Publications by authors named "Heini S A Huhtala"

10 Publications

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Risk factors of readmission after geriatric hospital care: An interRAI-based cohort study in Finland.

Arch Gerontol Geriatr 2021 Jan 20;94:104350. Epub 2021 Jan 20.

Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland.

Purpose: To identify risk factors for readmission after geriatric hospital care.

Methods: A retrospective cohort study of 1,167 community-dwelling patients aged ≥70 years who were hospitalised in two geriatric hospitals and discharged to their homes over a three-year period. We combined the results of the interRAI-post acute care instrument (interRAI-PAC) with hospital discharge records. Factors associated with readmissions within 90 days following discharge were analysed using logistic regression analysis.

Results: The patients' mean age was 84.5 (SD 6.2) years, and 71% (n = 827) were women. The 90-day readmission rate was 29.5%. The risk factors associated with readmission in the univariate analysis were as follows: age, admission from home vs. acute care hospital, Alzheimer's disease, unsteady gait, fatigue, unstable conditions, Activities of Daily Living Hierarchy Scale (ADLH) score, Cognitive Performance Scale (CPS) score, body mass index (BMI), frailty index, bowel incontinence, hearing difficulties, and poor self-rated health. In the multivariable analysis, age of ≥90 years, ADLH ≥1, unsteady gait, BMI <25 or ≥30 kg/m 2 , and frailty remained as risk factors for readmission. Surgical operation during the treatment period was associated with a lower readmission risk.

Conclusions And Implications: InterRAI-PAC performed upon admission to geriatric hospitals revealed patient-related risk factors for readmission. Based on the identified risk factors, we recommend that the patient's functional ability, activities of daily living (ADL) needs, and individual factors underlying ADL disability, as well as nutritional and mobility problems should be carefully addressed and managed during hospitalization to diminish the risk for readmission.
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http://dx.doi.org/10.1016/j.archger.2021.104350DOI Listing
January 2021

Glomerular Proteinuria Predicts the Severity of Acute Kidney Injury in Puumala Hantavirus-Induced Tubulointerstitial Nephritis.

Nephron 2017 21;136(3):193-201. Epub 2017 Mar 21.

National Reference Centre for Hantaviruses, University Hospitals Leuven, Leuven, Belgium.

Background: Puumala virus (PUUV)-induced hemorrhagic fever with renal syndrome is common in many European countries. The typical renal histologic lesion is acute tubulointerstitial nephritis. We examined the type and kinetics of urine protein excretion and prognostic significance of proteinuria for the severity of acute kidney injury (AKI) in acute PUUV infection.

Methods: The amount of dipstick albuminuria at hospital admission was analyzed in 205 patients with acute PUUV infection. Dipstick albuminuria at admission was graded into 3 categories: 0-1+, 2+, and 3+. In 70 patients, 24-h urinary excretion of protein, overnight urinary excretion of albumin, immunoglobulin (Ig) G, and α1-microglobulin also were measured over 3 consecutive days during the hospital stay.

Results: Maximum median daily proteinuria, overnight albuminuria, and IgG excretion were observed over 5 days, while that of creatinine values was observed 9 days after the onset of the disease. The medians of maximum plasma creatinine levels during hospital stay were different in the 3 categories of dipstick albuminuria: 0-1+: 98 µmol/L (58-1,499), 2+: 139 µmol/L (71-829), and 3+: 363 µmol/L (51-1,285; p < 0.001). Dipstick albuminuria ≥2+ at admission could be detected in 89% of the patients who subsequently developed severe AKI. Glomerular proteinuria, but not tubular proteinuria (α1-microglobulin), correlated with the severity of the emerging AKI.

Conclusion: In acute PUUV infection, maximum median proteinuria values preceded the most severe phase of AKI by a few days. A highly useful finding for clinical work was that a quick and simple albuminuria dipstick test at hospital admission predicted the severity of the upcoming AKI.
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http://dx.doi.org/10.1159/000459634DOI Listing
May 2018

Higher Blood Cobalt and Chromium Levels in Patients With Unilateral Metal-on-Metal Total Hip Arthroplasties Compared to Hip Resurfacings.

J Arthroplasty 2016 06 17;31(6):1261-1266. Epub 2015 Dec 17.

Coxa Hospital for Joint Replacement, Tampere, Finland.

Background: Adverse soft tissue reactions in metal-on-metal (MoM) hip replacements are associated with cobalt (Co) and chromium (Cr) ions in blood. We report the prevalence and risk factors for elevated blood Co and Cr levels in patients with a unilateral MoM hip.

Methods: From a single institution, blood Co and Cr levels were analyzed in 1748 patients (692 hip resurfacings and 1056 total hip arthroplasties [THAs]). Concentrations exceeding 7 ppb were considered elevated, and the risk factors for elevated levels were calculated with binary logistic regression.

Results: Elevated blood metal ion levels were more common in MoM THA than in resurfacing patients (17.4% vs 5.9%, P < .001), and in 5 of the 7 THA brands, more than 20% of patients had elevated metal ion concentrations, whereas the proportion was less than 10% in all hip resurfacings. In resurfacings, small femoral head (odds ratio [OR] 1.30 per millimeter decrease [CI, 1.12-1.49]), high acetabular inclination (OR 1.15 per degree increase [CI 1.09-1.22]), and young age (OR 1.05 per year decrease [1.02-1.10]) were independent risk factors for elevated ions. In the THA group, female gender (OR 2.04 [CI 1.35-3.06]), longer time between surgery and ion measurement (OR 1.19 per year increase [CI 1.05-1.34]), and large headsize (OR 1.07 per millimeter increase [CI 1.01-1.13]) were risk factors for elevated ions.

Conclusion: Given the high percentage of elevated levels, the systematic surveillance of especially large diameter MoM THAs seems justified.
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http://dx.doi.org/10.1016/j.arth.2015.11.045DOI Listing
June 2016

Satisfaction with maxillary sinus surgery might be influenced by risk factors.

Allergy Rhinol (Providence) 2013 ;4(1):e6-e12

Department of Otorhinolaryngology, University of Tampere, Tampere, Finland, ; Department of Otorhinolaryngology, Paijat-Hame Central Hospital, Lahti, Finland.

Chronic rhinosinusitis (CRS) is an inflammation of the nose and paranasal sinuses lasting for ≥12 weeks. Endoscopic sinus surgery (ESS) is considered during difficult to treat CRS. The minimally invasive technique focuses on the transition areas rather than on the ostia. The aim of this study was to evaluate symptoms, the number of acute sinusitis episodes, and satisfaction after ESS with either preservation or enlargement of the maxillary sinus ostium. Thirty patients with moderate nonpolypous CRS were enrolled. Uncinectomy only and additional middle meatal antrostomy were randomized for each side of each patient and performed single blindly. The symptoms questionnaires were filled at four time intervals. Significant symptom reduction was achieved independently of operation technique. The number of acute sinusitis episodes indicating the exacerbation rate decreased significantly at 9 and, on average, 68 months postoperatively. However, the exacerbation rate began to increase after 9 months postoperatively. Three revisions were performed on the side with uncinectomy only and one on the side with additional antrostomy. Most patients reported good satisfaction with both procedures. There was a trend for patients with asthma and/or job exposure to report insignificantly more frequently no satisfaction with surgery, especially with the uncinectomy-only procedure. Both procedures seem to be efficient in providing symptom relief and satisfaction. More studies are needed to evaluate if patients with risk factors benefit more from an ostium-enlarging procedure.
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http://dx.doi.org/10.2500/ar.2013.4.0039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679571PMC
June 2013

High activity of indoleamine 2,3-dioxygenase is associated with renal insufficiency in Puumala hantavirus induced nephropathia epidemica.

J Med Virol 2011 Apr;83(4):731-7

Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.

Nephropathia epidemica (NE) is a hemorrhagic fever with renal syndrome caused by Puumala hantavirus. The severity of NE varies greatly. The aim of the present study was to evaluate whether serum indoleamine 2,3-dioxygenase (IDO) activity is associated with the severity of NE. A prospectively collected cohort of 102 consecutive patients with acute serologically confirmed NE was examined. Serum kynurenine, tryptophan, creatinine, CRP, and blood cell count were measured for up to 5 consecutive days after admission. The kynurenine to tryptophan (kyn/trp) ratio reflecting IDO activity was calculated. A maximum kyn/trp ratio >202 µmol/mmol had a sensitivity of 85% and a specificity of 75% for detecting maximum serum creatinine values >250 µmol/L by receiver operating characteristic (ROC) analysis. A maximum kyn/trp ratio >202 µmol/mmol (high IDO level) was also associated with other parameters reflecting the severity of the disease and renal impairment. Patients with high IDO levels had higher maximum serum creatinine (379 vs. 102 µmol/L, P<0.001), plasma C-reactive protein (104.1 vs. 72.1 mg/L, P=0.029), and blood leukocyte values (11.9 vs. 9.0 × 10(9) /L, P<0.001) compared to patients with kyn/trp ratio ≤ 202 µmol/mmol. They also had lower minimum urinary output (1,100 vs. 1,900 ml/day, P<0.001) and longer hospital stays (8 vs. 5 days, P<0.001). In conclusion, high serum IDO activity was associated with increased disease severity and renal impairment in NE.
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http://dx.doi.org/10.1002/jmv.22018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874118PMC
April 2011

Use and acquisition of nicotine replacement therapy products among underaged adolescents after deregulation of the sales.

Nicotine Tob Res 2010 Aug 9;12(8):870-3. Epub 2010 Jul 9.

School of Public Health, University of Tampere, Tampere, Finland.

Introduction: Limited information is available on the use and acquisition of nicotine replacement therapy (NRT) products in minors after deregulation of the sales. In Finland, deregulation releasing the NRT products for general sale took place in 2006. The sale is prohibited to those under the age of 18 years. We examine underaged adolescents' use, acquisition, and awareness of NRT products after the deregulation.

Methods: Nationwide mailed survey of 12- to 18-year olds (N = 5,840, response rate 61%) was conducted in 2007. The main outcomes were ever use of NRT, acquisition of NRT products in different locations (retail outlet, family member, friend, health care personnel, and pharmacy), and awareness of NRT. Eighteen-year olds were analyzed as a comparison group as they were at legal age to buy the products.

Results: Among 14-year olds, 2% of boys and 2% of girls had used NRT. The corresponding figures for 16-year olds were 7% and 5%, respectively, and for 18-year olds 10% and 8%, respectively. Few 12-year olds had used NRT. Over a quarter of 12-year-old girls and 15% of boys did not know what NRT products were. Awareness increased with age. Of 12- to 16-year-old NRT users, 79% were daily smokers, 10% had smoked >50 but not daily, 10% had smoked <50, and 2% were never-smokers. The underaged NRT users acquired the products mainly not only from friends (42%) but also from retail outlets (13%).

Conclusions: One year after deregulation, NRT use among minors is uncommon. Also misuse seems rare. NRT products are sold to minors from retail outlets despite sales ban. However, the underaged NRT users acquired the products mainly from friends.
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http://dx.doi.org/10.1093/ntr/ntq110DOI Listing
August 2010

The severity of acute Puumala hantavirus infection does not predict the long-term outcome of patients.

Nephron Clin Pract 2010 21;116(2):c89-94. Epub 2010 May 21.

Department of Internal Medicine, Central Hospital of Jyväskylä, Jyväskylä, Finland.

Background/aims: We have found greater urinary protein excretion and higher glomerular filtration rate (GFR) and blood pressure in patients 6 years after acute nephropathia epidemica (NE) compared with seronegative controls. The present aim was to establish whether the long-term outcome is determined by the severity of acute illness.

Methods: Serial plasma interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), creatinine, C-reactive protein, blood cell count as well as 24-hour urinary protein and overnight α(1)-microglobulin and albumin excretions were measured in 37 patients with acute NE. Human leucocyte antigen (HLA)-B, HLA-DRB1, TNF-α(-308) and IL-6(-174) alleles were also analyzed. After 6 years, GFR, blood pressure and urinary protein excretion were examined.

Results: There were no associations between the clinical severity of acute NE or the genetic factors determined and the increased GFR, hypertension or 24-hour urinary protein excretion observed 6 years later. The degree of inflammation during the acute phase was higher in patients who had increased urinary excretion of α(1)-microglobulin 6 years later compared with those with no α(1)-microglobulin excretion.

Conclusion: Neither the severity of acute NE nor the host genetic factors determined the predicted renal function, blood pressure or 24-hour urinary protein excretion 6 years later.
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http://dx.doi.org/10.1159/000314657DOI Listing
August 2011

Adolescent snus use in Finland in 1981-2003: trend, total sales ban and acquisition.

Tob Control 2006 Oct;15(5):392-7

School of Public Health, 33014 University of Tampere, Tampere, Finland.

Objective: To study changes in adolescent snus use from 1981 to 2003, the effects of the total snus sales ban (1995) and snus acquisition.

Design: Biennial postal surveys in 1981-2003.

Setting And Participants: Entire Finland; 12-, 14-, 16-, and 18-year-olds (n = 73,946; 3105-8390 per year).

Main Outcome Measures: Snus use (experimental, daily/occasionally), snus acquisition (2001, 2003).

Results: Snus experimentation grew in popularity before the total sales ban in 16- and 18-year-old boys and after the ban in all age and sex groups. A decrease was seen between 2001 and 2003, except for 18-year-old boys. Daily/occasional use mainly followed the same pattern in boys while in girls the daily/occasional use was rare and no significant changes were observed. In 2003, boys experimented with snus more often than girls (12-year-olds 1% v 0%, 14-year-olds 9% v 4%, 16-year-olds 30% v 12%, 18-year-olds 44% v 18%). Hardly any girls used snus daily/occasionally, but 1% of 14-year-old boys, 7% of 16-year-olds, and 9% of 18-year-olds did. Of daily/occasional users, 84% acquired snus from friends or acquaintances, 55% from tourist trips to neighbouring countries (Estonia, Sweden), and 7% through sport teams; 24% obtained it from under-the-counter sources. For experimenters, the corresponding figures were 79%, 18%, 0.3%, and 5%.

Conclusions: The total sales ban did not stop snus use; instead, the increase continued after the ban. Friends who travel to neighbouring countries act as go-betweens reselling snus. Snus is used even by the youngest adolescents, thus contributing to the nicotine dependence process.
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http://dx.doi.org/10.1136/tc.2005.015313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2563665PMC
October 2006

Factors predisposing to periprosthetic fracture after hip arthroplasty: a case (n = 31)-control study.

Acta Orthop Scand 2004 Feb;75(1):16-20

Medical School, University of Tampere, Tampere, Finland.

We compared retrospectively 31 patients with a periprosthetic fracture to 31 patients in a control group. The Finnish Arthroplasty Register was used to count all periprosthetic fractures treated by revision arthroplasty in Finland and in Tampere University Hospital district during the years 1990-1999. We used the date of the previous operation to find the control group patients operated on at the same time in the same hospital district. No other selection or matching criteria were used. The type of prosthesis, complications, age, BMI, cementation and primary diagnosis were compared. We found that patients who had a fracture as the primary diagnosis ran a 4.4 (95%CI = 1.4-14) times higher risk of periprosthetic fracture than those operated on for other reasons.
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http://dx.doi.org/10.1080/00016470410001708030DOI Listing
February 2004

Periprosthetic fractures in total hip arthroplasty: an epidemiologic study.

Int Orthop 2003 30;27(6):359-61. Epub 2003 Jul 30.

Medical School, University of Tampere, Tampere, Finland.

This study was based on data from the Finnish Arthroplasty Register. From 1990 to 1999, 33,154 primary hip arthroplasties were performed in Finland. Only periprosthetic fractures treated by a revision arthroplasty were registered. The six most used femoral components were compared using survival analysis and Cox's regression model. The incidence of periprosthetic fractures was calculated separately for the years 1990-1994 and 1995-1999. The incidence in the first period was greater than in the latter. Survival analysis and Cox's regression model showed that gender, prosthesis type and age were of no significance as risk factors for periprosthetic fractures.
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http://dx.doi.org/10.1007/s00264-003-0493-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461876PMC
May 2004