Publications by authors named "Hannu Kautiainen"

541 Publications

Measuring functional outcome in upper extremity soft-tissue sarcoma: Validation of the Toronto extremity salvage score and the QuickDASH patient-reported outcome instruments.

J Plast Reconstr Aesthet Surg 2021 Dec 1. Epub 2021 Dec 1.

Department of Orthopaedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Teiskontie 35, FI-33521 Tampere, Finland.

Interest in functional outcome (FO) and health-related quality of life (HRQL) in extremity soft-tissue sarcoma (STS) patients has increased. The aim of this study was to validate two FO questionnaires for upper extremity STS patients: the Toronto Extremity Salvage Score (TESS) and short version of the Disability of Arm, Shoulder and Hand (QuickDASH), based on Finnish population data. A multi-center study was conducted at two academic sarcoma centers. Surgically treated upper extremity STS patients were invited to participate. Patients completed the TESS and the QuickDASH with HRQL questionnaires the 15D and the QLQ-C30. The scores were analyzed and compared. Fifty-five patients with a mean follow-up period of 4.7 years were included. Mean age was 63 years (standard deviation [SD] 14.6). The mean score for TESS was 88.5 (SD 15.1) and for QuickDASH 17.8 (SD 19.6). The QuickDASH had a statistically significantly better score coverage. A ceiling effect was noted, 27% and 20% for TESS and QuickDASH, respectively. The TESS and QuickDASH scores were strongly correlated (r= -0.89). The TESS score strongly correlated with the QLQ-C30 (r = 0.79) and the 15D score (r = 0.70). The QuickDASH score correlated strongly with the QLQ-C30 score (r=-0.71) and moderately with the 15D score (r= -0.56). The TESS score had a statistically significantly stronger correlation with the 15D score than QuickDASH (p<0.005). Both the TESS and the QuickDASH provide reliable scores for assessing FO in upper extremity STS patients. The QuickDASH has a better coverage, whereas TESS showed a stronger correlation to HRQL scores.
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http://dx.doi.org/10.1016/j.bjps.2021.11.081DOI Listing
December 2021

Oral disease burden of dentate older adults living in long-term care facilities: FINORAL study.

BMC Oral Health 2021 12 7;21(1):624. Epub 2021 Dec 7.

Institute of Dentistry, University of Eastern Finland, Yliopistonranta 1 B, P. O. Box 1627, 70211, Kuopio, Finland.

Background: A growing number of older adults have natural teeth and are at high risk of oral diseases, which are induced by oral bacterial accumulation and proceed unnoticed and quietly. Our aim was (1) to examine the association of oral disease burden (ODB) with health and functioning among dentate long-term care residents, and (2) to find easily detectable signs for nurses to identify residents' poor oral health.

Methods: In this cross-sectional observational study dentists examined 209 residents' oral status, and nurses assessed residents for their functioning and nutrition in long-term care facilities in Helsinki, Finland. ODB was defined by asymptotic dental score (ADS). Six clinical signs of residents' poor oral health were considered as potentially easy for nurses to detect: lesions on lips, teeth with increased mobility, lesions on oral mucosa, eating soft or pureed food, unclear speech, and needing assistance in eating. The association of these was tested with high ODB as outcome.

Results: Participants were grouped according to their ADS scores: low (n = 39), moderate (n = 96) and high ODB (n = 74). ODB was linearly associated with coronary artery disease and poor cognitive and physical functioning: needing assistance in eating, poor ability to make contact, and unclear speech but not with other diseases including dementia or demographic characteristics. Furthermore, ODB was linearly associated with eating soft or pureed food. Of the six selected, easily detectable signs, having at least two positive signs gave 89% sensitivity to detecting high ODB.

Conclusion: Poor oral health was common and ODB accumulated among residents with poor functioning. Nurses may use a few easily detectable signs to screen residents' oral health when considering a resident's need for consultation with an oral health professional.
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http://dx.doi.org/10.1186/s12903-021-01984-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8650260PMC
December 2021

Late-Pregnancy Fetal Hypoxia Is Associated With Altered Glucose Metabolism and Adiposity in Young Adult Offspring of Women With Type 1 Diabetes.

Front Endocrinol (Lausanne) 2021 27;12:738570. Epub 2021 Oct 27.

Folkhälsan Research Center, Helsinki, Finland.

Objective: To investigate associations between exposure to fetal hypoxia and indicators of metabolic health in young adult offspring of women with type 1 diabetes (OT1D).

Methods: 156 OT1D born between 7/1995 and 12/2000 at Helsinki University Hospital, Finland, were invited for follow-up between 3/2019 and 11/2019. A control group of 442 adults born from non-diabetic pregnancies, matched for date and place of birth, was obtained from the Finnish Medical Birth Register. In total, 58 OT1D and 86 controls agreed to participate. All OT1D had amniotic fluid (AF) sampled for erythropoietin (EPO) measurement within two days before delivery in order to diagnose fetal hypoxia. In total, 29 OTID had an AF EPO concentration <14.0 mU/l, defined as normal, and were categorized into the low EPO (L-EPO) group. The remaining 29 OT1D had AF EPO ≥14.0 mU/ml, defined as fetal hypoxia, and were categorized into the high EPO (H-EPO) group. At the age of 18-23 years, participants underwent a 2-h 75g oral glucose tolerance test (OGTT) in addition to height, weight, waist circumference, body composition, blood pressure, HbA, cholesterol, triglyceride, high-sensitivity CRP and leisure-time physical activity measurements.

Results: Two OT1D were diagnosed with diabetes and excluded from further analyses. At young adult age, OT1D in the H-EPO group had a higher BMI than those in the L-EPO group. In addition, among female participants, waist circumference and body fat percentage were highest in the H-EPO group. In the OGTTs, the mean (SD) 2-h post-load plasma glucose (mmol/L) was higher in the H-EPO [6.50 (2.11)] than in the L-EPO [5.21 (1.10)] or control [5.67 (1.48)] offspring (p=0.009). AF EPO concentrations correlated positively with 2-h post-load plasma glucose [r=0.35 (95% CI: 0.07 to 0.62)] and serum insulin [r=0.44 (95% CI: 0.14 to 0.69)] concentrations, even after adjusting for maternal BMI, birth weight z-score, gestational age at birth and adult BMI. Control, L-EPO and H-EPO groups did not differ with regards to other assessed parameters.

Conclusions: High AF EPO concentrations in late pregnancy, indicating fetal hypoxia, are associated with increased adiposity and elevated post-load glucose and insulin concentrations in young adult OT1D.
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http://dx.doi.org/10.3389/fendo.2021.738570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8578885PMC
October 2021

The relationship between health-related quality of life and melancholic depressive symptoms is modified by brain insulin receptor gene network.

Sci Rep 2021 11 3;11(1):21588. Epub 2021 Nov 3.

Folkhälsan Research Center, Finbyntie 136 Karjaa, 10300, Helsinki, Finland.

To investigate whether expression-based polygenic risk scores for the insulin receptor gene network (ePRS-IRs) modifiy the association between type of depressive symptoms and health-related quality of life (HRQoL). This cross-sectional study includes 1558 individuals from the Helsinki Birth Cohort Study. Between 2001 and 2004, the Short Form-36 questionnaire was employed to assess mental and physical components of HRQoL and Beck Depression Inventory (BDI) to assess depressive symptoms. Depressive symptoms were categorized into minimal (BDI < 10), non-melancholic and melancholic types of depression. The ePRS-IRs were calculated for the hippocampal (hePRS-IR) and the mesocorticolimbic (mePRS-IR) regions of the brain. General linear regression models adjusted for age, sex, population stratification, lifestyle factors and body mass index were applied to analyze the data. Both types of depressive symptoms were associated with lower HRQoL (p < 0.0001). HePRS-IR modified the association between the types of depression and mental HRQoL (p for interaction = 0.005). Melancholic type of depressive symptoms was associated with higher mental HRQoL compared to the non-melancholic symptoms among individuals with low hePRS-IR (adjusted mean 4.1, 95% CI 0.7-7.4, p = 0.018). However, no such difference was evident in moderate or high hePRS-IR groups as higher hePRS-IR was associated with lower mental HRQoL (B = - 3.4, 95% CI - 5.6 to - 1.2) in individuals with melancholic type of depressive symptoms. No direct associations were detected between the ePRS-IRs and type of depressive symptoms or HRQoL. Variations in the glucose-insulin metabolism can lower HRQoL in individuals with melancholic depressive symptoms.
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http://dx.doi.org/10.1038/s41598-021-00631-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8566480PMC
November 2021

Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study.

BMC Musculoskelet Disord 2021 Oct 29;22(1):911. Epub 2021 Oct 29.

Department of Physical Medicine and Rehabilitation, Central Finland Hospital, Jyväskylä, Finland.

Background: Neck pain has been associated with weaker neck muscle strength and decreased cervical spine range of motion. However, whether neck muscle strength or cervical spine mobility predict later neck disability has not been demonstrated. In this 16-year prospective study, we investigated whether neck muscle strength and cervical spine mobility are associated with future neck pain and related disability in women pain-free at baseline.

Methods: Maximal isometric neck muscle strength and passive range of motion (PROM) of the cervical spine of 220 women (mean age 40, standard deviation (SD) 12 years) were measured at baseline between 2000 and 2002. We conducted a postal survey 16 years later to determine whether any subjects had experienced neck pain and related disability. Linear regression analysis adjusted for age and body mass index was used to determine to what extent baseline neck strength and PROM values were associated with future neck pain and related disability assessed using the Neck Disability Index (NDI).

Results: The regression analysis Beta coefficient remained below 0.1 for all the neck strength and PROM values, indicating no association between neck pain and related disability. Of the 149 (68%) responders, mean NDI was lowest (3.3, SD 3.8) in participants who had experienced no neck pain (n = 50), second lowest (7.7, SD 7.1) in those who had experienced occasional neck pain (n = 94), and highest (19.6, SD 22.0) in those who had experienced chronic neck pain (n = 5).

Conclusions: This 16-year prospective study found no evidence for an association between either neck muscle strength or mobility and the occurrence in later life of neck pain and disability. Therefore, screening healthy subjects for weaker neck muscle strength or poorer cervical spine mobility cannot be recommended for preventive purposes.
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http://dx.doi.org/10.1186/s12891-021-04807-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8556991PMC
October 2021

Opioid use frequency in early axial spondyloarthritis in Finland - a pharmacoepidemic register study.

Joint Bone Spine 2021 Oct 20:105302. Epub 2021 Oct 20.

Terveystalo Healthcare, Lappeenranta, Finland.

Objectives: To evaluate opioid use among incident axial spondyloarthritis (axSpA) patients compared to general population.

Methods: From the national register, we identified all adult patients with axSpA (ICD-10 codes M45-46), who between 2010 and 2014 (index date, ID) were for the first time granted special reimbursement for any disease-modifying anti-rheumatic drugs (DMARDs). Three matched population controls were identified for each patient. Drug purchases were evaluated between 2009-15, and opioid use was analyzed for one year before and after the ID. The Defined Daily Dose (DDD) was used as a tool to assess the opioid consumption before and after the biological (b) DMARD initiation.

Results: We identified 3,577 axSpA patients and 10,573 controls. Of these patients, 97.2% started a conventional synthetic (cs) DMARD during a year after ID and 23.4% switched later to a self-injected bDMARD between the ID and 31 Dec 2015 (median follow-up 3.4 years). Opioids were purchased at least once by 29.8% and 21.7% of the patients in the years before and after the ID, respectively, compared to 8.1% and 7.8% of the controls. The proportion of opioid-using patients was greatest during the last quarter before the ID [relative risk (RR) 4.72 (95% CI 4.14 to 5.39)] compared to controls, and it remained higher [RR 2.84 (2.59 to 3.11)] also after the start of csDMARDs. DDD of opioid consumption decreased from 7.7 to 1.6/1,000 inhabitants after bDMARD initiation.

Conclusion: Considerably more axSpA patients than population controls used opioids. The opioid consumption by dose decreased clearly after bDMARD initiation.
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http://dx.doi.org/10.1016/j.jbspin.2021.105302DOI Listing
October 2021

Headache and quality of life in Finnish female municipal employees.

Scand J Pain 2021 Oct 22. Epub 2021 Oct 22.

Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.

Objectives: Migraine and other specific types of chronic headache impair health-related quality of life (HRQoL). However, undefined headache is common in general population and little is known about its impact on QoL. This study addresses the impact of undefined headache symptoms on quality of life in a population of working-age females.

Methods: This cross-sectional study consisted of 633 female municipal employees. Self-reported headache recurrence was defined by asking whether headache was occasional or recurrent. We assessed quality of life with two different instruments, the generic EUROHIS-QOL 8-item index (EUROHIS-8) and the preference-based instrument EuroQoL (EQ-5D) representing health-related QoL. Anxiety, depressive symptoms and work stress were measured using validated questionnaires. Adjusted hypothesis of linearity was evaluated using bootstrap type analysis of covariance with age, education and number of comorbidities as covariates.

Results: In the study population, 76% (n=481) had experienced headache during the past year, and of those 38% (n=184) had recurrent headache. The EQ-5D index decreased linearly with increasing headache symptoms and four out of five EQ-5D dimensions were lowest in recurrent headache group. Females with headache had lower QoL on every EUROHIS-8 item except for conditions of living place, compared to females without headache. These results remained statistically significant after adjustment with age, education and number of comorbidities. There were no differences in prevalence of musculoskeletal disorders between study groups.

Conclusions: This cross-sectional, observational study showed that self-reported recurrent headache is common among Finnish women belonging to active work force. Both health-related and general QoL is best in females without headache and lowest in the recurrent headache group. We conclude that recurrent headache, even when the subjects have low anxiety and depressive symptoms scores, is associated with low HRQoL in working-age females. These results underline the importance of headache, a common and neglected symptom deteriorating female employees' wellbeing.
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http://dx.doi.org/10.1515/sjpain-2021-0109DOI Listing
October 2021

The impact of antihypertensive treatment initiation on health-related quality of life and cardiovascular risk factor levels: a prospective, interventional study.

BMC Cardiovasc Disord 2021 09 16;21(1):444. Epub 2021 Sep 16.

Primary Health Care Unit, Kuopio University Hospital and University of Eastern Finland, University of Eastern Finland, Kuopio, Finland.

Background: Effective prevention and treatment of hypertension is one of the most potential interventions in terms of preventing cardiovascular deaths and disabilities. However, the treatment control is often poor. This may be partly explained by the impact of hypertension diagnoses and treatment on health-related quality of life. Quality of life is also an important outcome for a hypertensive patient. Most of the previous studies on health-related quality of life in hypertension have concentrated on patients with treated hypertension and less is known about the initiation of medication and the first treatment year.

Methods: In this interventional study, we followed 111 primary care patients with newly diagnosed hypertension in real world primary care setting in Finland for 12 months.

Results: We found significant decrease in both systolic and diastolic blood pressure levels, as well as modest decrease in cholesterol levels and alcohol consumption. However, the health-related quality of life also slightly deteriorated during the first treatment year.

Conclusions: Our study shows that the initiation of hypertension treatment results in cardiovascular risk decrease among newly diagnosed Finnish hypertensive patients, but it is accompanied by small negative impact on health-related quality of life. However, the deterioration in health-related quality of life is of small magnitude and earlier research demonstrates several measures to enhance treatment and avoid impairment in health-related quality of life. Trial registration ClinicalTrials NCT02377960 (Date of registration: 04/03/2015).
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http://dx.doi.org/10.1186/s12872-021-02252-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8447729PMC
September 2021

Obese people benefit from lumbar spinal stenosis surgery as much as people of normal weight.

J Orthop Surg Res 2021 Sep 7;16(1):550. Epub 2021 Sep 7.

Orton Orthopaedic Hospital, Tenholantie 10, 00280, Helsinki, Finland.

Background: Lumbar spinal stenosis (LSS) is a common degenerative condition of the spine that causes back pain radiating to the lower extremity. Surgical treatment is indicated to treat progressive radical symptoms. Obesity has been associated with inferior results in the domains of quality of life (QoL) following an LSS operation, but the research findings have been limited. This paper aims to identify whether obesity affects QoL due to back pain among patients who underwent an operation for LSS.

Methods: This study is based on a series of patients operated on for LSS between 2012 and 2018. Operated patients who returned for follow-up forms within the first or second years were included. A total of 359 patients were selected, 163 males (45%) and 196 females (55%). The mean age was 68.9 years. The EuroQol five-dimension scale (EQ-5D) questionnaire was chosen to measure QoL and the Oswestry Disability Index (ODI) for functional disability.

Results: QoL, as measured by EQ-5D, was preoperatively lower in those patients with a BMI ≥ 30. One year after the operation, all groups had a similar trend of improved QoL. At the second year, the results in all groups levelled off even though there was no statistical difference in clinical outcomes (p = 0.92). The ODI was preoperatively statistically higher in patients with a BMI ≥ 30 (p < 0.001). Two years after the surgery, all groups had improved ODI scores, but there was no statistical difference in ODI between the BMI groups (p = 0.54).

Conclusion: Surgical intervention for debilitating or longstanding symptoms of LSS should be considered as a treatment option for suitable patients in spite of an elevated BMI.
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http://dx.doi.org/10.1186/s13018-021-02692-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8422720PMC
September 2021

Prevalence of and Risk Factors for Back Pain Among Young Male Conscripts During Compulsory Finnish Military Service.

Mil Med 2021 Sep 4. Epub 2021 Sep 4.

Department of Orthopaedics and Traumatology, Clinicum, University of Helsinki, Helsinki 00014, Finland.

Introduction: Back pain is a major reason for sick leaves and disability pension in primary health care. The prevalence of back pain among adolescents and young adults is believed to be increasing, and back pain during military service predicts unspecified back pain during later life. The aim of this study was to investigate the prevalence and risk factors of back pain among conscripts in compulsory Finnish military service during the period 1987-2005.

Materials And Methods: The Finnish Defence Forces recruit all men aged 18 years for compulsory military service, and new conscripts enter the service twice a year. Before entering the service, all conscripts must pass a medical examination and conscripts entering the service are generally healthy.Health care in Finnish military service is organized by the public Garrison Health Center, and all medical records are stored as part of the Finnish health care operation plan. For this study, we randomly selected 5,000 men from the Finnish Population Register Centre, according to their year of birth from five different age categories (1969, 1974, 1979, 1984, and 1989).

Results: We gathered 4,029 documents for the analysis.The incidence of back pain varied between 18% and 21% and remained unchanged during the examination period.The risk factors for back pain were smoking (risk ratio 1.35,P-value <.001),elementary school only as education (risk ratio 1.55, P-value <.001), and back problems reported before military service (risk ratio 2.03,P-value.002).Half of the back pain incidences occurred during the first months of service.

Conclusions: The prevalence of back pain among male Finnish military service conscripts has not changed in the last 25 years. Twenty percent of conscripts suffer from back-related problems during their military service. The majority of the visits to health centers occurred in the first service months. The risk factors for back pain include smoking, low education level, and musculoskeletal disorders in general. Educating the young people about harms of tobacco and supporting education is a way to influence the back pain prevalence. Strength of this study is a good generalized population sample of young Finnish adult males because of the fact that the Finnish military service is compulsory for all men. All medical records of all visits to the Garrison Health Care Centre were available, and all the conscripts filled the same pre-service questionnaire, minimizing the possibility of selection bias. The sample size was also large. Weakness of this study is that the service time changed during the study period and in the latest conscript group born in 1989, data collection and the data available for this cohort was limited, because nearly half of the conscripts had not yet started their service. The Finnish military service is compulsory only for men and because of the low number of female conscripts, they were excluded from this study. Diagnoses were also missing from 70% of the back-related visits, and these visits were recorded as back pain-related visits according to the reason for seeking care.
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http://dx.doi.org/10.1093/milmed/usab375DOI Listing
September 2021

The impact of lifestyle counselling on weight management and quality of life among working-age females.

Scand J Prim Health Care 2021 Sep 3;39(3):382-388. Epub 2021 Sep 3.

Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.

Objective: Overweight and obesity are increasing globally. General practitioners (GP's) are at the first point of contact for medical support and consequently have a major role in resolving this overwhelming problem. The aim of this study was to assess the effectiveness of a brief lifestyle counselling on weight management and on the participants' quality of life (QoL).

Design: A cohort study with a one-year follow-up.

Setting: Occupational health care, city of Pori in southwestern Finland.

Participants: Female municipal employees ( = 625) with a mean age of 48 (SD 9) years.

Intervention: A nurse and a physiotherapist gave lifestyle counselling to all the participants; however, only the overweight/obese subjects were recommended to lose at least 5% of their initial weight.

Main Outcome Measure: Success in weight management and quality of life.

Results: At the follow-up visit, 10.4% (95% CI: 7.5-14.0) of the overweight/obese subjects had lost at least 5% of their weight, but 10.0% (95% CI: 6.7-14.3) of the normal-weight participants had become overweight. The mean weight change was +0.1 kg (95% CI: -0.3-0.5) in the overweight/obese group and +0.5 kg (95% CI: 0.2-0.8) in the normal weight group. The change in QoL was inversely correlated with relative weight change in overweight/obese subjects, albeit the effect size was small.

Conclusion: Weight management counselling should also be directed to individuals with a normal weight. Even with brief lifestyle counselling it may be possible to stabilize weight gain. Successful weight loss may improve the QoL of overweight/obese individuals.KEY POINTSPrimary health care has to deal with the increasing problem of overweight and obesity.Brief lifestyle counselling performed by a nurse and a physiotherapist seems to be quite effective in weight stabilization, considering the effort needed.People with normal weight tend to gain weight and weight management counselling should also be directed to them. Successful weight management may improve the quality of life of overweight/obese people.
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http://dx.doi.org/10.1080/02813432.2021.1958510DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475109PMC
September 2021

Relationship between Fried's frailty phenotype and oral frailty in long-term care residents.

Age Ageing 2021 11;50(6):2133-2139

Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.

Background: oral frailty (OFr) may be called a syndrome lacking a consensus on its definition.

Objective: the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care.

Design: the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition.

Setting: participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs).

Subjects: the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland.

Methods: frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination.

Results: a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties.

Conclusions: OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.
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http://dx.doi.org/10.1093/ageing/afab177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581380PMC
November 2021

The Association between Healthy Diet and Burnout Symptoms among Finnish Municipal Employees.

Nutrients 2021 Jul 13;13(7). Epub 2021 Jul 13.

Department of General Practice, Turku University and Turku University Hospital, Turku University, 20014 Turku, Finland.

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.
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http://dx.doi.org/10.3390/nu13072393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308766PMC
July 2021

Oral hygiene and health-related quality of life in institutionalized older people.

Eur Geriatr Med 2021 Jul 27. Epub 2021 Jul 27.

Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.

Purpose: We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored.

Methods: This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants' background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden.

Results: Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender.

Conclusions: Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents' oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups.
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http://dx.doi.org/10.1007/s41999-021-00547-8DOI Listing
July 2021

Randomized controlled study of the impact of a participatory patient care plan among primary care patients with common chronic diseases: a one-year follow-up study.

BMC Health Serv Res 2021 Jul 20;21(1):715. Epub 2021 Jul 20.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, FI-70211, Kuopio, Finland.

Backround: Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension.

Methods: The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017-2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up.

Results: A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes.

Conclusions: During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline.

Trial Registration: ClinicalTrials.gov Identifier: NCT02992431 . Registered 14/12/2016.
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http://dx.doi.org/10.1186/s12913-021-06716-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293542PMC
July 2021

Effect of 12-Month Supervised, Home-Based Physical Exercise on Functioning Among Persons With Signs of Frailty: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2021 12 18;102(12):2283-2290. Epub 2021 Jul 18.

South Karelia Social and Health Care District, Rehabilitation, Lappeenranta.

Objectives: To investigate the effects of a 12-month home-based exercise program on functioning and falls among persons with signs of frailty.

Design: A randomized controlled trial with a 1:1 allocation.

Setting: Home-based.

Participants: Home-dwelling persons aged 65 years or older meeting at least 1 frailty phenotype criteria (N=300). The mean age of the participants was 82.2±6.3 years, 75% were women, 61% met 1-2 frailty criteria, and 39% met ≥3 criteria.

Interventions: A 12-month, individually tailored, progressive, and physiotherapist-supervised physical exercise twice a week (n=150) vs usual care (n=149).

Main Outcome Measures: FIM, Short Physical Performance Battery (SPPB), handgrip strength, instrumental activities of daily living (IADL), and self-reported falls and physical activity (other than intervention). Assessed 4 times at home over 12 months.

Results: FIM deteriorated in both groups over 12 months, -4.1 points (95% confidence interval [CI], -5.6 to -2.5) in the exercise group and -6.9 (95% CI, -8.4 to -2.3) in the usual care group (group P=.014, time P<.001, interaction P=.56). The mean improvement in SPPB was significantly greater in the exercise group (1.6 [95% CI, 1.3-2.0]) than in the usual care group (0.01 [95% CI, -0.3 to 0.3]) (group P<.001, time P=.11, interaction P=.027). The exercise group reported significantly fewer falls per person-year than the usual care group (incidence rate ratio, 0.47 [95% CI, 0.40-0.55]; P<.001). There was no significant difference between the groups over 12 months in terms of handgrip strength, IADL function, or self-reported physical activity.

Conclusions: One year of physical exercise improved physical performance and decreased the number of falls among people with signs of frailty. FIM differed between the groups at 12 months, but exercise did not prevent deterioration of FIM, IADL, or handgrip strength.
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http://dx.doi.org/10.1016/j.apmr.2021.06.017DOI Listing
December 2021

Being moved by listening to unfamiliar sad music induces reward-related hormonal changes in empathic listeners.

Ann N Y Acad Sci 2021 10 17;1502(1):121-131. Epub 2021 Jul 17.

Music Department, University of Jyväskylä, Jyväskylän yliopisto, Finland.

Many people enjoy sad music, and the appeal for tragedy is widespread among the consumers of film and literature. The underlying mechanisms of such aesthetic experiences are not well understood. We tested whether pleasure induced by sad, unfamiliar instrumental music is explained with a homeostatic or a reward theory, each of which is associated with opposite patterns of changes in the key hormones. Sixty-two women listened to sad music (or nothing) while serum was collected for subsequent measurement of prolactin (PRL) and oxytocin (OT) and stress marker (cortisol and adrenocorticotropic hormone) concentrations. Two groups of participants were recruited on the basis of low and high trait empathy. In the high empathy group, PRL and OT levels were significantly lower with music compared with no music. And compared to the low empathy group, the high empathy individuals reported an increase of positive mood and higher ratings of being moved with music. None of the stress markers showed any changes across the conditions or the groups. These hormonal changes, inconsistent with the homeostatic theory proposed by Huron, exhibit a pattern expected of general reward. Our findings illuminate how unfamiliar and low arousal music may give rise to pleasurable experiences.
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http://dx.doi.org/10.1111/nyas.14660DOI Listing
October 2021

Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study.

Breast 2021 Oct 26;59:110-116. Epub 2021 Jun 26.

Helsinki University Hospital, Comprehensive Cancer Center, and University of Helsinki, Faculty of Medicine, Helsinki, Finland.

Objective: To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial.

Methods: Survivors (aged 35-68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors.

Results: The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference -0.017, 95% CI: -0.031 to -0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference -0.019, 95% CI: -0.031 to -0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up.

Conclusions: HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.
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http://dx.doi.org/10.1016/j.breast.2021.06.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264211PMC
October 2021

Body surface area may explain sex differences in findings from the oral glucose tolerance test among subjects with normal glucose tolerance.

Nutr Metab Cardiovasc Dis 2021 08 26;31(9):2678-2684. Epub 2021 May 26.

Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.

Background And Aims: Current guidelines on prediabetes and diabetes (T2D) recommend to regularly perform an oral glucose tolerance test (OGTT) on subjects at risk of T2D. However, it is not known why women tend to have relatively higher 2-h post-load plasma (2hPG) glucose concentrations during OGTT than men. The aim of the present study is to investigate if there are sex differences in fasting plasma glucose (FPG) and 2hPG concentrations in relation to body size in apparently healthy non-diabetic subjects with normal glucose tolerance. We hypothesized that sex differences in glucose tolerance are physiological and related to different body surface area (BSA) in men and women.

Methods And Results: A 2-h 75 g OGTT was performed on 2010 subjects aged 45-70 years. Their BSA was calculated using the Mosteller formula. Men and women were separately divided into five BSA levels. Within the normal 2hPG range, women had higher mean 2hPG concentrations during the OGTT than men in all BSA levels estimated by sex-standardized BSA (p for linearity < 0.001). BSA adjusted for age, waist circumference, leisure-time physical activity, and smoking, showed an inverse association with 2hPG concentration in both sexes. Mean FPG concentrations were higher in men than in women.

Conclusions: Body size has a negative inverse association with 2hPG concentration in an OGTT even within a physiological plasma glucose range. This may cause underestimation of glucose disorders in individuals with larger BSA and overestimation in individuals with smaller BSA when using an OGTT.
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http://dx.doi.org/10.1016/j.numecd.2021.05.018DOI Listing
August 2021

Psychiatric disorders in incident patients with juvenile idiopathic arthritis - a case-control cohort study.

Pediatr Rheumatol Online J 2021 Jul 2;19(1):105. Epub 2021 Jul 2.

PEDEGO Research Unit, University of Oulu, Oulu, Finland.

Background: Chronic illness, such as juvenile idiopathic arthritis (JIA), appears to have an impact on the mental health of children and adolescents. The aim of this study was to explore the incidence of mental and behavioural disorders according to age at JIA onset and gender in JIA patients compared to a control population.

Methods: Information on all incident patients with JIA in 2000-2014 was collected from the nationwide register, maintained by the Social Insurance Institution of Finland. The National Population Registry identified three controls (similar regarding age, sex and residence) for each case. They were followed up together until 31st Dec. 2016. ICD-10 codes of their psychiatric diagnoses (F10-F98) were obtained from the Care Register of the National Institute for Health and Welfare. The data were analysed using generalized linear models.

Results: The cumulative incidence of psychiatric morbidity was higher among the JIA patients than the controls, hazard ratio 1.70 (95% Cl 1.57 to 1.74), p < 0.001. Phobic, anxiety, obsessive-compulsive, stress-related and somatoform disorders (F40-48) and mood (affective) disorders (F30-39) were the most common psychiatric diagnoses in both the JIA patients (10.4 and 8.2%) and the control group (5.4 and 5.1%), respectively. Female patients were more prone to mental and behavioural disorders than males were, and the risk seemed to be higher in patients who developed JIA in early childhood or adolescence.

Conclusion: Patients with JIA are diagnosed with mental and behavioural disorders more often than controls, and the age at onset of JIA could have implications for future mental health.
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http://dx.doi.org/10.1186/s12969-021-00599-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252279PMC
July 2021

Oral Health and Frailty Among Older Long-Term Care Residents in Finland.

J Am Med Dir Assoc 2021 11 17;22(11):2394-2395. Epub 2021 Jun 17.

Department of General Practice and Primary Health Care, University of Helsinki, Finland; Helsinki University Hospital, Unit of Primary Health Care, Finland.

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http://dx.doi.org/10.1016/j.jamda.2021.05.027DOI Listing
November 2021

Temporal trends in nutrition intake among older long-term care residents.

Clin Nutr 2021 06 11;40(6):3793-3797. Epub 2021 May 11.

University of Helsinki, Department of General Practice and Primary Health Care, Helsinki, Finland, POB 20, 00014, Helsinki, Finland.

Background & Aims: The temporal trends in protein and other nutrient intakes among older long-term care residents have not been studied. The aim of this study was to explore the changes in energy, protein, and other nutrient intakes between 2007 and 2017-8 in two cross-sectional samples of older long-term care residents in the Helsinki metropolitan area. We also studied how the residents' disability and stage of cognition modified the association between observation year and protein intake (g/body weight kg).

Methods: Two cross-sectional samples were collected in 2007 (n = 350) and 2017-8 (n = 476) in long-term care settings. Residents' nutrient intake was determined by a one- or two-day food record. Residents' disability was determined by the Clinical Dementia Rating (CDR) "personal care" question and stage of cognition was determined by the CDR "memory" item.

Results: There was no significant difference in energy intake between the observation years. Carbohydrates, total protein, and protein (g/body weight kg) intakes were significantly lower in 2017-8 than in 2007. Fat intake was higher in 2017-8 than in 2007. In 2017-8, the intake of some vitamins and minerals was lower (thiamine, calcium) but some higher (vitamins A, D, C, E) compared to 2007. Residents' disability (p = 0.049) and observation year (p = 0.037) were significantly associated with protein intake (g/body weight kg), but the interaction was not significant (p = 0.35). Furthermore, residents' stage of cognition was not associated with protein intake (p = 0.22) but observation year was (p < 0.001). The interaction was not significant (p = 0.30).

Conclusions: Whereas the energy intake remained at the same level in the observation years, the ratio of macronutrient intake changed in an unfavorable way. The intake of protein and some vitamins were lower whereas the relative proportion of fat was higher in 2017-8 compared to 2007. As long-term care residents become more disabled in the future, more attention should be paid to diet quality.
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http://dx.doi.org/10.1016/j.clnu.2021.04.048DOI Listing
June 2021

Effects of Staff Training on Nursing Home Residents' End-Of-Life Care: A Randomized Controlled Trial.

J Am Med Dir Assoc 2021 08 13;22(8):1699-1705.e1. Epub 2021 Jun 13.

Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland. Electronic address:

Objectives: This trial examines the effects of end-of-life training on long-term care facility (LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital services.

Design: A single-blind, cluster randomized (at facility level) controlled trial (RCT). Our training intervention included 4 small-group 4-hour educational sessions on the principles of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff. Education was based on constructive learning methods and included resident cases, role-plays, and small-group discussions.

Setting And Participants: We recruited 324 residents with possible need for end-of-life care due to advanced illness from 20 LTCF wards in Helsinki.

Methods: Primary outcome measures were HRQoL and hospital inpatient days per person-year during a 2-year follow-up. Secondary outcomes were number of emergency department visits and cost of all hospital services.

Results: HRQoL according to the 15-Dimensional Health-Related Quality-of-Life Instrument declined in both groups, and no difference was present in the changes between the groups (P for group .75, adjusted for age, sex, do-not-resuscitate orders, need for help, and clustering). Neither the number of hospital inpatient days (1.87 vs 0.81 per person-year) nor the number of emergency department visits differed significantly between intervention and control groups (P for group .41). The total hospital costs were similar in the intervention and control groups.

Conclusions And Implications: Our rigorous RCT on end-of-life care training intervention demonstrated no effects on residents' HRQoL or their use of hospitals. Unsupported training interventions alone might be insufficient to produce meaningful care quality improvements.
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http://dx.doi.org/10.1016/j.jamda.2021.05.019DOI Listing
August 2021

Pain experience in an aging adult population during a 10-year follow-up.

Scand J Pain 2021 10 11;21(4):716-723. Epub 2021 Jun 11.

Department of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland.

Objectives: This 10-year follow-up study aimed to examine the persistence of SF-36 pain intensity and pain-related interference and to identify baseline factors that may relate to pain experience among community-dwelling aging adults.

Methods: Questionnaire and clinical data on a total of 1,954 participants (mean age at baseline 63 years) were collected in 2002, 2005, 2008, and 2012. Based on pain reports, four pain intensity, pain interference (PIPI) groups were formed at each time point: PIPI group I: none to mild pain intensity and interference; II: moderate to extreme pain intensity, none to mild pain-related interference; III: None to mild pain intensity, moderate to extreme pain-related interference, IV: Moderate to extreme pain intensity and interference.

Results: Participants with the most pain at baseline improved their pain situation the most during the follow-up. Higher BMI was associated with pain interference, and metabolic syndrome (MetS) and musculoskeletal diseases with both pain intensity and interference (p<0.05, statistically significant interaction between pain intensity and pain interference) at baseline. According to multivariate logistic regression analysis the following baseline characteristics were associated with remaining in PIPI group I throughout the follow-up: presence of musculoskeletal disease (OR 0.22 [95% CI 0.16-0.30]), high BMI (OR 0.93 [95% CI 0.90-0.97]), high household income (OR 1.46 [95% CI 1.07-1.98]), good childhood home environment (OR 1.03 [95% CI 1.00-1.05]).

Conclusions: Multiple factors may affect pain persistence in late adulthood with varying effect on pain intensity and pain-related interference. Pain situation of even those with most pain may be improved.
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http://dx.doi.org/10.1515/sjpain-2021-0061DOI Listing
October 2021

The feasibility and outcome of a community-based primary prevention program for cardiovascular disease in the 21st century.

Scand J Prim Health Care 2021 Jun 7;39(2):157-165. Epub 2021 Jun 7.

Department of General Practice, Turku University and Turku University Hospital, Turku, Finland.

Objective: There is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality. This study aimed to evaluate the effectiveness of a primary care CVD prevention program on mortality during a 13-year follow-up.

Design: A risk factor survey was sent, followed by a nurse-led lifestyle counselling to respondents with at least one CVD risk factor, and a general practitioner's (GP) appointment for high-risk persons. Screening and interventions were performed during 2005-2006.

Setting: A public health care centre in the town of Harjavalta, Finland.

Subjects: All home-dwelling 45-70-year old inhabitants without manifested CVD or diabetes.

Main Outcome Measures: All-cause and CVD mortality.

Results: Altogether 74% (2121/2856) inhabitants responded to the invitation. The intervention was received by 1465 individuals (52% of the invited population): 398 risk persons had an appointment with a nurse, followed by an appointment with a GP for 1067 high-risk persons. During the follow-up, 370 persons died. Mortality among the non-respondents was twofold compared to the participants'. In subjects who received the intervention, the age- and gender-adjusted hazard ratio for all-cause mortality was 0.44 (95% CI: 0.36 to 0.54) compared to the subjects who did not receive the intervention.

Conclusions: Reducing mortality is possible in a primary care setting by raising health awareness in the community with screening, by targeted lifestyle counselling and evidence-based preventive medication for persons at high risk for CVD. Subjects not willing to participate in health surveys have the worst prognosis.Key PointsPreviously, there is no evidence that systematic screening and risk factor modification in an unselected, asymptomatic population will reduce cardiovascular disease (CVD) mortality.With a stepwise screening program it is possible to scale the magnitude of CVD prevention in the community.Reducing mortality in a community is possible by screening, targeted lifestyle counselling, and by evidence-based preventive medication for high-risk persons.Subjects not willing to participate in health surveys have the worst prognosis.
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http://dx.doi.org/10.1080/02813432.2021.1913893DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8293959PMC
June 2021

Casting in finger trap traction without reduction versus closed reduction and percutaneous pin fixation of dorsally displaced, over-riding distal metaphyseal radius fractures in children under 11 years old: a study protocol of a randomised controlled trial.

BMJ Open 2021 05 26;11(5):e045689. Epub 2021 May 26.

Department of Pediatric Orthopedics and Traumatology, New Children's Hospital, Helsinki, Uusimaa, Finland.

Introduction: Distal radius is the most common site of fracture in children, comprising 23%-31% of all paediatric fractures. Approximately one-fifth of these fractures are displaced. Completely displaced distal metaphyseal radius fractures in children have traditionally been treated with closed reduction. Recent evidence suggests that correcting the shortening in over-riding distal metaphyseal radius fractures is not necessary in prepubertal children. To date, no published randomised controlled trial (RCT) has compared treatment of these fractures in children by casting the fracture in bayonet position to reduction and pin fixation.

Methods And Analysis: We will conduct an RCT to compare the outcomes of casting the fracture in bayonet position in children under 11 years of age to reduction and percutaneous pin fixation. 60 patients will be randomly assigned to casting or surgery groups. We have two primary outcomes. The first is ratio (injured side/non-injured side) in the total active forearm rotation and the second is ratio (injured side/non-injured side) in total active range of motion of the wrist in the flexion-extension plane at 6 months. The secondary outcomes will include axial radiographic alignment, passive extension of the wrists, grip strength and length of forearms and hands, patient-reported outcome QuickDASH and pain questionnaire PedsQL. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort. Patients not eligible for randomisation will be asked to participate in a non-eligible cohort. These cohorts are included to enhance the external validity of the results of the RCT. Our null hypothesis is that the results of the primary outcome measures in the casting group are non-inferior to surgery group.

Ethics And Dissemination: The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications.

Trial Registration Number: NCT04323410.

Protocol: V.1.1, 29 September 2020.
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http://dx.doi.org/10.1136/bmjopen-2020-045689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8160196PMC
May 2021

Both lean and fat body mass associate with blood pressure.

Eur J Intern Med 2021 09 13;91:40-44. Epub 2021 May 13.

Folkhälsan Research Center, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore; Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

High body mass index (BMI) is known to be associated with elevated blood pressure (BP). The present study aims to determine the relative importance of the two components of BMI, fat mass and lean body mass index, on BP levels. We assessed body composition with bioimpedance and performed 24 hour ambulatory BP measurements in 534 individuals (mean age 61 ± 3 years) who had no cardiovascular medication. Fat mass index and lean mass index were calculated analogously to BMI as fat mass or lean body mass (kg) divided by the square of height (m). Both fat mass index and lean mass index showed a positive, small to moderate relationship with all 24 hour BP components independently of age, sex, smoking, and leisure-time physical activity. There were no interaction effects between fat mass index and lean mass index on the mean BP levels. Adult lean body mass is a significant determinant of BP levels with an equal, albeit small to moderate magnitude as fat mass. Relatively high amount of muscle mass may not be beneficial to cardiovascular health.
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http://dx.doi.org/10.1016/j.ejim.2021.04.025DOI Listing
September 2021

Effects of Home-Based Physical Exercise on Days at Home, Health Care Utilization, and Functional Independence Among Patients With Hip Fractures: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2021 09 30;102(9):1692-1699. Epub 2021 Apr 30.

Department of Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta.

Objective: To evaluate the effects of a physical exercise program on days lived at home, the use and costs of health care and social services, mortality, and functional independence among patients with hip fractures.

Design: Randomized controlled trial with a parallel 2-group design consisting of a 12-month intervention and 12-month registry follow-up.

Setting: Home-based intervention.

Participants: Patients aged ≥60 years (N=121) with operated hip fracture and who were living at home were randomized into physical exercise (n=61) and usual care (n=60) groups.

Interventions: Supervised physical exercise twice a week.

Main Outcome Measures: The primary outcome was the number of days lived at home over 24 months. Secondary outcomes were the use and costs of health care and social services, mortality over 24 months, and Functional Independence Measure (FIM) over 12 months.

Results: Over 24 months, there was no significant difference between the groups in terms of days lived at home (incidence rate ratio, 1.01; 95% confidence interval [CI], 0.90-1.14) or mortality (hazard ratio, 1.01; 95% CI, 0.42-2.43). The mean total costs of health care and social services did not differ between the groups. The costs per person-year were 1.26-fold (95% CI, 0.87-1.86) greater in the physical exercise group than in the usual care group over 12 months and 1.08-fold (95% CI, 0.77-1.70) over 24 months. The mean difference between the change in FIM of the groups over 12 months was 4.5 points (95% CI, 0.5-8.5; P=.029) in favor of the physical exercise group.

Conclusions: Long-term home-based physical exercise had no effect on the number of days lived at home over 24 months among patients with hip fractures. The intervention was cost neutral over these 24 months. The FIM scores improved in both groups over 12 months, but the improvement was significantly greater in the physical exercise group than in the usual care group.
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http://dx.doi.org/10.1016/j.apmr.2021.04.004DOI Listing
September 2021

Comment on: Decrease of anticholinergic drug use in nursing home residents in the United States.

J Am Geriatr Soc 2021 07 30;69(7):2033-2035. Epub 2021 Apr 30.

Department of General Practice, University of Helsinki, Helsinki, Finland.

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http://dx.doi.org/10.1111/jgs.17182DOI Listing
July 2021

Secular trends in functional abilities, health and psychological well-being among community-dwelling 75- to 95-year-old cohorts over three decades in Helsinki, Finland.

Scand J Public Health 2021 Apr 25:14034948211007688. Epub 2021 Apr 25.

Department of General Practice and Primary Health Care, University of Helsinki, Finland.

Life expectancy has increased markedly in the past decades. Thus, it is of great importance to understand how people are ageing and if the trajectories of health and disability are changing over time. This study aimed to examine trends in functional abilities and health in independent cohorts of people aged 75-95 over three decades. This Helsinki Ageing Study consists of repeated cross-sectional postal surveys examining independent cohorts of old people (75, 80, 85 and 90+ years old). This study combined data from four waves (1989, 1999, 2009 and 2019). In the most recent wave, there was an increase in the portion of participants who were able to walk outdoors easily (75-year-olds =0.03, 80-year-olds =0.002, 85-year-olds <0.001; for linearity for the study year effect, all adjusted for sex). Fewer people in the youngest age group (75-year-olds) needed daily help from another person in 2019 compared to the earlier waves (=0.02 for linearity for the study year). Over the past three decades, the proportions of self-reported good mobility have risen 8.7% (95% confidence interval (CI) 2.3-15.1) in 75-year-olds, 11.7% (95% CI 3.9-19.6) in 80-year-olds and 20.1% (95% CI 10.7-29.4) in 85-year-olds, after adjusting for sex. Furthermore, in 2019, more people rated their health as good and scored better in psychological well-being than in the previous waves among 75-, 80- and 85-year-olds. However, no improvements were found among 90+-year-olds in any of these variables.
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April 2021
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