and Spain), focusing on participants aged 50+ (N = 21,000). Retirement was significantly associated with higher experiential wellbeing in both surveys, and time use accounted for more than 40% of the total effect. Retirees were higher in experiential wellbeing than working older adults, and differences in how individuals spend their day accounted for part of this relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

7.
Artigo em Inglês | MEDLINE | ID: mdl-31200553

RESUMO

The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30-59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002-2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43-0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with ≥4 physical workload factors (OR 2.71; 95% CI 1.99-3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors.

8.
Aging Ment Health ; : 1-10, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30990056

RESUMO

OBJECTIVES: To report prevalence estimates of 12-month suicide ideation and attempts in young-and-middle age adults and older people, as well as their respective associated factors. METHODS: A total of 52,150 community-dwelling adults who completed the adapted version of the Composite International Diagnostic Interview-Depression Module were included from SAGE and COURAGE in Europe studies. The presence of 12-month suicide ideation and attempts was measured among the participants who screened positively in the Depression Module. Global and national prevalence estimates of 12-month suicide ideation and attempts were calculated according to the total sample. Logistic regression analyses were conducted to separately determine factors associated with suicidal ideation and with suicide attempts in young-and-middle age adults and older adults. RESULTS: Higher estimates of 12-month suicidal ideation were found for high-income countries and people aged 65 years and older. Higher negative affect, higher disability, and presence of food insecurity were associated with 12-month suicidal ideation and suicide attempts for young-and-middle-adults and older adults. Higher isolation, being female, and greater number of chronic health conditions were also related to 12-month suicidal ideation in both age groups. Younger age was associated with 12-month suicidal ideation for older people, and with suicide attempts in the young-and-middle age group. Finally, higher income was related to lower rates of 12-month suicidal ideation for the young-and-middle age group. CONCLUSIONS: Older people are at increased risk of suicidal ideation globally and of suicide attempts in some countries. There were common and different factors related to suicide in adults and older adults.

9.
Skeletal Radiol ; 48(9): 1411-1416, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30834953

RESUMO

OBJECTIVE: The aims of this work are to determine how frequently medial tibial plateau fractures are accompanied by fibular head avulsion fractures and evaluate the sensitivity of radiographs detecting them, and also to assess if the presence of fibular fracture is correlated with long-term functional outcome and peroneal nerve damage. MATERIALS AND METHODS: A retrospective chart review of operated patients with medial tibial plateau fractures at level I trauma center during 2002-2008 was performed. From 63 patients imaged preoperatively, 59 had CT and radiographs, three had only CT, and one only radiograph. The presence and fragment size of fibular fracture were retrospectively evaluated. Body mass index (BMI) and functional outcome measurements (the Modified Lysholm knee score and WOMAC) were available for 46 patients. RESULTS: Fourteen out of 63 patients (22.2%) had fibular fractures. Of the 59 patients with both CT and radiographs, 12 had fibular fractures, and of these, nine were seen with both modalities and three only in CT. Functional scores were available for ten patients with fibular fracture. Patients with fibular fracture seen on radiographs had a significantly higher score on WOMAC function (26 vs. 7; p = 0.027). The patients with fibular fractures had also higher BMI (p = 0.035). Of the six patients with peroneal nerve damage, 50% had fibular fracture. CONCLUSIONS: In patients with operatively treated medial tibial plateau fracture, the fibular fractures are relatively common. Detecting it is important, as it may be associated with worse functional scores and peroneal nerve paresis. Some fibular fractures may remain undetected on radiographs, hence preoperative CT is recommended.

10.
J Epidemiol Community Health ; 73(5): 443-450, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30777889

RESUMO

BACKGROUND: Policy makers need disability projections for planning adequate services and measures for health promotion. The aim of this study is to provide projections on severe mobility limitations up to year 2044 and illustrate how the projected prevalence and the number of persons with severe mobility limitations are affected by potential changes in the modifiable risk factors, namely excess weight, physical inactivity and smoking. METHODS: We analysed the nationally representative, repeated measures Health 2000 and 2011 Surveys (BRIF8901) with 8615 and 6740 participants, respectively, aged 18 years and older. Severe mobility limitations were defined as major difficulties or unable to walk about half a kilometre. We applied a multistate model on repeated measures to account for both individual risk factors and their changes over time. RESULTS: The number of people with severe mobility limitations was projected to double by the year 2044 in Finland, due to the rapid ageing of the population. Eliminating half of the excess weight would reduce their number by one-fifth, while reductions in the prevalence of smoking and physical inactivity would have a minor impact. Even if excess weight, smoking and physical inactivity were completely eliminated, the number of persons with severe mobility limitations is projected to increase. CONCLUSIONS: Designing and implementing strategies to promote healthy weight are important to slow down the rapid increase in mobility limitations due to population ageing. Providing adequate health and social services for the increasing population with disabilities will nevertheless be an increasing national challenge.

11.
Emerg Radiol ; 26(4): 365-372, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30756247

RESUMO

PURPOSE: BCVI may lead to ischemic stroke, disability, and death, while being often initially clinically silent. Screening criteria for BCVI based on clinical findings and trauma mechanism have improved detection, with Denver criteria being most common. Up to 30% of patients do not meet BCVI screening criteria. The aim of this study was to analyze the effect of augmented Denver criteria on detection, and to determine the relative risk for ischemic stroke. METHODS: Denver screening criteria were augmented by any high-energy trauma of the cervical spine, thorax, abdomen, or pelvis. All acute blunt trauma WBCT including CT angiography (CTA) over a period of 38 months were reviewed retrospectively by two Fellowship-trained radiologists, as well as any cerebral imaging after the initial trauma. RESULTS: 1544 WBCT studies included 374 CTA (m/f = 271/103; mean age 41.5 years). Most common mechanisms of injury were MVA (51.5%) and fall from a height (22.3%). We found 72 BCVI in 56 patients (15.0%), with 13 (23.2%) multiple lesions. The ICA was affected in 49 (68.1%) and the vertebral artery in 23 (31.9%) of cases. The most common injury level was C2, with Biffl grades I and II most common in ICA, and II and IV in VA. Interobserver agreement was substantial (Kappa = 0.674). Of 215 patients imaged, 16.1% with BCVI and 1.9% of the remaining cases had cerebral ischemic stroke (p < .0001; OR = 9.77; 95% CI 3.3-28.7). Eleven percent of patients with BCVI would not have met standard screening criteria. CONCLUSIONS: The increase in detection rate for BCVI justifies more liberal screening protocols.

12.
Pediatr Transplant ; 23(1): e13327, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30536767

RESUMO

Our main goal with this study was to share our off-label experience with CEUS for identifying circulatory complications after liver transplantation in children. A total of 74 CEUS examinations performed on 34 pediatric patients who underwent a liver transplant were retrospectively included. About 53% of the examinations were performed on children 2 years old or younger. About 82% of the examinations were performed within 30 days from the transplant. About 62% of patients were transplanted due to a cholestatic disease, 11% due to a metabolic disease, 8% were re-transplanted due to graft failure, and 19% was due to other conditions. BA was the most common reason for transplantation and represented 38% of patients. About 38% of the transplantations were performed with whole grafts from DD, 40% with split liver grafts, and 22% with left lateral segments from LD. For diagnosing arterial circulatory complications, the PPV was 80%. For diagnosing portal vein circulatory complications, the PPV was 66.7%. NPV was 100%. In 28% of the examinations, the examiner could not visualize the normal arterial blood flow without CEUS. CEUS is a non-invasive and safe imaging technique that seems valuable in these patients and further efforts are needed to license its use in the post-transplant setting.


Assuntos
Transplante de Fígado , Complicações Pós-Operatórias/diagnóstico por imagem , Doenças Vasculares/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Meios de Contraste , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Hexafluoreto de Enxofre , Ultrassonografia , Doenças Vasculares/etiologia
13.
Nord J Psychiatry ; : 1-9, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-30383463

RESUMO

AIMS: This study aimed to examine changes in prevalence and correlates of alcohol-use disorders (AUD) between 2000 and 2011. We also explored the impact of using multiple imputation on prevalence estimates, to address survey nonresponse. METHODS: The study used a Finnish nationally representative survey of adults aged 30 years and older in 2000 and in 2011. The Munich Composite International Diagnostic Interview (M-CIDI) was used to diagnose AUD in 6005 persons in 2000 (response rate 75%) and 4381 in 2011 (response rate 55%). Multiple imputation using sociodemographic, health, and registry-linked data on mental health hospitalizations was compared with weights to account for nonresponse. RESULTS: Prevalence of 12-month AUD in Finland decreased from 4.6% (95% CI 4.0-5.1) in 2000 to 2.0% in 2011 (95% CI 1.6-2.4). Lifetime AUD prevalence decreased from 10.8% (95% CI 9.9-11.6) to 7.5% (CI 95% 6.8-8.3) from 2000 to 2011. The reduction was observed for people aged 30-64 years. At both time points, AUD prevalence was higher among individuals aged 30-64, men and those unmarried, widowed or divorced. The observed prevalence changes can be partly attributed to reporting and selection bias. The latter was addressed by multiple imputation. CONCLUSIONS: Alcohol use disorders appear to have decreased in Finland from 2000 to 2011, especially for the 30-64 years age group. Males, younger adults and those unmarried, widowed or divorced had a higher risk of AUD.

14.
BMJ Open ; 8(10): e022752, 2018 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-30327404

RESUMO

OBJECTIVE: To evaluate if obstructive sleep apnoea (OSA) modifies the risk of coronary heart disease, type 2 diabetes (T2D) and diabetic complications in a gender-specific fashion. DESIGN AND SETTING: A longitudinal population-based study with up to 25-year follow-up data on 36 963 individuals (>500 000 person years) from three population-based cohorts: the FINRISK study, the Health 2000 Cohort Study and the Botnia Study. MAIN OUTCOME MEASURES: Incident coronary heart disease, diabetic kidney disease, T2D and all-cause mortality from the Finnish National Hospital Discharge Register and the Finnish National Causes-of-Death Register. RESULTS: After adjustments for age, sex, region, high-density lipoprotein (HDL) and total cholesterol, current cigarette smoking, body mass index, hypertension, T2D baseline and family history of stroke or myocardial infarction, OSA increased the risk for coronary heart disease (HR=1.36, p=0.0014, 95% CI 1.12 to 1.64), particularly in women (HR=2.01, 95% CI 1.31 to 3.07, p=0.0012). T2D clustered with OSA independently of obesity (HR=1.48, 95% CI 1.26 to 1.73, p=9.11×[Formula: see text]). The risk of diabetic kidney disease increased 1.75-fold in patients with OSA (95% CI 1.13 to 2.71, p=0.013). OSA increased the risk for coronary heart disease similarly among patients with T2D and in general population (HR=1.36). All-cause mortality was increased by OSA in diabetic individuals (HR=1.35, 95% CI 1.06 to 1.71, p=0.016). CONCLUSION: OSA is an independent risk factor for coronary heart disease, T2D and diabetic kidney disease. This effect is more pronounced even in women, who until now have received less attention in diagnosis and treatment of OSA than men.

17.
J Affect Disord ; 241: 311-318, 2018 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-30142590

RESUMO

BACKGROUND: Socioeconomic status, as measured by education, occupation or income, is associated with depression. However, data are lacking on the psychosocial, material and behavioral mediators of these associations. We have examined the association of education, occupation and income with depression and the potential mediations using community-based data. METHODS: A total of 7,966 older adults were interviewed in Finland, Poland and Spain. The differential associations between depression and SES, mediator variables, country of residence and cofounder variables, such as chronic physical conditions, were assessed through logistic regression models. Meditation analyses were carried out using khb method for Stata 13.1. RESULTS: Education, followed by household income, were the SES indicators most frequently significantly associated with depression. These SES markers, but not occupation, showed an independent effect in this association. Psychosocial factors and loneliness in particular showed the strongest associations with depression among mediator variables. However, material factors and, especially, financial strain had a higher mediating function in the association between SES and depression. Overall, SES markers, chronic conditions and mediation factors were more positive in Finland than in Poland and Spain. CONCLUSION: Improving psychosocial and material dimensions as well as access to the educational system for older adults might result in a reduction in the prevalence of depression in the general population and particularly among individuals with low SES.

18.
Eur J Public Health ; 28(5): 898-903, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-29878120

RESUMO

Background: The Second European Union Minorities and Discrimination Survey recently demonstrated widespread discrimination across EU countries, with high discrimination rates observed in countries like Finland. Discrimination is known to negatively impact health, but fewer studies have examined how different types of perceived discrimination are related to health. Methods: This study examines (i) the prevalence of different types of perceived discrimination among Russian, Somali and Kurdish origin populations in Finland, and (ii) the association between different types of perceived discrimination (no experiences; subtle discrimination only; overt or subtle and overt discrimination) and health (self-rated health; limiting long-term illness (LLTI) or disability; mental health symptoms). Data are from the Finnish Migrant Health and Wellbeing Study (n = 1795). Subtle discrimination implies reporting being treated with less courtesy and/or treated with less respect than others, and overt discrimination being called names or insulted and/or threatened or harassed. The prevalence of discrimination and the associations between discrimination and health were calculated with predicted margins and logistic regression. Results: Experiences of subtle discrimination were more common than overt discrimination in all the studied groups. Subtle discrimination was reported by 29% of Somali origin persons and 35% Russian and Kurdish origin persons. The prevalence of overt discrimination ranged between 22% and 24%. Experiences of discrimination increased the odds for poor self-reported health, LLTI and mental health symptoms, particularly among those reporting subtle discrimination only. Conclusions: To promote the health of diverse populations, actions against racism and discrimination are highly needed, including initiatives that promote shared belonging.

19.
Neuron ; 98(4): 743-753.e4, 2018 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-29731251

RESUMO

Complex traits, including migraine, often aggregate in families, but the underlying genetic architecture behind this is not well understood. The aggregation could be explained by rare, penetrant variants that segregate according to Mendelian inheritance or by the sufficient polygenic accumulation of common variants, each with an individually small effect, or a combination of the two hypotheses. In 8,319 individuals across 1,589 migraine families, we calculated migraine polygenic risk scores (PRS) and found a significantly higher common variant burden in familial cases (n = 5,317, OR = 1.76, 95% CI = 1.71-1.81, p = 1.7 × 10-109) compared to population cases from the FINRISK cohort (n = 1,101, OR = 1.32, 95% CI = 1.25-1.38, p = 7.2 × 10-17). The PRS explained 1.6% of the phenotypic variance in the population cases and 3.5% in the familial cases (including 2.9% for migraine without aura, 5.5% for migraine with typical aura, and 8.2% for hemiplegic migraine). The results demonstrate a significant contribution of common polygenic variation to the familial aggregation of migraine.

20.
Sleep Med ; 48: 16-22, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29843023

RESUMO

BACKGROUND: Sleep problems are commonly reported in seasonal affective disorder (SAD) and major depressive disorder (MDD). However, the specific characteristics of sleep difficulties differ. Frequent sleep problems in MDD are insomnia and night awakenings, whereas SAD patients complain of hypersomnia and daytime sleepiness. No previous studies have reported differences in sleep functioning between these two disorders. METHODS: We interviewed 4554 subjects from the Health 2011 survey and included 4153 individuals in this study. We selected participants who fulfilled the criteria for SAD (n = 223), nonseasonal-MDD (n = 238), SAD + MDD (n = 65), and controls (n = 3627). They completed the World Health Organization Composite International Diagnostic Interview, Munich version (M-CIDI), the Seasonal Pattern Assessment Questionnaire (SPAQ), The Beck Depression Inventory (BDI), the EuroQoL (EQ-5), the Alcohol Use Disorders Identification Test (AUDIT) and several questions about sleeping, based on the Basic Nordic Sleep Questionnaire (BNSQ). RESULTS: We found Significant differences between groups for "enough sleep", "breathing interruptions during sleep", "tiredness during the day", and "sleeping difficulties". Controls reported better functioning in all sleep variables. SAD + MDD individuals showed more problems in "enough sleep" than SAD, more "breathing interruptions during sleep" than SAD and nonseasonal-MDD, felt more "tired during the day" than SAD and nonseasonal-MDD, and reported more "sleeping difficulties" than SAD and nonseasonal-MDD. Finally, nonseasonal-MDD individuals felt more "tired during the day" than SAD. CONCLUSION: Individuals with SAD + MDD show generalized sleeping problems. However, when SAD and nonseasonal-MDD appear separately, similar sleep functioning is observed. Nonseasonal-MDD subjects report to be more tired during the day than SAD.

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