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1.
Euro Surveill ; 26(36)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34505568

RESUMO

BackgroundCohort studies on vaccine effectiveness are prone to confounding bias if the distribution of risk factors is unbalanced between vaccinated and unvaccinated study subjects.AimWe aimed to estimate influenza vaccine effectiveness in the elderly population in Finland by controlling for a sufficient set of confounders based on routinely available register data.MethodsFor each of the eight consecutive influenza seasons from 2012/13 through 2019/20, we conducted a cohort study comparing the hazards of laboratory-confirmed influenza in vaccinated and unvaccinated people aged 65-100 years using individual-level medical and demographic data. Vaccine effectiveness was estimated as 1 minus the hazard ratio adjusted for the confounders age, sex, vaccination history, nights hospitalised in the past and presence of underlying chronic conditions. To assess the adequacy of the selected set of confounders, we estimated hazard ratios of off-season hospitalisation for acute respiratory infection as a negative control outcome.ResultsEach analysed cohort comprised around 1 million subjects, of whom 37% to 49% were vaccinated. Vaccine effectiveness against laboratory-confirmed influenza ranged from 16% (95% confidence interval (CI): 12-19) to 48% (95% CI: 41-54). More than 80% of the laboratory-confirmed cases were hospitalised. The adjusted off-season hazard ratio estimates varied between 1.00 (95% CI: 0.94-1.05) and 1.08 (95% CI: 1.01-1.15), indicating that residual confounding was absent or negligible.ConclusionSeasonal influenza vaccination reduces the hazard of severe influenza disease in vaccinated elderly people. Data about age, sex, vaccination history and utilisation of hospital care proved sufficient to control confounding.


Assuntos
Vacinas contra Influenza , Influenza Humana , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Finlândia/epidemiologia , Hospitalização , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Estações do Ano , Vacinação
2.
Epidemiol Infect ; 149: e187, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34340722

RESUMO

We update our previous insights into COVID-19 vaccine acceptance and hesitancy in Finland. Vaccine acceptance increased from 64% (November/December 2020) to 74% (April 2021). However, there was a group of participants that were preferring to wait to get vaccinated ranging from 6% of over-64-years-olds to 29% of under-30-years-olds. The previously identified enablers convenience (below-50-years-olds), worry about severe disease and protection for oneself (above-50-years-olds) were no longer significantly associated with increased vaccine acceptance. Understanding barriers and enablers behind vaccine acceptance is decisive in ensuring a successful implementation of COVID-19 vaccination programs, which will be key to ending the pandemic.


Assuntos
Vacinas contra COVID-19/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Vacinação/psicologia , Adulto , Fatores Etários , Idoso , Feminino , Finlândia , Humanos , Programas de Imunização/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
BMJ Open ; 11(8): e049675, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348953

RESUMO

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) guidelines advocate treatment with combinations of long-acting bronchodilators for patients with COPD who have persistent symptoms or continue to have exacerbations while using a single bronchodilator. This study assessed the cost-utility of the fixed dose combination of the bronchodilators tiotropium and olodaterol versus two comparators, tiotropium monotherapy and long-acting ß2 agonist/inhaled corticosteroid (LABA/ICS) combinations, in three European countries: Finland, Sweden and the Netherlands. METHODS: A previously published COPD patient-level discrete event simulation model was updated with most recent evidence to estimate lifetime quality-adjusted life years (QALYs) and costs for COPD patients receiving either tiotropium/olodaterol, tiotropium monotherapy or LABA/ICS. Treatment efficacy covered impact on trough forced expiratory volume in 1 s (FEV1), total and severe exacerbations and pneumonias. The unit costs of medication, maintenance treatment, exacerbations and pneumonias were obtained for each country. The country-specific analyses adhered to the Finnish, Swedish and Dutch pharmacoeconomic guidelines, respectively. RESULTS: Treatment with tiotropium/olodaterol gained QALYs ranging from 0.09 (Finland and Sweden) to 0.11 (the Netherlands) versus tiotropium and 0.23 (Finland and Sweden) to 0.28 (the Netherlands) versus LABA/ICS. The Finnish payer's incremental cost-effectiveness ratio (ICER) of tiotropium/olodaterol was €11 000/QALY versus tiotropium and dominant versus LABA/ICS. The Swedish ICERs were €6200/QALY and dominant, respectively (societal perspective). The Dutch ICERs were €14 400 and €9200, respectively (societal perspective). The probability that tiotropium/olodaterol was cost-effective compared with tiotropium at the country-specific (unofficial) threshold values for the maximum willingness to pay for a QALY was 84% for Finland, 98% for Sweden and 99% for the Netherlands. Compared with LABA/ICS, this probability was 100% for all three countries. CONCLUSIONS: Based on the simulations, tiotropium/olodaterol is a cost-effective treatment option versus tiotropium or LABA/ICS in all three countries. In both Finland and Sweden, tiotropium/olodaterol is more effective and cost saving (ie, dominant) in comparison with LABA/ICS.


Assuntos
Broncodilatadores , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Benzoxazinas , Broncodilatadores/uso terapêutico , Análise Custo-Benefício , Finlândia , Humanos , Países Baixos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Suécia , Brometo de Tiotrópio/uso terapêutico , Resultado do Tratamento
4.
Viruses ; 13(7)2021 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-34372520

RESUMO

The 2019 novel coronavirus (COVID-19) pandemic has placed a significant strain on hepatitis programs and interventions (screening, diagnosis, and treatment) at a critical moment in the context of hepatitis C virus (HCV) elimination. We sought to quantify changes in Direct Acting Antiviral (DAA) utilization among different countries during the pandemic. We conducted a cross-sectional time series analysis between 1 September 2018 and 31 August 2020, using the IQVIA MIDAS database, which contains DAA purchase data for 54 countries. We examined the percent change in DAA units dispensed (e.g., pills and capsules) from March to August 2019 to the same period of time in 2020 across the 54 countries. Interrupted time-series analysis was used to examine the impact of COVID-19 on monthly rates of DAA utilization across each of the major developed economies (G7 nations). Overall, 46 of 54 (85%) jurisdictions experienced a decline in DAA utilization during the pandemic, with an average of -43% (range: -1% in Finland to -93% in Brazil). All high HCV prevalence (HCV prevalence > 2%) countries in the database experienced a decline in utilization, average -49% (range: -17% in Kazakhstan to -90% in Egypt). Across the G7 nations, we also observed a decreased trend in DAA utilization during the early months of the pandemic, with significant declines (p < 0.01) for Canada, Germany, the United Kingdom, and the United States of America. The global response to COVID-19 led to a large decrease in DAA utilization globally. Deliberate efforts to counteract the impact of COVID-19 on treatment delivery are needed to support the goal of HCV elimination.


Assuntos
Antivirais/administração & dosagem , COVID-19/tratamento farmacológico , Antivirais/normas , Brasil/epidemiologia , COVID-19/epidemiologia , Canadá/epidemiologia , Estudos Transversais , Egito/epidemiologia , Finlândia/epidemiologia , Alemanha/epidemiologia , Hepacivirus/isolamento & purificação , Hepatite C , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/epidemiologia , Humanos , Cazaquistão/epidemiologia , Pandemias , Prevalência , SARS-CoV-2/isolamento & purificação , Reino Unido/epidemiologia , Estados Unidos
5.
Eur J Endocrinol ; 185(4): 577-586, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34374651

RESUMO

Objective: Insulinomas are rare functional pancreatic neuroendocrine tumours. As previous data on the long-term prognosis of insulinoma patients are scarce, we studied the morbidity and mortality in the Finnish insulinoma cohort. Design: Retrospective cohort study. Methods: Incidence of endocrine, cardiovascular, gastrointestinal and psychiatric disorders, and cancers was compared in all the patients diagnosed with an insulinoma in Finland during 1980-2010 (n = 79, including two patients with multiple endocrine neoplasia type 1 syndrome), vs 316 matched controls, using the Mantel-Haenszel method. Overall survival was analysed with Kaplan-Meier and Cox regression analyses. Results: The median length of follow-up was 10.7 years for the patients and 12.2 years for the controls. The long-term incidence of atrial fibrillation (rate ratio (RR): 2.07 (95% CI: 1.02-4.22)), intestinal obstruction (18.65 (2.09-166.86)), and possibly breast (4.46 (1.29-15.39) and kidney cancers (RR not applicable) was increased among insulinoma patients vs controls, P < 0.05 for all comparisons. Endocrine disorders and pancreatic diseases were more frequent in the patients during the first year after insulinoma diagnosis, but not later on. The survival of patients with a non-metastatic insulinoma (n = 70) was similar to that of controls, but for patients with distant metastases (n = 9), the survival was significantly impaired (median 3.4 years). Conclusions: The long-term prognosis of patients with a non-metastatic insulinoma is similar to the general population, except for an increased incidence of atrial fibrillation, intestinal obstruction, and possibly breast and kidney cancers. These results need to be confirmed in future studies. Metastatic insulinomas entail a markedly decreased survival.


Assuntos
Insulinoma/epidemiologia , Neoplasias Pancreáticas/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Finlândia/epidemiologia , Seguimentos , História do Século XX , História do Século XXI , Humanos , Incidência , Insulinoma/complicações , Insulinoma/diagnóstico , Insulinoma/mortalidade , Pessoa de Meia-Idade , Morbidade , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Fatores de Tempo
6.
Respir Res ; 22(1): 237, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446020

RESUMO

Follow-up studies of COVID-19 patients have found lung function impairment up to six months after initial infection, but small airway function has not previously been studied. Patients (n = 20) hospitalised for a severe SARS-CoV-2 infection underwent spirometry, impulse oscillometry, and multiple measurements of alveolar nitric oxide three to six months after acute infection. None of the patients had small airway obstruction, nor increased nitric oxide concentration in the alveolar level. None of the patients had a reduced FEV1/FVC or significant bronchodilator responses in IOS or spirometry. In conclusion, we found no evidence of inflammation or dysfunction in the small airways.


Assuntos
COVID-19/complicações , COVID-19/fisiopatologia , Doenças Respiratórias/fisiopatologia , Adulto , Idoso , Feminino , Finlândia , Seguimentos , Volume Expiratório Forçado , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Alvéolos Pulmonares/metabolismo , Testes de Função Respiratória , Doenças Respiratórias/etiologia , Espirometria , Sobreviventes , Capacidade Vital
7.
Artigo em Inglês | MEDLINE | ID: mdl-34360025

RESUMO

The COVID-19 pandemic and social distancing measures targeting the transmission of the virus impacted everyday life in 2020. This study investigated pre- to in-pandemic changes in health behaviors and depressive symptoms during the COVID-19 pandemic and the role of personality traits in these changes in Finland. Data from a larger population-based cohort study of 51-59-year-old Finnish women were used (n = 358). Self-reported questionnaires gathered information about depressive symptoms, eating behavior, physical activity, and alcohol consumption before the pandemic time, at the onset, and at the end of the COVID-19 emergency conditions. Information about personality traits (extraversion and neuroticism) and sociodemographic factors was available from the pre-pandemic baseline. Women reported more depressive symptoms and unhealthier eating habits at the end of the emergency conditions compared to the pre-pandemic time. An increase in depressive symptoms was associated with changing to unhealthier eating habits. Higher extraversion was associated with a perceived decrease in alcohol consumption and with changing to healthier eating habits. Women with higher neuroticism reported changing to either healthier or unhealthier eating habits. In general, some women reported healthier lifestyle changes while other women reported the opposite. Personality traits help to understand these individual differences in adaptation to the pandemic situation.


Assuntos
COVID-19 , Pandemias , Estudos de Coortes , Depressão/epidemiologia , Extroversão Psicológica , Feminino , Finlândia/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Pessoa de Meia-Idade , SARS-CoV-2
8.
Artigo em Inglês | MEDLINE | ID: mdl-34360478

RESUMO

This article summarizes the results of studies on the exposure of the Finnish Sami people to radioactive fallout and the estimations of the related cancer risk. We also discuss the lifestyle, genetic origin and diet of this population. The Sami people are an indigenous people who live in the northern part of Scandinavia and Finland. The review is based on the available scientific literature of Finnish Sami. The traditional Sami diet, high in animal products, persists in Sami groups still involved in reindeer-herding, but others have adopted the typical diet of western cultures. Studies have consistently shown an overall reduced cancer risk among the Finnish Sami people, except for stomach cancer among the Skolt Sami. Common cancers among the Finnish main population, such as prostate, breast and skin cancer are especially rare among the Finnish Sami. The incidence of cancer among the Finnish Sami are mostly similar to those of the Swedish and Norwegian Sami. To conclude, we observed no effect of radioactive pollution on cancer incidence. The lifestyles and environments of the Sami are changing, and their cancer mortality rate today is similar to that of the majority of the Finnish and western population.


Assuntos
Cinza Radioativa , Neoplasias Gástricas , Animais , Grupos Étnicos , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Noruega , Grupos Populacionais
9.
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
10.
J Agric Food Chem ; 69(32): 8891-8894, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34404215

RESUMO

The International Symposium on Lipid Science and Health (ISLSH) has been organized annually by the Oil Crops Research Institute of Chinese Academy of Agricultural Sciences (OCRI-CAAS) since 2016. The purpose of the symposium was to bring together the leading lipid science and health researchers throughout the world to discuss the current state of knowledge as well as research needs with respect to chemistry and beneficial health properties of lipids. The Fifth International Symposium on Lipid Science and Health was held on October 2020 in Wuhan, Hubei, China. Speakers from China, the United States, Australia, Finland, and other countries delivered wonderful presentations. The presentations covered such diverse topics as lipid profiling and characterization, lipid preparation and modification, lipid improvement and regulation, and lipid nutrition and health. As a record of the symposium proceedings, this special issue comprises a selection of 27 papers from oral presentations and poster contributions and is prefaced by this introduction.


Assuntos
Produtos Agrícolas , Lipídeos , Austrália , China , Finlândia , Humanos
11.
Nurse Educ Today ; 106: 105060, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34315050

RESUMO

BACKGROUND: Nursing informatics competences (ie. knowledge and skills in electronic and structured documentation) have become a necessary prerequisite for nurses to carry out their professional roles. Therefore, there is a global need to integrate nursing informatics into nursing curricula. In Finland, the requirements to increase nursing informatics education were noted in eHealth strategies in 2015. However, it is not known whether these educational initiatives have succeeded in increasing nursing informatics competences of recent nursing graduates. OBJECTIVES: To examine whether nurses who graduated after the Finnish educational initiatives have higher nursing informatics competences than nurses who graduated before the initiatives. Additionally, the associations of age, gender, work setting and geographical area with the nurses' informatics competences were examined. DESIGN: Cross-sectional study. SETTINGS: The study was carried out between October-December 2018 in Finland. PARTICIPANTS: Registered nurses who graduated before (n = 931) and after (n = 712) the 2015 educational initiatives. METHODS: Nursing informatics competences were measured by four items: (1) terminology-based documentation, (2) patient-related digital work, (3) general IT competency and (4) electronic documentation according to structured national headings. The associations of the year of the graduation and demographic background variables with nurses' overall nursing informatics competence and also separately with four specific competence items were examined with analysis of covariance. RESULTS: Nurses' graduation year was associated with their overall nursing informatics competence and the specific competence related to terminology-based documentation. Nurses who had graduated after the initiatives had higher competence than nurses with earlier graduation years. Associations were also found between age and work setting with the nursing informatics competences. Younger nurses and nurses working in specialised healthcare and elderly care had the highest competence. CONCLUSIONS: The national eHealth strategies with educational initiatives seem to have affected favorably on nursing informatics education in Finnish nursing programs and have potentially led to increased nursing informatics competences of recent nursing graduates. The results of this study highlight the importance of educational policies stating the directions and objectives of education programs.


Assuntos
Educação em Enfermagem , Enfermeiras e Enfermeiros , Informática em Enfermagem , Idoso , Competência Clínica , Estudos Transversais , Finlândia , Humanos
13.
Environ Int ; 156: 106766, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34271428

RESUMO

BACKGROUND: Occupational exposure to pesticides has been reported among general population worldwide. However, little is known about the associations between non-occupational exposure to pesticides, and biological markers of health and their response by sex. OBJECTIVES: We aimed to assess the associations between non-occupational overall pesticide exposure, length of exposure and specific pesticides reported with 35 biological markers of health representing cardiometabolic, haematological, lung function, sex hormones, liver and kidney function profiles, and vitamin D in Finnish cohort. METHODS: 31-year cross-sectional examination of the Northern Finland Birth Cohort 1966 provided blood samples for biomarker measurements in 1997-1998. Number of subjects varied between 2361 and 5037 for given exposures and certain outcome associations. Multivariable regression analyses were performed to examine associations between overall pesticide exposure (OPE), length of pesticide exposure in months (PEM), in years (PEY), and specific pesticides use (PEU) or not with cardiometabolic [SBP, DBP, TC, LDL, HDL, triglycerides, fasting glucose, insulin, HOMA-IR, HOMA-B, HOMA-S, hs-CRP], hematological [WBC, RBC, Hb, HCT, MCV, MCH, MCHC, platelets], lung function (FVC, FEV1), sex hormones [luteinizing hormone (LH), testosterone (TT), sex-hormone binding globulin (SHBG)], liver and kidney function profiles [total protein, albumin, globulin, ALP, ALT, GGT, urea, creatinine], and vitamin D adjusting for sex, BMI, socioeconomic position (SEP) and season of pesticide use. RESULTS: This cohort study on up to 5037 adults with non-occupational OPE, PEM, PEY and PEU differed by sex and SEP. In regression analyses, all the exposures were positively associated with total cholesterol and low-density lipoprotein cholesterol, and PEU was negatively associated with high-density lipoprotein cholesterol in females. OPE and PEM were positively associated with haematocrit in females and PEU with platelets in males. PEU was negatively associated with mean corpuscular haemoglobin. OPE and PEM were positively associated with LH in males. OPE was negatively associated with total protein and albumin in males. DISCUSSION: In Finnish young adults, non-occupational overall pesticide exposure, length of exposure and specific pesticides were associated with multiple biological markers of health. The biological markers seem to be indicative of adverse effects of pesticides and warrant for further studies to replicate the findings and determine the underlying mechanisms.


Assuntos
Exposição Ocupacional , Praguicidas , Biomarcadores , Estudos de Coortes , Estudos Transversais , Feminino , Finlândia , Humanos , Masculino , Praguicidas/toxicidade
14.
Lancet Diabetes Endocrinol ; 9(9): 575-585, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34303414

RESUMO

BACKGROUND: Cardiovascular disease is the main determinant of premature mortality in patients with type 1 diabetes. However, time trends regarding different types of cardiovascular disease in childhood-onset type 1 diabetes with a long timespan from the diagnosis of diabetes are not well established. This study aimed to investigate the cumulative incidence of cardiovascular disease in individuals with type 1 diabetes in a population-based cohort in Finland, the country with the world's highest incidence of type 1 diabetes. METHODS: In this retrospective, nationwide registry-based, cohort study, all patients who were diagnosed between Jan 1, 1965, and Dec 31, 1999 with type 1 diabetes when they were younger than 15 years old in Finland were followed up and monitored for the occurrence of cardiovascular disease (including coronary artery disease, stroke, peripheral artery disease, and heart failure) until the end of 2016 and for cardiovascular disease mortality until 2017. Cumulative incidences of cardiovascular disease were calculated by the Fine and Gray method according to the year of diabetes diagnosis using six diagnosis cohorts: 1965-69, 1970-74, 1975-1979, 1980-84, 1985-89, 1990-94, and 1990-95. Trends in cardiovascular disease event rates were analysed by Fine and Gray competing risks regression models using year of diabetes diagnosis as continuous variable. In addition, non-linearity in trends was assessed with restricted cubic splines. The excess risk of coronary artery disease and stroke was estimated by comparison with the risk in the Finnish general population by calculating standardised incidence ratios (SIRs) and their time trends. The data for Finnish general population were drawn from the Cardiovascular Disease Register of the National Institute of Health and Welfare. The SIRs were calculated as ratios of observed and expected number of events in individuals with type 1 diabetes during 1991-2014. FINDINGS: 11 766 individuals were included in this study. During 361 033 person-years of follow-up and a median of 29·6 years (IQR 22·3-37·9) follow-up, a total of 1761 individuals had single or multiple types of cardiovascular disease events. 2686 events (864 [32·2%] coronary artery disease events, of which 663 were acute myocardial infarctions; 497 [18·5%] strokes; 854 [31·8%] peripheral artery diseases, of which 498 were lower extremity amputations; and 471 [17·5%] heart failure events) were reported until Dec 31, 2016, and 1467 deaths until Dec 31, 2017. Cardiovascular disease risk decreased linearly by 3·8% (hazard ratio [HR] 0·96 [95% CI 0·96-0·97]; p<0·0001) by later calendar year of diabetes diagnosis (p<0·0001). There was a decrease in the SIRs for both coronary artery disease and stroke within all 10-year age groups under 65 years, except for stroke in the oldest age group. However, the SIR was still 8·9 (95% CI 3·9-17·5) for coronary artery disease and 2·9 (1·3-5·7) for stroke in those diagnosed with type 1 diabetes in the 1990s. Finally, the cardiovascular disease death rate decreased constantly by diagnosis year. INTERPRETATION: The risk of cardiovascular disease has decreased over time in Finland in individuals with childhood-onset type 1 diabetes. However, there is still considerable excess cardiovascular disease risk in individuals with type 1 diabetes compared with the general population. These results highlight the need for studies on the mechanisms of atherosclerosis from the time of diagnosis of type 1 diabetes to facilitate early and effective prevention of cardiovascular disease in these individuals. FUNDING: Folkhälsan Research Foundation, Academy of Finland, Wilhelm and Else Stockmann Foundation, Liv och Hälsa Society, Novo Nordisk Foundation, Finnish Foundation for Cardiovascular Research, Finnish Diabetes Research Foundation, Diabetes Research Foundation, Medical Society of Finland, Sigrid Jusélius Foundation, and Helsinki University Hospital Research Funds.


Assuntos
Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Idade de Início , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco
15.
Eur J Endocrinol ; 185(4): 515-524, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34324430

RESUMO

Objective: In primary hyperparathyroidism (PHPT) with osteoporosis, bone mineral density (BMD) improves after parathyroidectomy. It is unclear whether combining surgery with postoperative bisphosphonate treatment can further improve bone health. Design: This randomized, placebo-controlled study compared the effects of surgery alone and surgery combined with zoledronic acid on bone metabolism in PHPT with osteoporosis. Methods: Fifty-six patients (f/m 47/9, mean age 68.4 years) with PHPT and osteoporosis were randomized 1-3 months after parathyroidectomy to receive a 2-year treatment of zoledronic acid or placebo. Dual-energy X-ray absorptiometry (DXA) and bone turnover markers (N-terminal propeptide of type 1 procollagen, C-terminal telopeptide of type 1 collagen, and alkaline phosphatase) were measured annually during the 2-year follow-up. Results: Two years after parathyroidectomy, BMD was significantly higher in the zoledronic acid (ZOL) group compared with the placebo (PBO) group at the femoral neck (P = 0.045 for Z-score) and lumbar spine (P = 0.039 and 0.017 for T- and Z-scores, respectively). Bone turnover markers were significantly lower in the ZOL group (P < 0.001 for all markers). Of the 18 patients who had received bisphosphonates for >1 year before surgery, BMD improved significantly in the ZOL group both in the femoral neck and lumbar spine (n = 10; all P < 0.001-0.01), but in the PBO group, only in the lumbar spine (n = 8, P = 0.03), (P = 0.08-0.95 for between-group changes). Conclusion: BMD increases after parathyroidectomy both with and without zoledronic acid but the increase is significantly higher with postoperative zoledronic acid.


Assuntos
Hiperparatireoidismo Primário , Osteoporose , Ácido Zoledrônico/administração & dosagem , Idoso , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/administração & dosagem , Terapia Combinada , Método Duplo-Cego , Esquema de Medicação , Feminino , Finlândia , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/tratamento farmacológico , Hiperparatireoidismo Primário/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoporose/tratamento farmacológico , Osteoporose/etiologia , Osteoporose/cirurgia , Paratireoidectomia , Período Pós-Operatório , Resultado do Tratamento
16.
Infect Dis (Lond) ; 53(11): 839-846, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34197270

RESUMO

BACKGROUND: Respiratory infection is the 4th most common reason for absence from work in Finland. There is limited knowledge of how social distancing affects the spread of respiratory infections during respiratory epidemics. We assessed the effect of nationwide infection control strategies against coronavirus disease in 2020 on various respiratory infections (International Statistical Classification of Diseases and Related Health Problems code J06) in occupational outpatient clinics. METHODS: We used occupational healthcare data of respiratory infection J06 diagnoses from 2017 to 2020 obtained from the largest health service provider in Finland. The data was divided into three 252 day-long pieces and was weekday-matched and smoothed by 7-day-moving average. The difference in the J06 diagnosis rate between the follow-up years was measured using Pearson correlation. Possible confounding by sex, age, and region was investigated in a stratified analysis. Confounding by respiratory syncytial virus was analysed using nationwide data of confirmed cases obtained from the national registry. RESULTS: In the second quarter of 2020, the trend in the daily number of J06 diagnoses was significantly different from the follow-up years 2019 and 2018. The number of J06 diagnoses peaked between March and April 2020 with roughly 2-fold higher count compared to normal. The timing of these peaks matched with the government issued infection control strategies and lockdowns. Based on stratified analysis, the increase in the number of J06 diagnoses was not confounded by region, age, or sex. Moreover, the rapid increase in the number of J06 diagnoses was not governed by the respiratory syncytial virus. CONCLUSION: Nationwide infection control strategies were effective to slow down the spread of common respiratory infectious diseases in the occupational population.


Assuntos
COVID-19 , Epidemias , Saúde do Trabalhador , Infecções Respiratórias , Finlândia/epidemiologia , Humanos , Controle de Infecções , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , SARS-CoV-2 , Estações do Ano
17.
J Med Virol ; 93(10): 6063-6067, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34228369

RESUMO

Social restrictions during the coronavirus disease 2019 pandemic strongly affected the epidemiology of influenza and respiratory syncytial virus (RSV). As rhinovirus seemed to spread despite the restrictions, we aimed to analyze rhinovirus epidemiology in children during the pandemic. This register-based study used data from the Finnish Infectious Disease Register. Nationwide rhinovirus findings from July 2015 to March 2021 were included and stratified by age (0-4, 5-9, and 10-14). Cumulative 14-day incidence per 100000 children was calculated. Four thousand five hundred and seventy six positive rhinovirus findings were included, of which 3788 (82.8%) were among children aged 0-4. The highest recorded incidence was 36.2 among children aged 0-4 in October 2017. The highest recorded incidence during the pandemic period was 13.6 in November 2020. The impact of the restrictions was mostly seen among children aged 0-4 years of age in weeks 14-22 in 2020. The incidence has since remained near reference levels in all age groups. Strict restrictions temporarily interrupted the circulation of rhinovirus in spring 2020. Rhinovirus incidence returned to normal levels soon after the harsh restrictions were lifted. These looser social restrictions prevented RSV and influenza seasons but failed to prevent the spread of rhinovirus.


Assuntos
Infecções por Picornaviridae/epidemiologia , Infecções por Picornaviridae/prevenção & controle , Rhinovirus , Adolescente , Fatores Etários , COVID-19 , Criança , Pré-Escolar , Finlândia/epidemiologia , Humanos , Lactente , Recém-Nascido , Pandemias , Distanciamento Físico , Vírus Sincicial Respiratório Humano , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , Infecções Respiratórias/virologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34281083

RESUMO

The aim of this study is to investigate whether personal, social and organizational level resources can buffer against the negative effects of perceived loneliness on stress and exhaustion. The data was collected from Finnish university employees (n = 1463) in autumn 2020 via an electronic survey. Of the respondents, about 78% were working remotely, and 64% were female. Hierarchical multiple regression analyses were used to analyze the main and moderating (i.e., buffering) effects. The results indicated that perceived loneliness was directly and positively associated with stress and exhaustion. Further, as hypothesized, personal resilience moderated the relationship between loneliness and stress and exhaustion, and organizational support moderated the relationship between loneliness and stress. Unexpectedly, organizational support did not moderate the loneliness-exhaustion relationship. Moreover, a sense of social belonging was not associated with stress and exhaustion, nor did it moderate loneliness and well-being relationships. The results demonstrate the importance of personal resilience and organizational support in enhancing well-being in organizations during the COVID-19 pandemic. Future research directions and practical ways to promote resilience and to increase organizational support are discussed.


Assuntos
COVID-19 , Pandemias , Feminino , Finlândia/epidemiologia , Humanos , Solidão , SARS-CoV-2 , Estresse Psicológico/epidemiologia , Universidades
19.
BMC Health Serv Res ; 21(1): 747, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315457

RESUMO

BACKGROUND: Recruiting and retaining staff are standing challenges in eldercare. Low pay, difficult working conditions, and social relations at the workplace impact on turnover intentions. Few studies have used quantitative data for estimating the role of recognition by the wider society for staff instability. This study examines how perceived lack of recognition at the societal level affects Nordic eldercare workers' considerations of leaving their jobs. METHODS: The 2015 Nordcare survey among frontline eldercare workers in Denmark, Finland, Norway, and Sweden (N = 3,677) is analysed. Issues such as working conditions, financial strain, work-life balance, and appreciation by care recipients and colleagues, were covered. Recognition at the societal level was measured by perceptions of being valued by top municipal leaders, mass media, and the general public. Analyses are made with cross-tabulations and multivariate linear probability regression models. RESULTS: In the total sample, 41.1 % had "seriously considered to quit during the last 12 months". About one third felt "not at all valued" by top municipal leaders, while one fourth felt "not at all valued" by mass media. In bivariate analyses, perceptions of recognition were strongly associated with considerations to quit. These associations were reduced, but remained sizeable and highly significant in multivariate analyses adjusted for age, gender, health, working conditions, financial stress, workplace relations, and other known turnover predictors. CONCLUSIONS: Lack of recognition by societal agents such as top municipal leaders, mass media, and the general public, is widely felt by Nordic eldercare workers. Feeling poorly valued by such sources is associated with frequent considerations to leave one's employment. Perceived lack of recognition by the wider society has a significant and independent impact on staff instability in the eldercare sector. Societies' recognition order is embedded in social structures which are resistant to change, but policies which succeed in raising the societal recognition of eldercare work may contribute to reduced retention difficulties in eldercare.


Assuntos
Reorganização de Recursos Humanos , Finlândia , Humanos , Noruega , Inquéritos e Questionários , Suécia
20.
Aging Clin Exp Res ; 33(8): 2345-2353, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34232484

RESUMO

BACKGROUND: Older people with limited health literacy may encounter difficulties in finding relevant information on COVID-19, understanding its relevance, and complying with recommended protective measures. Complying with such recommendations has required older as well as younger persons to change their daily lives in ways that have reduced their opportunities for engaging in many activities meaningful to them. AIMS: To find out from what sources older people have obtained information on protective measures, the level of their coronavirus-related health literacy (CHL), and whether CHL is associated with their perceptions of the restrictiveness of coronavirus-related protective measures. METHODS: 696 Finnish men and women aged over 77 answered a mailed questionnaire on their CHL, sources of information and perceptions of the restrictiveness of the recommended protective measures. The association of CHL with perceived restrictiveness was studied using multinomial logistic regression analysis. RESULTS: Television and newspapers were the most frequently reported sources of information. Reporting high confidence in the ability to assess how one's behavior influences coronavirus infection risk was associated with higher odds of perceiving the protective measures to be highly restrictive, when controlling for age, gender, and difficulty in using digital devices (OR 3.21, 95% CI 1.09, 9.46). DISCUSSION: Participants who reported being highly confident about their ability to appraise the influence of their behavior on their susceptibility to coronavirus infection were more likely to perceive that the recommended protective measures had restricted their daily lives. CONCLUSIONS: Health literacy plays a role in complying with recommended restrictions.


Assuntos
COVID-19 , Letramento em Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Finlândia , Humanos , Vida Independente , Masculino , SARS-CoV-2 , Inquéritos e Questionários
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