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1.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
2.
Nord J Psychiatry ; 73(6): 357-364, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271336

RESUMO

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.


Assuntos
Transtornos Mentais/mortalidade , Adolescente , Adulto , Alcoolismo/mortalidade , Alcoolismo/psicologia , Causas de Morte , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Autodestrutivo/mortalidade , Comportamento Autodestrutivo/psicologia , Fatores Socioeconômicos , Suicídio/estatística & dados numéricos , Adulto Jovem
3.
Health Qual Life Outcomes ; 17(1): 117, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286982

RESUMO

BACKGROUND: Type 2 diabetes (T2D) causes significant health and economic burden. In addition to comorbidities there are also coexisting diseases linked to obesity, lifestyle and T2D. The aim of this study was to examine the effect of T2D and T2D-coexisting diseases on health-related quality of life (HRQoL) in the Finnish population and whether it is T2D or the coexisting diseases that have the largest impact on HRQoL. METHODS: The study was based on a national cross-sectional population survey (n = 5305). Respondents' HRQoL was measured using the EQ-5D-5 L instrument. Our study included diabetic respondents treated with non-insulin medications (NI-T2D) with or without insulin and non-diabetic respondents, whereas diabetic respondents not taking any anti-diabetic medications or treated with insulin alone were excluded. A crosswalk algorithm was used to convert EQ-5D-5 L index scores into EQ-5D-3 L index scores as a sensitivity analysis. A two-part model was used to examine the association between T2D and coexisting diseases and HRQoL. RESULTS: The unadjusted mean (SD) EQ-5D-5 L index scores for non-diabetics (n = 4856) was 0.90 (0.13) and 0.85 (0.16) for respondents with NI-T2D (n = 449). With adjustment for demographic factors, the difference in EQ-5D-5 L index scores was 0.036 (95% CI 0.023-0.050). After adjusting for the number of coexisting diseases, the EQ-5D-5 L index scores among respondents with NI-T2D and three or more coexisting diseases were lower when compared to all non-diabetics but not when compared to non-diabetics with similar number of coexisting diseases. The number of T2D-coexisting diseases had a larger effect on EQ-5D-5 L index scores in younger age groups (20 and 40 years old). CONCLUSIONS: Lower EQ-5D-5 L index score is associated with NI-T2D when compared to non-diabetic respondents. When compared to non-diabetics, the disutility associated with NI-T2D increases as more coexisting diseases appear. The disutility effect of coexisting diseases was equally large in non-diabetics and respondents with NI-T2D. Thus, public health interventions targeting the prevention of both T2D and its coexisting diseases have potential to have significant benefits also in terms of HRQoL.


Assuntos
Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Feminino , Finlândia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Insulinas , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
4.
Cancer Immunol Immunother ; 68(8): 1263-1272, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31240326

RESUMO

BACKGROUND: An emerging subset of oropharyngeal squamous cell carcinomas (OPSCC) is caused by HPV. HPV-positive OPSCC has a better prognosis than HPV-negative OPSCC, but other prognostic markers for these two different diseases are scarce. Our aim was to evaluate serum levels and tumor expression of matrix metalloproteinase-8 (MMP-8) and tissue inhibitor of metalloproteinase-1 (TIMP-1) and to assess their prognostic role in HPV-positive and HPV-negative OPSCC. MATERIALS AND METHODS: A total of 90 consecutive OPSCC patients diagnosed and treated with curative intent at the Helsinki University Hospital between 2012 and 2016 were included. Serum samples were prospectively collected. An immunofluorometric assay and an enzyme-linked immunosorbent assay were used to determine MMP-8 and TIMP-1 serum concentrations, respectively. HPV status of the tumors was determined using a combination of HPV-DNA genotyping and p16-INK4a immunohistochemistry. The endpoints were overall survival (OS) and disease-free survival (DFS). RESULTS: High TIMP-1 serum levels were strongly and independently associated with poorer OS (adjusted HR 14.7, 95% CI 1.8-117.4, p = 0.011) and DFS (adjusted HR 8.7, 95% CI 1.3-57.1, p = 0.024) among HPV-negative patients; this association was not observed in HPV-positive OPSCC. Although TIMP-1 was immunoexpressed in the majority of the tumor tissue samples, the level of immunoexpression was not associated with prognosis, nor did MMP-8 serum levels. CONCLUSION: Our results indicate that serum TIMP-1 levels may serve as an independent prognostic marker for HPV-negative OPSCC patients.


Assuntos
Biomarcadores Tumorais/sangue , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Orofaríngeas/diagnóstico , Papillomaviridae/fisiologia , Infecções por Papillomavirus/diagnóstico , Inibidor Tecidual de Metaloproteinase-1/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/mortalidade , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Metaloproteinase 8 da Matriz/sangue , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/mortalidade , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/mortalidade , Prognóstico , Análise de Sobrevida
5.
Int J Food Microbiol ; 304: 97-105, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31176965

RESUMO

Listeria monocytogenes causes severe consequences especially for persons belonging to risk groups. Finland is among the countries with highest number of listeriosis cases in the European Union. Although most reported cases appear to be sporadic and the maximum bacterial concentration of 100 cfu/g is not usually exceeded at retail, cold smoked and salt-cured fish products have been noted as those products with great risk especially for the elderly. In order to investigate the listeriosis risk more carefully, an exposure assessment was developed, and laboratory results for cold smoked and salt-cured salmon products were exploited. L. monocytogenes exposure was modeled for consumers in two age groups, the elderly population as a risk group and the working-age population as a reference. Incidence was assessed by estimating bacterial growth in the food products at three temperatures. Bayesian estimation of the risk was based on bacterial occurrence and product consumption data and epidemiological population data. The model builds on a two-state Markov chain describing repeated consumption on consecutive days. The cumulative exposure is probabilistically governed by the daily decreasing likelihood of continued consumption and the increasing bacterial concentrations due to growth. The population risk was then predicted with a Poisson distribution accounting for the daily probabilities of purchasing a contaminated product and the cumulative total probability of infection from its use. According to the model presented in this article, elderly Finns are at a greater risk of acquiring listeriosis than healthy adults. The risk for the elderly does not fully diminish even if the products have been stored at the recommended temperature (between 0 and 3 °C). It can be concluded that the stage after retail, i.e. food handling and storage by consumer or professional kitchens, is essential to protection against listeriosis. The estimation model provides means for assessing the joint impacts of these effects.


Assuntos
Manipulação de Alimentos/métodos , Doenças Transmitidas por Alimentos/epidemiologia , Listeria monocytogenes/crescimento & desenvolvimento , Listeriose/epidemiologia , Salmão/microbiologia , Alimentos Marinhos/microbiologia , Idoso , Animais , Teorema de Bayes , Qualidade de Produtos para o Consumidor , Finlândia/epidemiologia , Pesqueiros , Doenças Transmitidas por Alimentos/microbiologia , Humanos , Medição de Risco , Fumaça , Cloreto de Sódio , Temperatura Ambiente
6.
Cancer Causes Control ; 30(8): 877-888, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31209595

RESUMO

PURPOSE: Anticoagulants may reduce mortality of cancer patients, though the evidence remains controversial. We studied the association between different anticoagulants and cancer death. METHODS: All anticoagulant use during 1995-2015 was analyzed among 75,336 men in the Finnish Randomized Study of Screening for Prostate Cancer. Men with prevalent cancer were excluded. Multivariable Cox regression was performed to compare risk of death from any cancer and disease-specific death from 9 specific cancer types between (1) anticoagulant users overall and (2) warfarin users compared to anticoagulant non-users and (3) warfarin or (4) low-molecular-weight heparins (LMWH) compared to users of other anticoagulants. Medication use was analyzed as time-dependent variable to minimize immortal time bias. 1-, 2- and 3-year lag-time analyses were performed. RESULTS: During a median follow-up of 17.2 years, a total of 27,233 men died of whom 8033 with cancer as the primary cause of death. In total, 32,628 men (43%) used anticoagulants. Any anticoagulant use was associated with an increased risk of cancer death (HR = 2.50, 95% CI 2.37-2.64) compared to non-users. Risk was similar independent of the amount, duration, or intensity of use. The risk increase was observed both among warfarin and LMWH users, although not as strong in warfarin users. Additionally, cancer-specific risks of death were similar to overall cancer mortality in all anticoagulant categories. CONCLUSION: Our study does not support reduced cancer mortality among anticoagulant users. Future studies on drug use and cancer mortality should be adjusted for anticoagulants as they are associated with significantly higher risk of cancer death.


Assuntos
Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Neoplasias da Próstata , Varfarina/uso terapêutico , Idoso , Detecção Precoce de Câncer , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/mortalidade , Fatores de Risco
7.
Forensic Sci Int ; 300: 85-88, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082566

RESUMO

U-47,700 is a synthetic opioid that emerged on the novel psychoactive substance market a few years ago. After incorporating the substance into the urine UPLC-TOF-MS screening used in post-mortem toxicology, the drug was detected in 10 autopsy cases within routine case work. In all cases, the cause of death was accidental poisoning by U-47,700 alone or in combination with other psychoactive substances. The concentration of U-47,700 in the blood samples ranged between 0.15-2.0 mg/L with a median of 0.30 mg/L. In one of the cases with a U-47,700 concentration of 0.27 mg/L, no other psychoactive substances were detected. The stored TOF-MS analytical data from the year preceding the incorporation of U-47,700 into the screening was reprocessed in order to search for more positive cases. The data-independent acquisition of the original screening allowed for retrospective re-analysis of the full-scan data without additional experiments on the actual sample. The retrospective data-analysis revealed two additional cases positive for U-47,700. The first mention of U-47,700 on a Finnish internet discussion forum was in March 2015. After having been detected in several death cases, the drug was put under national control in November 2016 and the last fatality occurred in 2017. The toxic lifespan of U-47,700 thus lasted for approximately 2 years in Finland. Forensic and clinical laboratories need to rapidly adjust their screening procedures in order to adapt to the continuously expanding field of novel psychoactive substances. Retrospective data-analysis is a practical tool for monitoring the emergence of new substances onto the market.


Assuntos
Benzamidas/análise , Drogas Desenhadas/análise , Transtornos Relacionados ao Uso de Opioides/mortalidade , Psicotrópicos/análise , Adulto , Benzamidas/envenenamento , Cromatografia Líquida de Alta Pressão , Drogas Desenhadas/envenenamento , Finlândia/epidemiologia , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Masculino , Espectrometria de Massas , Psicotrópicos/envenenamento , Adulto Jovem
8.
Eur Arch Otorhinolaryngol ; 276(7): 2039-2045, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31069467

RESUMO

PURPOSE: Late-stage OTSCC is associated with poor overall survival (OS). Non-curative treatment approach aims to improve quality of life and prolong survival of patients deemed incurable. The purpose of this study was to investigate the used non-curative treatment modalities for OTSSC and patient survival. METHODS: All patients diagnosed with OTSCC and treated with non-curative intent at the HUS Helsinki University Hospital (Helsinki, Finland) during the 12-year period of 2005-2016 were included. Survival analysis after the non-curative treatment decision was conducted using the Kaplan-Meier method in this population-based study. RESULTS: Eighty-two patients were identified. A non-curative treatment decision was made at presentation without any previous treatment in 26 patients (7% of all patients diagnosed with OTSCC during the study period). Palliative radiotherapy was administered to 24% of all patients. The average survival time after the non-curative treatment decision was 3.7 months (median 2 and range 0-26). CONCLUSIONS: Due to the short mean survival time after decision for treatment with non-curative intent, and the notable symptom burden in this patient population, a prompt initiation of all non-curative measures is warranted.


Assuntos
Cuidados Paliativos , Qualidade de Vida , Carcinoma de Células Escamosas de Cabeça e Pescoço , Neoplasias da Língua , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/mortalidade , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/psicologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia , Análise de Sobrevida , Taxa de Sobrevida , Neoplasias da Língua/mortalidade , Neoplasias da Língua/patologia , Neoplasias da Língua/psicologia , Neoplasias da Língua/terapia
9.
Eur Arch Otorhinolaryngol ; 276(7): 2069-2073, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31093734

RESUMO

PURPOSE: To review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist-head and neck surgeons in a single tertiary care center. METHODS: Surgical tracheostomies performed by otolaryngologist-head and neck surgeons at Helsinki University Hospital between January 2014 and February 2017 were retrospectively reviewed. Patient demographics, surgical data, and peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18 months. RESULTS: The total population was 255, with a majority (n = 181; 71%) of males. The majority of patients (n = 178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9 days (range 1-425). The surgical mortality was 0.4%. CONCLUSION: Simultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two-thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy dependent for a prolonged period. Tracheostomy was found to be a safe procedure. LEVEL OF EVIDENCE: 2b.


Assuntos
Neoplasias de Cabeça e Pescoço , Complicações Pós-Operatórias/epidemiologia , Traqueostomia , Adulto , Idoso , Remoção de Dispositivo/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/estatística & dados numéricos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Traqueostomia/efeitos adversos , Traqueostomia/métodos , Traqueostomia/estatística & dados numéricos
10.
Emerg Microbes Infect ; 8(1): 675-683, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31084456

RESUMO

Number of tick-borne encephalitis (TBE) cases has increased and new foci have emerged in Finland during the last decade. We evaluated risk for locally acquired TBE in the capital region inhabited by 1.2 million people. We screened ticks and small mammals from probable places of TBE virus (TBEV) transmission and places without reported circulation. The TBEV positive samples were sequenced and subjected to phylogenetic analysis. Within the study period 2007-2017, there was a clear increase of both all TBE cases and locally acquired cases in the Helsinki area. The surveillance of ticks and small mammals for TBEV confirmed four distinct TBEV foci in the Helsinki area. All detected TBEV strains were of the European subtype. TBEV genome sequences indicated that distinct TBEV lineages circulate in each focus. Molecular clock analysis suggested that the virus lineages were introduced to these foci decades ago. In conclusion, TBE has emerged in the mainland of Helsinki area during the last decade, with at least four distinct virus lineages independently introduced into the region previously. Although the overall annual TBE incidence is below the threshold for recommending general vaccinations, the situation requires further surveillance to detect and prevent possible further emergence of local TBE clusters.


Assuntos
Vírus da Encefalite Transmitidos por Carrapatos/classificação , Vírus da Encefalite Transmitidos por Carrapatos/isolamento & purificação , Encefalite Transmitida por Carrapatos/epidemiologia , Encefalite Transmitida por Carrapatos/virologia , Variação Genética , Mamíferos/virologia , Carrapatos/virologia , Animais , Transmissão de Doença Infecciosa , Vírus da Encefalite Transmitidos por Carrapatos/genética , Finlândia/epidemiologia , Genótipo , Humanos , Incidência , Epidemiologia Molecular , Filogenia , Análise de Sequência de DNA
11.
Traffic Inj Prev ; 20(3): 325-331, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013176

RESUMO

Objective: We examined both fatal and injury at-fault crashes of a population of passenger cars fitted with electronic stability control (ESC). Crash rates were calculated in relation to both registration years and mileage. Crash rates were also calculated for a non-ESC car population and crash rate ratios were calculated to compare the crash risk between ESC-fitted and non-ESC-fitted passenger cars. Methods: Passenger car models with and without ESC were identified (ESC-equipped cars: 3,352,813 registration years; non-ESC-equipped: 5,839,946 registration years) and their vehicle information for the period 2009-2013, including mileage (ESC-equipped vehicles: 89.3 billion kilometers; non-ESC-equipped: 72.4 billion kilometers), was drawn from the national Vehicular and Driver Data Register. The registry of Finnish road accident investigation teams was accessed and all fatal at-fault crashes among the cars in the study populations (ESC 97; non-ESC 377) for the period 2009-2013 were analyzed. The motor insurance database includes at-fault crashes leading to injuries and was utilized for analyses (ESC: N = 8,827, non-ESC: N = 21,437). Crash rates and crash rate ratios were calculated to evaluate crash risk of both ESC-equipped and non-ESC-equipped passenger cars. Poisson regression was used to model crash involvement rate ratios both per registration year and per mileage for vehicles with ESC and without ESC, controlling for age and gender of the vehicle owner and vehicle mass. Results: Passenger cars fitted with ESC showed lower crash rates than non-ESC-equipped cars in all crash types studied. In general, the difference in crash rates between ESC-equipped and non-ESC-equipped vehicles was greater when the crashes were compared to the mileage rather than registration years. The mileage-proportional crash rate of ESC-equipped cars was 64% (95% confidence interval, 61%; 67%) lower in run-off-road crashes resulting in injury and as much as 82% (65%; 91%) lower in fatal run-off-road crashes when suicides and disease attacks were not taken into account. Conclusions: Our results show that modern passenger cars provide a significant crash risk reduction, which depends on both ESC and passive safety features introduced. Results also show that exposure evaluation in terms of registration years (or vehicle population) instead of true mileage can provide an overly pessimistic view of the crash risk.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Automóveis/estatística & dados numéricos , Equipamentos de Proteção , Ferimentos e Lesões/epidemiologia , Bases de Dados Factuais , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Ferimentos e Lesões/mortalidade
12.
Vet Microbiol ; 231: 107-115, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30955796

RESUMO

Mycoplasma bovis causes bovine respiratory disease, mastitis, arthritis and otitis. The importance of M. bovis has escalated because of recent outbreaks and introductions into countries previously free of M. bovis. We characterized the course of M. bovis infection on 19 recently infected dairy farms over 24 months. Our objective was to identify diagnostic tools to assess the efficacy of control measures to assess low risk infection status on M. bovis infected farms. PCR assays and culture were used to detect M. bovis, and in-house and BioX ELISAs were used to follow antibody responses. Cows and young stock were sampled on four separate occasions, and clinical cases were sampled when they arose. On 17 farms, a few cases of clinical mastitis were detected, mostly within the first eight weeks after the index case. Antibodies detected by in-house ELISA persisted in the serum of cows at least for 1.5 years on all farms, regardless of the M. bovis infection status or signs of clinical disease or subclinical mastitis on the farm. Six out of 19 farms became low risk as the infection was resolved. Our results suggest that, for biosecurity purposes, regular monitoring should be conducted on herds by screening for M. bovis in samples from cows with clinical mastitis and calves with pneumonia, in conjunction with testing young stock by screening longitudinally collected nasal swabs for M. bovis and sequential serum samples for antibody against recombinant antigen.


Assuntos
Anticorpos Antibacterianos/sangue , Mastite Bovina/diagnóstico , Infecções por Mycoplasma/veterinária , Animais , Infecções Assintomáticas , Bovinos , Indústria de Laticínios , Ensaio de Imunoadsorção Enzimática , Feminino , Finlândia/epidemiologia , Lactação , Mastite Bovina/imunologia , Mastite Bovina/microbiologia , Infecções por Mycoplasma/diagnóstico , Infecções por Mycoplasma/imunologia , Mycoplasma bovis , Reação em Cadeia da Polimerase
13.
BMC Public Health ; 19(1): 391, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30971258

RESUMO

BACKGROUND: Persons of African and Middle-Eastern origin living in European countries have a high prevalence of type 2 diabetes, accompanied by high prevalence of obesity among women but not always among men. The aim of this study was to examine whether there are differences in the association between anthropometric measures and glucose levels measured with glycated haemoglobin and fasting blood glucose among persons of migrant origin in Finland. METHODS: Cross-sectional population-based data of the 30-64 year-old participants in the health examination of the Migrant Health and Wellbeing Study was used, selecting persons without diabetes (Russian origin n = 293, Somali origin n = 184, Kurdish origin n = 275). The reference group were non-diabetic participants in the Health 2011 Survey (n = 653), representative of the general Finnish population. Anthropometric measures included body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR, available for Maamu Study participants only). RESULTS: Depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-18% of variation in HbA1c among persons of Russian origin, 5-10% among persons of Somali origin, 1-3% among persons of Kurdish origin and 11-13% among the general population. Also depending on whether continuous or categorical anthropometric measures were used, age, sex and anthropometrics explained 13-19% of variation in fasting blood glucose among persons of Russian origin, 15-20% among persons of Somali origin, 13-17% among persons of Kurdish origin and 16-17% among the general population. With exception for BMI, strength of the association between continuous anthropometric measures and HbA1c was significantly lower among persons of Kurdish origin compared with the general Finnish population (p = 0.044 for WC and p = 0.040 for WHtR). CONCLUSIONS: A low degree of association between anthropometric measures and HbA1c was observed among persons of Kurdish origin. Findings of this study suggest caution is warranted when using HbA1c as a screening tool for glucose impairment among persons without diabetes in populations of diverse origin.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Hemoglobina A Glicada/análise , Migrantes/estatística & dados numéricos , Adulto , Antropometria , Índice de Massa Corporal , Estudos Transversais , Feminino , Finlândia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Federação Russa/etnologia , Somália/etnologia , Circunferência da Cintura , Razão Cintura-Estatura , Relação Cintura-Quadril
14.
Int Arch Allergy Immunol ; 179(4): 273-280, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30999310

RESUMO

BACKGROUND: Asthma, allergic conditions, and COPD overlap, but the effect of them and their combinations on disease severity, need for drugs, use of healthcare, and costs is poorly known. OBJECTIVE: To study how different allergic diseases co-occur in asthma and allergy patients and evaluate the use of medication well as drug and healthcare costs. METHODS: Nationwide Allergy Barometer Survey was carried out in the Finnish pharmacies during 1 week in September 2016. Altogether, 956 patients (5-75 years) who purchased asthma or allergy drugs with prescription participated in 351 pharmacies. RESULTS: Of the participants, 78% reported physician-diagnosed asthma, 57% allergic rhinitis, 24% atopic eczema, 21% food allergy, 20% allergic conjunctivitis, 8% anaphylaxis, and 8% COPD. One-third of the patients had at least three conditions, and multimorbidity was common across all age groups. Disease severity increased with the number of coexisting conditions, and asthma severity also with age. Patients with asthma alone used on average 3.8 drugs with the annual costs of EUR 661. This increased to 4.9 drugs and EUR 847 in asthmatics with multimorbidity. For all participants, costs of drugs and healthcare services together during the preceding year were on average EUR 1,214, of which 56% were drug costs. The costs doubled to EUR 2,714 in 65 subjects (7%) who had both asthma and COPD. CONCLUSIONS: In asthma and allergy, multimorbidity and polypharmacy are major concerns. Disease severity, drug use, and costs increased with multimorbid conditions. To reduce the burden, allergy management should be better integrated and more comprehensive.


Assuntos
Asma/epidemiologia , Hipersensibilidade/epidemiologia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/economia , Criança , Pré-Escolar , Comorbidade , Custos e Análise de Custo , Uso de Medicamentos , Finlândia/epidemiologia , Humanos , Hipersensibilidade/economia , Pessoa de Meia-Idade , Farmácia , Doença Pulmonar Obstrutiva Crônica/economia , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
15.
Gastroenterology ; 157(1): 119-127.e1, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30940524

RESUMO

BACKGROUND & AIMS: Bariatric surgery might reduce overall mortality from obesity. We investigated whether the survival times of patients who have had bariatric surgery are similar to those of the general population and are longer than of obese individuals who did not receive surgery. METHODS: We performed a population-based cohort study of persons with a diagnosis of obesity listed in nationwide registries from Nordic countries from 1980 through 2012. Bariatric surgery was analyzed in relation to all-cause mortality and the obesity-related morbidities cardiovascular disease, diabetes, cancer, and suicide. Poisson models provided standardized mortality ratios (SMRs) with 95% confidence intervals (CIs). Multivariable Cox regression provided hazard ratios (HRs) for mortality in participants who did and did not have surgery. RESULTS: Among 505,258 participants, 49,977 had bariatric surgery. Overall all-cause SMR was increased after surgery (1.94; 95% CI, 1.83-2.05) and increased with longer follow-up, to 2.28 (95% CI, 2.07-2.51) at ≥15 years after surgery. SMRs were increased for cardiovascular disease (2.39; 95% CI, 2.17-2.63), diabetes (3.67; 95% CI, 2.85-4.72), and suicide (2.39; 95% CI, 1.96-2.92) but not for cancer (1.05; 95% CI, 0.95-1.17); SMRs increased with time. In obese participants who did not have surgery, all-cause SMR was 2.15 (95% CI, 2.11-2.20), which remained stable during follow-up. Compared with obese participants who did not have surgery, patients who had bariatric surgery had decreased overall mortality from all causes (HR, 0.63; 95% CI, 0.60-0.66), cardiovascular disease (HR, 0.57; 95% CI, 0.52-0.63), and diabetes (HR, 0.38; 95% CI, 0.29-0.49) but increased mortality from suicide (HR, 1.68; 95% CI, 1.32-2.14). Cancer mortality was decreased overall (HR, 0.84; 95% CI, 0.76-0.93) but increased at ≥15 years of follow-up (HR, 1.20; 95% CI, 1.02-1.42). CONCLUSIONS: In a study of persons with a diagnosis of obesity listed in nationwide registries of Nordic countries, we found that obese patients who have bariatric surgery have longer survival times than obese individuals who did not have bariatric surgery, but their mortality is higher than that of the general population and increases with time. Obesity-related morbidities could account for these findings.


Assuntos
Cirurgia Bariátrica , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus/mortalidade , Mortalidade , Neoplasias/mortalidade , Obesidade/cirurgia , Suicídio/estatística & dados numéricos , Taxa de Sobrevida , Adulto , Estudos de Casos e Controles , Causas de Morte , Dinamarca/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Islândia/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Noruega/epidemiologia , Obesidade/mortalidade , Modelos de Riscos Proporcionais , Suécia/epidemiologia
16.
BMC Musculoskelet Disord ; 20(1): 170, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991977

RESUMO

BACKGROUND: A small cross sectional area (CSA) of the paraspinal muscles may be related to low back pain among military aviators but previous studies have mainly concentrated on spinal disc degeneration. Therefore, the primary aim of the study was to investigate the changes in muscle CSA and composition of the psoas and paraspinal muscles during a 5-year follow up among Finnish Air Force (FINAF) fighter pilots. METHODS: Study population consisted of 26 volunteered FINAF male fighter pilots (age: 20.6 (±0.6) at the baseline). The magnetic resonance imaging (MRI) examinations were collected at baseline and after 5 years of follow-up. CSA and composition of the paraspinal and psoas muscles were obtained at the levels of 3-4 and 4-5 lumbar spine. Maximal isometric strength tests were only performed on one occasion at baseline. RESULTS: The follow-up comparisons indicated that the mean CSA of the paraspinal muscles increased (p < 0.01) by 8% at L3-4 level and 7% at L4-5 level during the 5-year period. There was no change in muscle composition during the follow-up period. The paraspinal and psoas muscles' CSA was positively related to overall maximal isometric strength at the baseline. However, there was no association between LBP and muscle composition or CSA. CONCLUSIONS: The paraspinal muscles' CSA increased among FINAF fighter pilots during the first 5 years of service. This might be explained by physically demanding work and regular physical activity. However, no associations between muscle composition or CSA and low back pain (LBP) experienced were observed after the five-year follow-up.


Assuntos
Dor Lombar/epidemiologia , Força Muscular/fisiologia , Doenças Profissionais/epidemiologia , Músculos Paraespinais/anatomia & histologia , Pilotos , Adulto , Anatomia Transversal , Finlândia/epidemiologia , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Dor Lombar/fisiopatologia , Vértebras Lombares , Imagem por Ressonância Magnética , Masculino , Doenças Profissionais/fisiopatologia , Músculos Paraespinais/fisiologia , Adulto Jovem
17.
Int Marit Health ; 70(1): 47-54, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931517

RESUMO

BACKGROUND: The agriculture, forestry and fishing industry sector has high rates of occupational injuries. Fishing has globally particularly high occupational fatality rates, but injuries and illnesses to people working in its sub-sectors, aquaculture and fish farming, are not well understood. MATERIALS AND METHODS: This study characterised injuries and occupational diseases to fish farmers and people employed on fish farms in Finland using national employment and accident insurance (workers' compensation) data. RESULTS: A total of 392 injuries and 18 occupational diseases were compensated during 1996 to 2015 to fish farmers and people employed on fish farms in Finland. The average injury rate was 3.2 injuries per 100 employed persons with no significant trend over time. Two of the injuries were fatal. Injured persons were primarily male (87.2%), in 45-54 year age group (39.1%), and working in coastal areas (49%). Com- mon injury characteristics included: incident type: slips, trips, and falls (37%); location: building, structure or ground level surface (28%); injured body part: hand or finger (25%); type of injury: dislocation, sprain, strain (35%); and lost worktime: 1 to 2 weeks (26.9%). Seven out of 18 occupational diseases occurred to women, most resulting in cumulative trauma from fish processing. CONCLUSIONS: The injury rate in fish farming corresponds to rate in all industries combined in Finland, and is higher than the rate in available Nordic statistics on fish farming. Fish farming injuries could be reduced further by slip resistant surfaces, protection of hands and fingers and ergonomics in processing.


Assuntos
Aquicultura/estatística & dados numéricos , Doenças Profissionais/epidemiologia , Traumatismos Ocupacionais/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Finlândia/epidemiologia , Pesqueiros/estatística & dados numéricos , Indústria de Processamento de Alimentos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Naval/estatística & dados numéricos , Traumatismos Ocupacionais/mortalidade , Indenização aos Trabalhadores/estatística & dados numéricos
18.
Clin Child Psychol Psychiatry ; 24(2): 379-387, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30968719

RESUMO

The aim of this study was to explore whether there has been an increase in prevalence and changes in sex ratio in feelings of gender dysphoria (GD) in an adolescent population in Northern Europe, and to study the impact of invalid responding on this topic. We replicated an earlier survey among junior high school students in Tampere, Finland. All first and second year students, aged 16-18, in the participating schools were invited to respond to an anonymous classroom survey on gender experience during the 2012-2013 school year and in the spring and autumn terms of 2017. Gender identity/GD was measured using the GIDYQ-A. A total of 318 male and 401 female youth participated in 2012-2013, and 326 male and 701 female youth in 2017. In the earlier survey, the GIDYQ-A scores, both among males and females, were strongly skewed toward a cis-gender experience with very narrow interquartile ranges. Of males, 2.2%, and of females, 0.5% nevertheless reported possibly clinically significant GD. The 2017 GIDYQ-A distribution was similarly skewed. The proportion of those reporting potentially clinically significant GD was 3.6% among males and 2.3% among females. Validity screening proved to have a considerable impact on conclusions. GD seems to have increased in prevalence in the adolescent population.


Assuntos
Disforia de Gênero/epidemiologia , Identidade de Gênero , Adolescente , Feminino , Finlândia/epidemiologia , Inquéritos Epidemiológicos/normas , Humanos , Masculino , Reprodutibilidade dos Testes , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos
19.
Acta Vet Scand ; 61(1): 15, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871641

RESUMO

Seventy-two canine serum samples were analyzed for post-vaccination serum titers of rabies antibodies. The samples were divided into two groups: Group 1 dogs (n = 36) were imported dogs from the Russian Federation (n = 31) or Romania (n = 5), with a mean serum antibody titer value of 1.54 IU/mL. Group 2 dogs (n = 36) were Finnish dogs vaccinated in Finland, with a mean titer of 4.19 IU/mL. Altogether, 14 (39%) dogs (CI 95% 23-56) were without detectable antibodies (≤ 0.1 IU/mL) in Group 1, whereas in Group 2, all dogs had an antibody titer greater than 0.1 IU/mL. A statistically significant difference was observed between these groups when comparing the proportions of dogs with antibody levels less than or exceeding 0.5 IU/mL. In Group 1, 19 out of the 36 dogs (CI 95% 36-70) had serum titer values < 0.5 IU/mL, while in Group 2, only 2 dogs had serum titer values < 0.5 IU/mL. Despite the small sample size, this raises concern over the imported dogs having insufficient antibody levels required for international travel and implies that these dogs had perhaps not been vaccinated, even though they had documentation of vaccination upon arrival.


Assuntos
Anticorpos Antivirais/sangue , Doenças do Cão/prevenção & controle , Vacinas Antirrábicas/imunologia , Vírus da Raiva/imunologia , Raiva/veterinária , Animais , Doenças do Cão/epidemiologia , Cães , Finlândia/epidemiologia , Raiva/epidemiologia , Raiva/prevenção & controle , Vacinação/veterinária
20.
BMC Infect Dis ; 19(1): 264, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885144

RESUMO

BACKGROUND: Tuberculosis (TB) is a major cause of death in HIV patients worldwide. Here we describe the epidemiology and outcome of HIV-TB co-infections in a high-income country with low TB incidence and integrated HIV and TB therapy according to European guidelines. METHODS: This study was based on the HIV cohort of the Helsinki University Hospital which includes all HIV patients in the Helsinki region with a population of 1.5 million. Totally, 1939 HIV-positives who have been under follow-up between 1998 and 2015 were included. RESULTS: TB was diagnosed in 53 (2.7%) of the HIV-patients. The TB incidence rate was higher in injecting drug users (IRR 3.15; 95% CI 1.33-7.52) and heterosexuals (IRR 3.46; 95% CI 1.64-7.29) compared to men having sex with men. The incidence rate was also higher in those born in Sub-Saharan Africa (IRR 3.53; 95% CI 1.78-7.03) compared to those born in Finland. There was a significant reduction in the total TB incidence rate of 59% per 6-year period between 1998 and 2015 (p < 0.001). In injecting drug users there was a reduction in incidence rate from 1182 to 88 per 100,000 (p < 0.001) and in people born in Sub-Saharan Africa from 2017 to 195 per 100,000 (p < 0.001). Among the 53 HIV-TB co-infected cases, one female and 15 males died during follow up. HIV was the primary cause of death in five patients but none of the deaths were caused by TB. CONCLUSION: The incidence rate of tuberculosis among HIV-positives in Finland has been declining between 1998 and 2015. Among injecting drug users, the reduction is probably explained by harm reduction interventions and care in comprehensive care centers in Helsinki. The increased coverage of antiretroviral therapy is probably another main reason for the decline in TB incidence rates. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males with HIV-TB was high, and common causes of death were intoxications and suicides.


Assuntos
Infecções por HIV/epidemiologia , Tuberculose Pulmonar/epidemiologia , Adolescente , Adulto , África ao Sul do Saara/etnologia , Idoso , Criança , Pré-Escolar , Estudos de Coortes , Coinfecção , Feminino , Finlândia/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Heterossexualidade , Homossexualidade Masculina , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Adulto Jovem
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