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1.
BMC Oral Health ; 21(1): 333, 2021 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229689

RESUMO

BACKGROUND: An association between childhood anthropometric measurements and dental caries is conflicting. The prevalence and severity of dental caries and its association with anthropometric and behavioural factors, were investigated among Finnish teenagers. METHODS: The study sample comprised 202 15-17-year-old participants in the Physical Activity and Nutrition in Children (PANIC) Study. Dental caries findings were recorded using International Caries Detection and Assessment System (ICDAS) criteria, including activity estimation; numbers of decayed teeth (DT) and decayed, missing and filled teeth (DMFT) were recorded. Body weight, height and waist circumference were measured and respective body mass index (BMI) was calculated. Body fat percentage was assessed by dual-energy X-ray absorptiometry. Health-related behaviours and consumption of food and drinks were assessed using questionnaires, and intake of nutrients using a 4-day food record. RESULTS: Mean DMFT for all the participants was 2.4 (SD = 2.9), DT 0.6 (SD = 1.3), and 36% had DMFT = 0. No difference between genders was observed. In bivariate analyses, use of sugar-sweetened beverages (SSB) three times or less per week and not having used snuff associated significantly, whereas higher carbohydrate intake (E%), toothbrushing less often than twice a day and higher caries experience at baseline almost significantly with DT > 0. In adjusted regression analyses, frequent use of SSB and higher carbohydrate intake increased the odds for DT > 0. Additionally, higher carbohydrate intake (E%) and infrequent tooth brushing significantly associated with a higher number of DT. CONCLUSION: Caries prevalence is still low and similar in Finnish teenage girls and boys. Behavioural factors are, but anthropometric factors are not associated with dental caries.


Assuntos
Cárie Dentária , Adolescente , Criança , Estudos Transversais , Índice CPO , Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Dieta , Exercício Físico , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Prevalência
2.
PLoS One ; 16(7): e0253875, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34228727

RESUMO

BACKGROUND: A concern has been that health care reorganizations during the first COVID-19 wave have led to delays in elective surgeries, resulting in increased complications and even mortality. This multicenter study examined the changes in waiting times of elective surgeries during the COVID-19 pandemic in Finland. METHODS: Data on elective surgery were gathered from three Finnish public hospitals for years 2017-2020. Surgery incidence and waiting times were examined and the year 2020 was compared to the reference years 2017-2019. The mean annual, monthly, and weekly waiting times were calculated with 95% confidence intervals (CI). The most common diagnosis groups were examined separately. FINDINGS: A total of 88 693 surgeries were included during the study period. The mean waiting time in 2020 was 92.6 (CI 91.5-93.8) days, whereas the mean waiting time in the reference years was 85.8 (CI 85.1-86.5) days, resulting in an average 8% increase in waiting times in 2020. Elective procedure incidence decreased rapidly in the onset of the first COVID-19 wave in March 2020 but recovered in May and June, after which the surgery incidence was 22% higher than in the reference years and remained at this level until the end of the year. In May 2020 and thereafter until November, waiting times were longer with monthly increases varying between 7% and 34%. In gastrointestinal and genitourinary diseases and neoplasms, waiting times were longer in 2020. In cardiovascular and musculoskeletal diseases, waiting times were shorter in 2020. CONCLUSION: The health care reorganizations due to the pandemic have increased elective surgery waiting times by as much as one-third, even though the elective surgery rate increased by one-fifth after the lockdown.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , COVID-19/patologia , COVID-19/virologia , Finlândia/epidemiologia , Hospitais Públicos , Humanos , Pandemias , SARS-CoV-2/isolamento & purificação , Fatores de Tempo , Listas de Espera
3.
Eur J Endocrinol ; 185(2): 279-288, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34081616

RESUMO

Objective: It has been suggested that adverse early life exposures increase the risk of developing polycystic ovary syndrome (PCOS) in later life. We hypothesized that women born preterm would have more biochemical and clinical signs of PCOS than women born at term. Design: The ESTER Preterm Birth Study participants were born in Northern Finland and identified from the Northern Finland Birth Cohort and the Finnish Medical Birth Register. Altogether, 74 women born very or moderately preterm (<34 gestational weeks, VMPT), 127 born late preterm (at 34-36 weeks, LPT), and 184 born full term (≥37 weeks, controls) were included in the analysis (mean age: 23.2 years). Methods: We measured serum total testosterone and sex hormone-binding globulin (SHBG) and calculated the free androgen index (FAI). PCOS according to the clinical and biochemical signs was defined either as hirsutism and oligoamenorrhea (via questionnaire) or as oligoamenorrhea and elevated testosterone levels (>2.4 nmol/L). Results: Women born VMPT/LPT exhibited 33.0% (8.7, 62.8)/16.4% (-2.0, 38.1) higher testosterone, 28.5% (5.3, 45.9)/24.1% (5.6, 38.9) lower SHBG levels, and 64.6% (19.4, 127.1)/42.5% (11.1, 82.9) higher FAI than controls after adjusting for age and recruitment cohort, maternal BMI, smoking, and pregnancy disorders, parental education, history of hypertension, diabetes, myocardial infarction or stroke, and subject's birth weight s.d. Odds ratios for having PCOS were 1.67 (0.44, 6.23)/3.11 (1.26, 7.70). Conclusions: Women born preterm have a more hyperandrogenic hormonal profile, and those born LPT are approximately three times more likely at risk to have PCOS compared to women born at term.


Assuntos
Biomarcadores , Síndrome do Ovário Policístico/diagnóstico , Síndrome do Ovário Policístico/epidemiologia , Nascimento Prematuro/epidemiologia , Adulto , Crianças Adultas/estatística & dados numéricos , Androgênios/sangue , Biomarcadores/análise , Biomarcadores/sangue , Índice de Massa Corporal , Estudos de Casos e Controles , Feminino , Finlândia/epidemiologia , Idade Gestacional , Hirsutismo/sangue , Hirsutismo/diagnóstico , Hirsutismo/epidemiologia , Humanos , Recém-Nascido , Síndrome do Ovário Policístico/sangue , Síndrome do Ovário Policístico/etiologia , Gravidez , Complicações na Gravidez/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/etiologia , Fatores de Risco , Testosterona/sangue , Adulto Jovem
4.
BMC Public Health ; 21(1): 1088, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34098909

RESUMO

BACKGROUND: The aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland. METHODS: A total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 - I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA. RESULTS: Migraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls (p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45-7.05) and IS (2.57, 95% CI 1.28-5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35-7.84 and 5.0, 95% CI 1.94-12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively. CONCLUSION: Cardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.


Assuntos
Doenças Cardiovasculares , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Idoso , Doenças Cardiovasculares/epidemiologia , Feminino , Finlândia/epidemiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
5.
BMC Womens Health ; 21(1): 242, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34126992

RESUMO

BACKGROUND: A persistent research finding in Finland and elsewhere has been variation in medical practices both between and within countries. Variation seems to exist especially if medical decision making involves discretion and the best treatment cannot be identified unambiguously. This is true for hysterectomy when performed for benign causes. The aim of the current study was to investigate regional trends in hysterectomy in Finland and the potential convergence of rates over time. METHODS: We used hospital discharge register data on hysterectomies performed, diagnoses, age, and region of residence to examine hospital discharges for women undergoing hysterectomy in 2001-2018 among total female population aged 25 years or older in Finland. We examined hysterectomy rates among biannual cohorts by indication, calculated age-standardised rates and used multilevel models to analyse potential convergence over time. RESULTS: Altogether 131,695 hysterectomies were performed in Finland 2001-2018. We found a decreasing trend, with the age-adjusted overall hysterectomy rate decreasing from 553/100,000 person years in 2001-2002 to 289/100,000 py in 2017-2018. Large but converging regional differences were found. The correlations between hospital district intercepts and slopes in time ranged from - 0.71 to - 0.97 (p < 0.001) suggesting diminishing variation. CONCLUSIONS: Our findings demonstrate that change in hysterectomy practices and more uniformity across regions are achievable goals. Regional variation still exists suggesting differences in medical practices.


Assuntos
Histerectomia , Feminino , Finlândia/epidemiologia , Humanos
6.
BMC Geriatr ; 21(1): 358, 2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34112108

RESUMO

BACKGROUND: Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults. METHODS: In this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses. RESULTS: The mean age of the participants (n = 1259) was 73.5 years (range 64.0-100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models. CONCLUSIONS: The categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual's health evaluation when screening for future adverse outcomes.


Assuntos
Avaliação Geriátrica , Vida Independente , Idoso , Idoso de 80 Anos ou mais , Finlândia/epidemiologia , Seguimentos , Humanos , Institucionalização , Estudos Prospectivos
7.
Eur J Pediatr ; 180(8): 2693-2698, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34173042

RESUMO

The aim of this nationwide population-based case-control study was to assess the incidence of inguinal hernia (IH) among patients with congenital abdominal wall defects. All infants born with congenital abdominal wall defects between Jan 1, 1998, and Dec 31, 2014, were identified in the Finnish Register of Congenital Malformations. Six controls matched for gestational age, sex, and year of birth were selected for each case in the Medical Birth Register. The Finnish Hospital Discharge Register was searched for relevant diagnosis codes for IH, and hernia incidence was compared between cases and controls. We identified 178 infants with gastroschisis and 150 with omphalocele and selected randomly 1968 matched, healthy controls for comparison. Incidence of IH was significantly higher in gastroschisis girls than in matched controls, relative risk (RR) 7.20 (95% confidence interval [CI] 2.25-23.07). In boys with gastroschisis, no statistically significant difference was observed, RR 1.60 (95% CI 0.75-3.38). Omphalocele was associated with higher risk of IH compared to matched controls, RR 6.46 (95% CI 3.90-10.71), and the risk was equally elevated in male and female patients.Conclusion: Risk of IH is significantly higher among patients with congenital abdominal wall defects than in healthy controls supporting hypothesis that elevated intra-abdominal pressure could prevent natural closure of processus vaginalis. Parents should be informed of this elevated hernia risk to avoid delays in seeking care. We also recommend careful follow-up during the first months of life as most of these hernias are diagnosed early in life. What is Known: • Inguinal hernia is one of the most common disorders encountered by a pediatric surgeon. • Prematurity increases the risk of inguinal hernia. What is New: • Children with congenital abdominal wall defects have a significantly higher risk of inguinal hernia than general population. • Families should be informed of this elevated hernia risk to avoid delays in seeking care.


Assuntos
Parede Abdominal , Hérnia Inguinal , Hérnia Umbilical , Estudos de Casos e Controles , Criança , Feminino , Finlândia/epidemiologia , Hérnia Inguinal/epidemiologia , Hérnia Umbilical/epidemiologia , Humanos , Incidência , Lactente , Masculino
8.
Nat Commun ; 12(1): 3991, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183681

RESUMO

As SARS-CoV-2 has been circulating for over a year, dozens of vaccine candidates are under development or in clinical use. The BNT162b2 mRNA COVID-19 vaccine induces spike protein-specific neutralizing antibodies associated with protective immunity. The emergence of the B.1.1.7 and B.1.351 variants has raised concerns of reduced vaccine efficacy and increased re-infection rates. Here we show, that after the second dose, the sera of BNT162b2-vaccinated health care workers (n = 180) effectively neutralize the SARS-CoV-2 variant with the D614G substitution and the B.1.1.7 variant, whereas the neutralization of the B.1.351 variant is five-fold reduced. Despite the reduction, 92% of the seronegative vaccinees have a neutralization titre of >20 for the B.1.351 variant indicating some protection. The vaccinees' neutralization titres exceeded those of recovered non-hospitalized COVID-19 patients. Our work provides evidence that the second dose of the BNT162b2 vaccine induces cross-neutralization of at least some of the circulating SARS-CoV-2 variants.


Assuntos
Anticorpos Amplamente Neutralizantes/sangue , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Imunogenicidade da Vacina , SARS-CoV-2/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Anticorpos Amplamente Neutralizantes/imunologia , COVID-19/sangue , COVID-19/epidemiologia , COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Proteção Cruzada/imunologia , Feminino , Finlândia/epidemiologia , Humanos , Imunização Secundária/métodos , Imunização Secundária/estatística & dados numéricos , Masculino , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Testes de Neutralização/estatística & dados numéricos , Reinfecção/imunologia , Reinfecção/prevenção & controle , Reinfecção/virologia , SARS-CoV-2/genética , Adulto Jovem
9.
Nat Commun ; 12(1): 3991, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: covidwho-1286457

RESUMO

As SARS-CoV-2 has been circulating for over a year, dozens of vaccine candidates are under development or in clinical use. The BNT162b2 mRNA COVID-19 vaccine induces spike protein-specific neutralizing antibodies associated with protective immunity. The emergence of the B.1.1.7 and B.1.351 variants has raised concerns of reduced vaccine efficacy and increased re-infection rates. Here we show, that after the second dose, the sera of BNT162b2-vaccinated health care workers (n = 180) effectively neutralize the SARS-CoV-2 variant with the D614G substitution and the B.1.1.7 variant, whereas the neutralization of the B.1.351 variant is five-fold reduced. Despite the reduction, 92% of the seronegative vaccinees have a neutralization titre of >20 for the B.1.351 variant indicating some protection. The vaccinees' neutralization titres exceeded those of recovered non-hospitalized COVID-19 patients. Our work provides evidence that the second dose of the BNT162b2 vaccine induces cross-neutralization of at least some of the circulating SARS-CoV-2 variants.


Assuntos
Anticorpos Amplamente Neutralizantes/sangue , Vacinas contra COVID-19/imunologia , COVID-19/prevenção & controle , Imunogenicidade da Vacina , SARS-CoV-2/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Anticorpos Amplamente Neutralizantes/imunologia , COVID-19/sangue , COVID-19/epidemiologia , COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Proteção Cruzada/imunologia , Feminino , Finlândia/epidemiologia , Humanos , Imunização Secundária/métodos , Imunização Secundária/estatística & dados numéricos , Masculino , Vacinação em Massa/métodos , Vacinação em Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Testes de Neutralização/estatística & dados numéricos , Reinfecção/imunologia , Reinfecção/prevenção & controle , Reinfecção/virologia , SARS-CoV-2/genética , Adulto Jovem
10.
Bone ; 151: 116030, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34098163

RESUMO

BACKGROUND: Osteoporosis and atherosclerosis are complex multifactorial diseases sharing common risk factors and pathophysiological mechanisms suggesting that these are comorbidities. Omics studies identifying joint molecular markers associated with these diseases are sparse. SUBJECTS AND METHODS: Using liquid chromatography-tandem mass spectrometry, we quantified 437 molecular lipid species from the Young Finns Study cohort (aged 30-45 years and 57% women) and performed lipidome-wide multivariate analysis of variance (MANOVA) with early markers for both diseases. Carotid intima-media thickness for atherosclerosis measured with ultrasound and bone mineral density from distal radius and tibia for osteoporosis measured with peripheral quantitative computed tomography were used as early markers of the diseases. RESULTS: MANOVA adjusted with age, sex and body mass index, identified eight statistically significant (adjusted p-value (padj) < 0.05) and 15 suggestively significant (padj < 0.25) molecular lipid species associated with the studied markers. Similar analysis adjusted additionally for smoking habit, physical activity and alcohol consumption identified four significant and six suggestively significant molecular lipid species. These most significant lipid classes/species jointly associated with the studied markers were glycerolipid/TAG(18:0/18:0/18:1), glycerophospholipid/PC(40:3), sphingolipid/Gb3(d18:1/22:0), and sphingolipid/Gb3(d18:1/24:0). CONCLUSION: Our results support the osteoporosis-atherosclerosis comorbidity hypothesis and present potential new joint lipid biomarkers for these diseases.


Assuntos
Aterosclerose , Osteoporose , Biomarcadores , Espessura Intima-Media Carotídea , Comorbidade , Feminino , Finlândia/epidemiologia , Humanos , Lipidômica , Masculino , Osteoporose/epidemiologia , Fatores de Risco
11.
Artigo em Inglês | MEDLINE | ID: mdl-34067158

RESUMO

Many long-term adverse effects of smoking during pregnancy are known. Increasingly, adverse effects in the grandchild after grandmaternal smoking during pregnancy are reported. We explored this in a birth cohort of 24,000 grandmother-mother-child triads identified from the Finnish Medical Birth Register in 1991-2016. Multiple logistic regression was used to analyze the association between any smoking during pregnancy by both grandmother and mother, or only grandmother or mother on adverse birth outcomes. No smoking by neither grandmother nor mother was used as the reference. As endpoints, preterm birth, low birth weight, small for gestational age (birth weight, birth length, head circumference), and body proportionality (low ponderal index, high brain-to-body ratio, high head-to-length ratio) were included. Smoking by both grandmother and mother was consistently associated with higher risks than smoking only by the mother. Birth length and weight were especially sensitive to (grand)maternal smoking. In conclusion, the combined effect of grandmaternal and maternal smoking is associated with higher risks than only maternal smoking.


Assuntos
Nascimento Prematuro , Fumar , Peso ao Nascer , Tamanho Corporal , Criança , Feminino , Finlândia/epidemiologia , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Fumar/efeitos adversos
12.
J Safety Res ; 77: 99-104, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34092332

RESUMO

BACKGROUND: Land motor traffic crash (LMTC) -related drownings are an overlooked and preventable cause of injury death. The aim of this study was to analyze the profile of water-related LMTCs involving passenger cars and leading to drowning and fatal injuries in Finland, 1972 through 2015. MATERIALS AND METHODS: The database of the Finnish Crash Data Institute (FCDI) that gathers detailed information on fatal traffic accidents provided records on all LMTCs leading to drowning during the study period and, from 2002 to 2015, on all water-related LMTCs, regardless of the cause of death. For each crash, we considered variables on circumstances, vehicle, and fatality profiles. RESULTS: During the study period, the FCDI investigated 225 water-related LMTCs resulting in 285 fatalities. The majority of crashes involved passenger cars (124), and the cause of death was mostly drowning (167). Only 61 (36.5%) fatalities suffered some-generally mild-injuries. The crashes frequently occurred during fall or summer (63.7%), in a river or ditch (60.5%), and resulted in complete vehicle's submersion (53.7 %). Half of the crashes occurred in adverse weather conditions and in over 40% of the cases, the driver had exceeded the speed limit. Among drivers, 77 (68.8%) tested positive for alcohol (mean BAC 1.8%). CONCLUSION: Multidisciplinary investigations of LMTCs have a much higher potential than do exclusive police and medico-legal investigations. The risk factors of water-related LMTCs are similar to those of other traffic crashes. However, generally the fatal event in water-related LMTC is not the crash itself, but drowning. The paucity of severe physical injuries suggests that victims' functional capacity is usually preserved during vehicle submersion. Practical Applications: In water-related LMTCs, expansion of safety measures is warranted from general traffic-injury prevention to prevention of drowning, including development of safety features for submerged vehicles and simple self-rescue protocols to escape from a sinking vehicle.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Afogamento/epidemiologia , Imersão/efeitos adversos , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Afogamento/etiologia , Afogamento/mortalidade , Feminino , Finlândia/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
13.
World J Surg Oncol ; 19(1): 190, 2021 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-34183025

RESUMO

BACKGROUND: The purpose of this study was to evaluate the effects of cytoreductive nephrectomy (CN) and metastasectomies on the survival of patients with synchronous metastatic renal cell cancer (mRCC) using real-life, population-based national dataset. METHODS: Nationwide data, including all cases of synchronous mRCC in Finland diagnosed on a 6-year timeframe, based on the Finnish Cancer Registry and complemented with patient records from the treating hospitals, were analyzed. Patients with Eastern Cooperative Oncology Group (ECOG) performance status 3-4 were excluded. Univariate and adjusted multivariable survival analysis were performed, including subgroup analysis for patients with different medical therapies. Nephrectomy complications were also analyzed. RESULTS: A total of 732 patients were included in the analysis. CN was performed for 389 (53.1%) patients, whereas 68 (9.3%) patients underwent nephrectomy and metastasectomies of all lesions (surgery with curative intent). Median overall survival (OS) for patients who did not undergo nephrectomy was 5.9 (95% confidence interval [CI] = 4.6-7.2) months. Patients who had a CN had a median OS of 16.6 (95% CI = 14.2-19.1, p < 0.001) months, whereas patients who had surgery with curative intent had a median OS of 51.3 (95% CI = 36.0-66.6, p < 0.001) months. The survival benefit of CN and metastasectomies remained significant in all medical therapy subgroups and in both of the applied multivariable statistical models. CONCLUSIONS: Surgical treatment of metastatic renal cell cancer is associated with a significant survival benefit in patients with good and moderate performance status, regardless of the chosen medical therapy.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Carcinoma de Células Renais/cirurgia , Procedimentos Cirúrgicos de Citorredução , Finlândia/epidemiologia , Humanos , Neoplasias Renais/cirurgia , Nefrectomia , Prognóstico , Estudos Retrospectivos
14.
Diving Hyperb Med ; 51(2): 182-189, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34157734

RESUMO

INTRODUCTION: Sinus barotrauma is a common occurrence in diving and subaquatic medicine, potentially compromising dive safety. To gain a more thorough understanding of the condition, an in-depth investigation is justified. METHODS: This was a survey study. An anonymous, electronic questionnaire was distributed to 7,060 recipients: professional divers of the Finnish Border Guard, the Finnish Rescue Services, and the Finnish Heritage agency, as well as recreational divers registered as members of the Finnish Divers' Association reachable by email (roughly two-thirds of all members and recreational divers in Finland). Primary outcomes were self-reported prevalence, clinical characteristics, and health effects of sinus barotrauma while diving. Secondary outcomes were adjusted odds ratios (OR) for frequency of sinus barotrauma with respect to possible risk factors. RESULTS: In total, 1,881 respondents participated in the study (response rate 27%). A total of 49% of the respondents had experienced sinus barotrauma while diving and of those affected, 32% had used medications to alleviate their symptoms. The factors associated with sinus barotrauma were pollen allergies (OR 1.59; 95% CI 1.10-2.29), regular smoking (OR 2.04; 95% CI 1.07-3.91) and a high number of upper respiratory tract infections per year (≥ 3 vs. < 3 infections per year: OR 2.76; 95% CI 1.79-4.24). CONCLUSIONS: Sinus barotrauma is the second most common condition encountered in diving medicine, having affected 49% of the respondents. Possible risk factors include allergies to pollen, regular smoking, and a high number of URTIs per year.


Assuntos
Barotrauma , Mergulho , Barotrauma/epidemiologia , Barotrauma/etiologia , Mergulho/efeitos adversos , Finlândia/epidemiologia , Humanos , Prevalência , Fumar
15.
Infect Dis (Lond) ; 53(8): 607-618, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33970737

RESUMO

BACKGROUND: The Nordic countries have comparable nationwide antibiotic resistance surveillance systems and individual antibiotic stewardship programmes. The aim of this study was to assess antibiotic resistance among major pathogens in relation to practice guidelines for hospital antibiotic treatment and antibiotic use in Nordic countries 2010-2018. METHODS: Antibiotic resistance among invasive isolates from 2010-2018 and aggregated antibiotic use were obtained from the European Centre for Disease Prevention and Control. Hospital practice guidelines were obtained from national or regional guidelines. RESULTS: Antibiotic resistance levels among Escherichia coli and Klebsiella pneumoniae were similar in all Nordic countries in 2018 and low compared to the European mean. Guidelines for acute pyelonephritis varied; 2nd generation cephalosporin (Finland), 3rd generation cephalosporins (Sweden, Norway), ampicillin with an aminoglycoside or aminoglycoside monotherapy (Denmark, Iceland and Norway). Corresponding guidelines for sepsis of unknown origin were 2nd (Finland) or 3rd (Sweden, Norway, Iceland) generation cephalosporins, carbapenems, (Sweden) combinations of penicillin with an aminoglycoside (Norway, Denmark), or piperacillin-tazobactam (all Nordic countries). Methicillin-resistant Staphylococcus aureus rates were 0-2% and empirical treatment with anti-MRSA antibiotics was not recommended in any country. Rates of penicillin non-susceptibility among Streptococcus pneumoniae were low (<10%) except in Finland and Iceland (<15%), but benzylpenicillin was recommended for community-acquired pneumonia in all countries. CONCLUSION: Despite similar resistance rates among Enterobacteriaceae there were differences in practice guidelines for pyelonephritis and sepsis. National surveillance of antibiotic resistance can be used for comparison and optimization of guidelines and stewardship interventions to preserve the low levels of antibiotic resistance in Nordic countries.


Assuntos
Antibacterianos , Staphylococcus aureus Resistente à Meticilina , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Resistência Microbiana a Medicamentos , Finlândia/epidemiologia , Hospitais , Humanos , Islândia/epidemiologia , Noruega/epidemiologia , Suécia
16.
J Med Internet Res ; 23(6): e29036, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34048356

RESUMO

BACKGROUND: The COVID-19 pandemic has changed work life profoundly and concerns regarding the mental well-being of employees' have arisen. Organizations have made rapid digital advancements and have started to use new collaborative tools such as social media platforms overnight. OBJECTIVE: Our study aimed to investigate how professional social media communication has affected work engagement before and during the COVID-19 pandemic and the role of perceived social support, task resources, and psychological distress as predictors and moderators of work engagement. METHODS: Nationally representative longitudinal survey data were collected in 2019-2020, and 965 respondents participated in all 4 surveys. Measures included work engagement, perceived social support and task resources, and psychological distress. The data were analyzed using a hybrid linear regression model. RESULTS: Work engagement remained stable and only decreased in autumn 2020. Within-person changes in social media communication at work, social support, task resources, and psychological distress were all associated with work engagement. The negative association between psychological distress and work engagement was stronger in autumn 2020 than before the COVID-19 outbreak. CONCLUSIONS: The COVID-19 pandemic has exerted pressure on mental health at work. Fostering social support and task resources at work is important in maintaining work engagement. Social media communication could help maintain a supportive work environment.


Assuntos
COVID-19 , Pandemias , Mídias Sociais/estatística & dados numéricos , Engajamento no Trabalho , Adulto , COVID-19/epidemiologia , Surtos de Doenças , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Saúde Mental/estatística & dados numéricos , Angústia Psicológica , Apoio Social , Local de Trabalho/psicologia
17.
Epidemiology ; 32(4): 525-532, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33935135

RESUMO

BACKGROUND: Information about social mixing patterns under heavy social distancing is needed to model the impact of nonpharmaceutical interventions on SARS-CoV-2 transmission. METHODS: We conducted a survey on daily person-to-person contacts during the early phase of the SARS-CoV-2 epidemic in Finland, one month after strong social distancing measures had been introduced nationwide. We defined a contact as exchange of at least a few words in proximity of another person. We also considered physical ("skin-to-skin") contacts separately. Based on 3,171 reported contacts by 1,320 participants of 1-79 years of age, we estimated age-stratified contact matrices essential in modeling virus transmission. RESULTS: Compared with contacts during prepandemic conditions, as learned from the Finnish part of the Polymod study, there was a 72% (95% credible interval, CI = 71, 74) reduction in the daily number of all contacts and a 69% (95% CI = 66, 73) reduction in the daily number of physical contacts in April 2020. The largest reduction, of almost 90%, occurred in physical contacts by individuals more than 70 years of age. The estimated reduction in the transmission potential of the virus attributable solely to reduced contact frequencies varied between 59% (whole population; physical contacts; 95% CI = 52, 68) and 77% (over 20-year olds; physical contacts; 95% CI = 70, 89). CONCLUSIONS: We surmise that the large reduction in the daily numbers of social contacts in the early part of the SARS-CoV-2 epidemic in Finland was likely a major contributor to the steady decline of the epidemic in the country since early April.


Assuntos
COVID-19 , Epidemias , Finlândia/epidemiologia , Humanos , Distanciamento Físico , SARS-CoV-2
18.
J Med Internet Res ; 23(6): e29036, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: covidwho-1278307

RESUMO

BACKGROUND: The COVID-19 pandemic has changed work life profoundly and concerns regarding the mental well-being of employees' have arisen. Organizations have made rapid digital advancements and have started to use new collaborative tools such as social media platforms overnight. OBJECTIVE: Our study aimed to investigate how professional social media communication has affected work engagement before and during the COVID-19 pandemic and the role of perceived social support, task resources, and psychological distress as predictors and moderators of work engagement. METHODS: Nationally representative longitudinal survey data were collected in 2019-2020, and 965 respondents participated in all 4 surveys. Measures included work engagement, perceived social support and task resources, and psychological distress. The data were analyzed using a hybrid linear regression model. RESULTS: Work engagement remained stable and only decreased in autumn 2020. Within-person changes in social media communication at work, social support, task resources, and psychological distress were all associated with work engagement. The negative association between psychological distress and work engagement was stronger in autumn 2020 than before the COVID-19 outbreak. CONCLUSIONS: The COVID-19 pandemic has exerted pressure on mental health at work. Fostering social support and task resources at work is important in maintaining work engagement. Social media communication could help maintain a supportive work environment.


Assuntos
COVID-19 , Pandemias , Mídias Sociais/estatística & dados numéricos , Engajamento no Trabalho , Adulto , COVID-19/epidemiologia , Surtos de Doenças , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Saúde Mental/estatística & dados numéricos , Angústia Psicológica , Apoio Social , Local de Trabalho/psicologia
19.
Epidemiology ; 32(4): 525-532, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: covidwho-1211431

RESUMO

BACKGROUND: Information about social mixing patterns under heavy social distancing is needed to model the impact of nonpharmaceutical interventions on SARS-CoV-2 transmission. METHODS: We conducted a survey on daily person-to-person contacts during the early phase of the SARS-CoV-2 epidemic in Finland, one month after strong social distancing measures had been introduced nationwide. We defined a contact as exchange of at least a few words in proximity of another person. We also considered physical ("skin-to-skin") contacts separately. Based on 3,171 reported contacts by 1,320 participants of 1-79 years of age, we estimated age-stratified contact matrices essential in modeling virus transmission. RESULTS: Compared with contacts during prepandemic conditions, as learned from the Finnish part of the Polymod study, there was a 72% (95% credible interval, CI = 71, 74) reduction in the daily number of all contacts and a 69% (95% CI = 66, 73) reduction in the daily number of physical contacts in April 2020. The largest reduction, of almost 90%, occurred in physical contacts by individuals more than 70 years of age. The estimated reduction in the transmission potential of the virus attributable solely to reduced contact frequencies varied between 59% (whole population; physical contacts; 95% CI = 52, 68) and 77% (over 20-year olds; physical contacts; 95% CI = 70, 89). CONCLUSIONS: We surmise that the large reduction in the daily numbers of social contacts in the early part of the SARS-CoV-2 epidemic in Finland was likely a major contributor to the steady decline of the epidemic in the country since early April.


Assuntos
COVID-19 , Epidemias , Finlândia/epidemiologia , Humanos , Distanciamento Físico , SARS-CoV-2
20.
J Dairy Sci ; 104(8): 9173-9184, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34024607

RESUMO

Digital dermatitis (DD) is a severe bacterial hoof disease found worldwide. The disease can be classified into 5 different stages, denoted as M1 to M4 and M4.1, by clinical examination. The main objective of this study was to estimate prevalence of DD lesions in Finnish freestall dairy cattle population through hind feet inspection of standing cows with a mirror. Another aim was to estimate the sensitivity and specificity of mirror scoring on standing cows in a pen or in a milking parlor without washing the feet. Three veterinarians visited 81 randomly selected herds across the country. During the herd visits, hind feet of standing cows (n = 7,010) were scored with a mirror without washing the feet, either when the cows were standing in a pen (n = 4,992) or in the milking parlor (n = 2018). In total, 128 cows (111 from pen and 17 from milking parlor) including 256 feet were chosen with cross-sectional sampling and scored in a trimming chute. Animal-level sensitivity for scoring M2 lesions with a mirror was 55% and specificity was 97%; for all active DD lesions (M1, M2, or M4.1), sensitivity was 36% and specificity was 96%. Sensitivity for scoring any DD lesions was 90% and specificity was 82%. The bias-corrected sensitivity and specificity for scoring any DD lesions were 79% and 92%, respectively. The bias-corrected sensitivity and specificity for scoring M2 DD lesions were 10% and 100%. We found M2 lesions in 12.1% of the study herds, and true herd-level prevalence was the same. Altogether, 33.3% (true prevalence 28.4%) of the herds had either M1, M2, or M4.1 DD lesions. However, only 0.7% (true prevalence 5.4%) of cows in total had active M2 lesions. The within-herd prevalence of M2 lesions (in herds where at least 1 cow had a M2 lesion) was 5.7% and varied between 0.4% and 18.8%. Herds with active DD lesions also had more any DD lesions than herds without active DD lesions. The herd-level prevalence was higher than previously thought, with only 1 herd without any DD lesions. However, the animal-level prevalence of active DD lesions was relatively low. Farmers and veterinarians need to be informed of the disease and possible control measures. Because of the low within-herd prevalence, the control of the disease might be easier than in countries where DD is widespread. Further studies are needed to identify factors associated with DD prevalence in Finnish dairy herds.


Assuntos
Doenças dos Bovinos , Dermatite Digital , Animais , Bovinos , Doenças dos Bovinos/epidemiologia , Estudos Transversais , Indústria de Laticínios , Dermatite Digital/epidemiologia , Feminino , Finlândia/epidemiologia , Prevalência
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