Publications by authors named "Pertti Aarnio"

34 Publications

Decreased forced expiratory volume in first second is associated with erectile dysfunction in apparently healthy men. A preliminary study.

Int J Impot Res 2020 Jul 5;32(4):420-425. Epub 2019 Sep 5.

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Although it has been evaluated that even 76% of men with chronic obstructive pulmonary disease suffer from erectile dysfunction, the association has been poorly characterised. The aim of the study was to describe the association between forced expiratory volume in first second and erectile dysfunction in apparently healthy men. All together 331 men aged 45-70 years old were randomly drawn from a cross-sectional population-based study conducted in 2005 in Finland. Decreased forced expiratory volume was defined by performing mini-spirometry and erectile dysfunction by International Index of Erectile Function short form questionnaire. After adjustment for age and depressive symptoms predicted forced expiratory volume (FEV < 65%) was associated with 2.66 (95% CI, 1.18-5.99) increased risk of moderate to severe erectile dysfunction (International Index of Erectile Function short form score < 17). Therefore, the authors highlight the importance of erectile and sexual health evaluation and treatment, if necessary, in men with decreased lung function.
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http://dx.doi.org/10.1038/s41443-019-0184-1DOI Listing
July 2020

Long-term persistence of withdrawal of temazepam, zopiclone, and zolpidem in older adults: a 3-year follow-up study.

BMC Geriatr 2018 06 15;18(1):142. Epub 2018 Jun 15.

Division of Pharmacology and Pharmacotherapy, Clinical Pharmacy Group, University of Helsinki, Helsinki, Finland.

Background: Studies on persistence of benzodiazepine agonist (BZDA) withdrawal in older outpatients are few, and few studies on long-term persistence over years have yet been published. To describe the persistence of temazepam, zolpidem, and zopiclone (BZDA) withdrawal among older outpatients at 3 years from the beginning of withdrawal, as well as any changes in use of other medications.

Methods: 92 outpatients (≥55 years) with primary insomnia, long-term BZDA use as hypnotics (mean duration of BZDA use 9.9 ± 6.2 years), and willingness to withdraw from BZDAs each received either melatonin or a placebo nightly for one month. During this period, BZDAs were meant to be gradually withdrawn. Sleep hygiene counselling and psychosocial support were provided. Three years later, use of BZDAs and other medications was determined by interview and confirmed from medical records.

Results: Of the original 92 outpatients, 83 (90%) participated in the 3-year survey (mean follow-up 3.3 ± 0.2 years). The number of BZDA-free participants decreased from 34 (37%) at 6 months to 26 (28%; intention-to-treat) at 3 years, that of irregular BZDA users decreased from 44 (48%) at 6 months to 27 (29%) at 3 years, while that of regular users increased from 11 (12%) at 6 months to 30 (33%) at 3 years (P = 0.001). Those who were regular BZDA users at 3 years had at baseline (before withdrawal) higher BMI (P = 0.001) than did other participants. At 3 years, the total number of medications remained unchanged for non-users (P = 0.432), but increased for the irregular (P = 0.011) and regular users (P = 0.026) compared to baseline. At 3 years, compared to baseline, use of antidepressants, dopamine agonists, melatonin, and NSAIDs/paracetamol was significantly more common in the whole cohort, but their use did not differ between the BZDA-user subgroups. Randomization to melatonin or placebo during BZDA withdrawal was unrelated to BZDA-withdrawal result.

Conclusions: At 3 years after withdrawal, the number of BZDA-free participants had decreased, but still one-third of the subjects remained BZDA-free, and one-third had reduced their use. Successful BZDA withdrawal did not lead to any increase in total number of medications; use of symptomatic medications in the whole cohort, however, did increase.
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http://dx.doi.org/10.1186/s12877-018-0829-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003076PMC
June 2018

Short stature in men is associated with subclinical peripheral arterial disease.

Vasa 2016 11 6;45(6):486-490. Epub 2016 Sep 6.

1 Department of General Practice, University of Turku, Turku, Finland.

Background: Peripheral arterial disease (PAD) affects approximately 202 million individuals around the world and is associated with a high risk of myocardial infarction, stroke and death. Although there is a clear inverse association between adult height and the risk of cardiovascular disease, little is known about the relationship between height and PAD. The aim of our study was to assess the relationship between subclinical PAD and height.

Patients And Methods: In a cross-sectional cardiovascular risk factor study in southwestern Finland, ankle brachial index (ABI) and other risk factors were measured from a total of 972 cardiovascular risk subjects derived from the general population. None of them had previously diagnosed diabetes, cardiovascular or renal disease or intermittent claudication. Subjects with an ABI ≤ 0.90 were categorized as having subclinical PAD.

Results: The average age of the study subjects was 58.1 ± 6.7 years for men and 58.8 ± 6.9 years for women. The prevalence of subclinical PAD was 5 % (95 % CI 3 % - 7 %) (23/455) among men and 5 % (95 % CI 3 %-7 %) (26/517) among women. The mean ABI among men and women was 1.09 ± 0.12 and 1.08 ± 0.12, respectively. In men, there was an inverse association between height and the prevalence of subclinical PAD (p < 0.001) along with a positive association between height and ABI values (p < 0.001). In a multivariate model, height, age and current smoking status remained independent factors that were associated with subclinical PAD in men, whereas in women, only pulse pressure was associated with subclinical PAD.

Conclusions: Short stature in men is associated with subclinical PAD and lower ABI values.
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http://dx.doi.org/10.1024/0301-1526/a000566DOI Listing
November 2016

Physical Activity Improves Borderline Ankle-Brachial Index Values in a Cardiovascular Risk Population.

Ann Vasc Surg 2016 Apr 22;32:50-6. Epub 2016 Jan 22.

Department of General Practice, University of Turku, Turku, Finland; Department of Primary Care, Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Background: Peripheral arterial disease (PAD) is an underdiagnosed and undertreated disease because it remains asymptomatic for so long. The ankle-brachial index (ABI) is a valid method for detecting PAD in lower extremities. ABI ≤0.90 indicates incident PAD. Recent studies have found that subjects with borderline ABI values (0.91-1.00) have increased mortality rates. The objective of our 7-year follow-up study was to investigate the progression of PAD in borderline ABI subjects, who underwent a multifactorial cardiovascular intervention.

Methods: A total of 193 subjects with borderline ABI were examined in 2005-2006. None of them had previously diagnosed diabetes, cardiovascular or renal disease or intermittent claudication. They were given conventional treatment for multiple risk factors of cardiovascular diseases (hypertension, hypercholesterolemia, elevated blood glucose, smoking, and overweight). Sixty-four percent of these subjects (n = 123) attended a follow-up visit in 2012.

Results: Of the 123 subjects with borderline ABI (mean age 59.0 ± 6.5 years, 62% female) at baseline, 18 (15%, 95% confidence intervals [CI]: 9%-22%) developed incident PAD during the follow-up. The mean ABI was 0.97 ± 0.03 at baseline and 1.01 ± 0.12 at 7-year follow-up visit. The change in mean ABI was +0.04 (95% CI: 0.03-0.07), P < 0.001. ABI improved significantly in 25 (20%) subjects. In multivariate ordered logistic regression analyses high and even moderate leisure-time physical activity (LTPA; odds ratio 6.15; 95% CI: 1.99-19.1) predicted a rise in ABI in comparison to low LTPA.

Conclusions: Physical activity seems to improve significantly ABI values among men and women with borderline ABI (0.91-1.00).
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http://dx.doi.org/10.1016/j.avsg.2015.11.004DOI Listing
April 2016

Vitamin D status and physical function in older Finnish people: A one-year follow-up study.

Arch Gerontol Geriatr 2015 Nov-Dec;61(3):419-24. Epub 2015 Aug 20.

Institute of Clinical Medicine, Family Medicine, University of Turku, Turku, Finland; Faculty of Pharmacy, Division of Social Pharmacy, University of Helsinki, Helsinki, Finland.

Objective: The aim was to describe vitamin D status and its association with changes in PF during 12 months in Finnish community-dwelling elderly (≥65 years).

Methods And Results: Baseline serum 25-hydroxyvitamin D (25OHD) concentration was measured by enzymeimmunoassay, and participants (n=518) were divided according to 25OHD to three groups (I <50 nmol/l, II 50-74.9 nmol/l, and III ≥75 nmol/l). PF (maximal isometric extension strength of right and left knee, and time in five-repetition sit-to-stand test (5STS) and 10-m walking test) was measured at baseline and after 12 months. 25OHD deficiency (<50 nmol/l) was found in 20.5% of the participants. During a 12-month follow-up, differences in changes in knee extensor strength of right (p=0.044) and left (p=0.010) lower extremity and in 10-m walking test (p=.040) between the groups were significant. According to further pairwise comparisons these differences were between groups I and III (right knee, p=0.036; left knee, p=0.009; 10-m walk, p=0.044), with the exception of left knee extensor strength in which there were also significant difference between groups I and II (p=0.039). All significant differences in changes were in favour of group II or III. Significant differences in changes in knee extensor strengths maintained after adjustments for group (intervention/control), parathyroid hormone, and baseline level of knee extensor strength.

Conclusions: Prospective analyses showed low 25OHD concentrations (<50 nmol/l) to be associated with deterioration in PF during 12 months compared with high 25OHD concentrations (≥75 nmol/l).
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http://dx.doi.org/10.1016/j.archger.2015.08.014DOI Listing
January 2016

Erectile dysfunction cannot be used in primary screening of pre-diabetes.

Diabetes Res Clin Pract 2015 Jun 3;108(3):e60-2. Epub 2015 Mar 3.

Department of Urology, Turku University Hospital, Turku, Finland.

We hypothesized that erectile dysfunction is associated with impaired fasting glucose and impaired glucose tolerance and could be used in primary screening of pre-diabetes. Although erectile dysfunction is known to be closely associated with diabetes, we demonstrate that it is not associated with pre-diabetes in 926 apparently healthy men.
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http://dx.doi.org/10.1016/j.diabres.2015.02.030DOI Listing
June 2015

High-intensity physical activity, stable relationship, and high education level associate with decreasing risk of erectile dysfunction in 1,000 apparently healthy cardiovascular risk subjects.

J Sex Med 2014 Sep 9;11(9):2277-84. Epub 2014 Jun 9.

Department of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland; Department of Surgery, Satakunta Central Hospital, Pori, Finland.

Introduction: Erectile dysfunction (ED) is especially common in men with cardiovascular diseases (CVDs). However, the data are scarce concerning populations without manifested CVD.

Aim: The aim of this study was to describe factors associated with ED, especially those associated with decreasing risk of ED, in men with cardiovascular risk factors but without CVD, diabetes, or chronic renal disease.

Methods: In 2004 to 2007, a cross-sectional population-based sample of men 45 to 70 years old in two rural towns in Finland was collected. Men with previously diagnosed CVD, diabetes, or kidney disease were not invited to the study. In total 1,000 eligible men with cardiovascular risk factors, i.e., central obesity, high scores in the Finnish Diabetes Risk Score, high blood pressure, antihypertensive medication, or family history of coronary heart disease, myocardial infarction, or stroke, were included in the analysis. Questionnaires, clinical measurements, and laboratory tests were obtained. The prevalence of ED was studied comparing the means, and risk factors were studied using multivariate logistic regression analysis.

Main Outcome Measures: The rate of ED was defined by the International Index of Erectile Function short form (IIEF-5) and by two questions (2Q) about the ability to achieve and to maintain an erection.

Results: The prevalence of ED was 57% or 68% using IIEF-5 or 2Q, respectively. Age (odds ratio [OR]: up to 9.16; 95% confidence interval [CI], 5.00-16.79; P < 0.001), smoking (OR: 1.41; 95% CI, 1.04-1.91; P = 0.028), depressive symptoms (OR: 4.04 for moderate and severe; 95% CI,1.22-13.45; P = 0.001), high-intensity physical activity (OR: 0.50; 95% CI, 0.29-0.86; P = 0.045), high education (OR: 0.52; 95% CI, 0.33-0.83; P = 0.013), and stable relationship (OR: 0.43; 95% CI, 0.21-0.88; P = 0.046) were associated with ED.

Conclusions: In apparently healthy men with cardiovascular risk factors, decreasing risk of ED is associated with high-intensity physical activity, stable relationship, and high education level.
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http://dx.doi.org/10.1111/jsm.12618DOI Listing
September 2014

Gene expression profiling of negative-pressure-treated skin graft donor site wounds.

Burns 2013 Jun 8;39(4):687-93. Epub 2012 Nov 8.

Institute of Biomedicine, Pharmacology, Biomedicum, University of Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland.

Negative-pressure wound therapy (NPWT) is widely used to improve skin wound healing. Although NPWT has been studied as a treatment for wound closure and healing, the molecular mechanisms explaining its therapeutic effects remain unclear. To investigate the effect of NPWT on gene expression, and to discover the genes most dominantly responding to this treatment during skin wound healing, we applied negative pressure on split-thickness skin graft donor sites from the first postoperative day (POD) to the seventh POD. Biopsies were collected from 4 NPWT-treated and 2 control patients. Two biopsy samples were taken from each patient: one from intact skin before graft harvesting, and one on the seventh POD from the donor site wound. Genome-wide microarrays were performed on all samples. Gene expression changes on the seventh POD were compared between NPWT and control patients, and were analyzed for statistical significance. In addition, we analyzed wound exudates for volume, and for concentrations of leukocytes, erythrocytes, and haemoglobin. NPWT induced major changes in gene expression during healing. These changes ranged from 10-fold induction to 27-fold suppression. The genes most induced were associated with cell proliferation and inflammation, and the most down-regulated genes were linked to epidermal differentiation. Our results provide the first insight into the molecular mechanisms behind NPWT, and suggest that NPWT enhances specific inflammatory gene expression at the acute phase associated with epithelial migration and wound healing. However, its continued use may inhibit epithelial differentiation.
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http://dx.doi.org/10.1016/j.burns.2012.09.014DOI Listing
June 2013

Human skin transcriptome during superficial cutaneous wound healing.

Wound Repair Regen 2012 Nov-Dec;20(6):830-9. Epub 2012 Oct 19.

Institute of Biomedicine, Pharmacology, Biomedicum, University of Helsinki, Helsinki, Finland.

Healing of the epidermis is a crucial process for maintaining the skin's defense integrity and its resistance to environmental threats. Compromised wound healing renders the individual readily vulnerable to infections and loss of body homeostasis. To clarify the human response of reepithelialization, we biopsied split-thickness skin graft donor site wounds immediately before and after harvesting, as well as during the healing process 3 and 7 days thereafter. In all, 25 biopsies from eight patients qualified for the study. All samples were analyzed by genome-wide microarrays. Here, we identified the genes associated with normal skin reepithelialization over time and organized them by similarities according to their induction or suppression patterns during wound healing. Our results provide the first elaborate insight into the transcriptome during normal human epidermal wound healing. The data not only reveal novel genes associated with epidermal wound healing but also provide a fundamental basis for the translational interpretation of data acquired from experimental models.
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http://dx.doi.org/10.1111/j.1524-475X.2012.00831.xDOI Listing
April 2013

Surrogates of Large Artery versus Small Artery Stiffness and Ankle-Brachial Index.

Int J Angiol 2011 Sep;20(3):167-72

Peripheral artery tonometry (PAT) is a novel method for assessing arterial stiffness of small digital arteries. Pulse pressure can be regarded as a surrogate of large artery stiffness. When ankle-brachial index (ABI) is calculated using the higher of the two ankle systolic pressures as denominator (ABI-higher), leg perfusion can be reliably estimated. However, using the lower of the ankle pressures to calculate ABI (ABI-lower) identifies more patients with isolated peripheral arterial disease (PAD) in ankle arteries. We aimed to compare the ability of PAT, pulse pressure, and different calculations of ABI to detect atherosclerotic disease in lower extremities. We examined PAT, pulse pressure, and ABI in 66 cardiovascular risk subjects in whom borderline PAD (ABI 0.91 to 1.00) was diagnosed 4 years earlier. Using ABI-lower to diagnose PAD yielded 2-fold higher prevalence of PAD than using ABI-higher. Endothelial dysfunction was diagnosed in 15/66 subjects (23%). In a bivariate correlation analysis, pulse pressure was negatively correlated with ABI-higher (r = -0.347, p = 0.004) and with ABI-lower (r = -0.424, p < 0.001). PAT hyperemic response was not significantly correlated with either ABI-higher (r = -0.148, p = 0.24) or with ABI-lower (r = -0.208, p = 0.095). Measurement of ABI using the lower of the two ankle pressures is an efficient method to identify patients with clinical or subclinical atherosclerosis and worth performing on subjects with pulse pressure above 65 mm Hg. The usefulness of PAT measurement in detecting PAD is vague.
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http://dx.doi.org/10.1055/s-0031-1284200DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3331653PMC
September 2011

Assessment of cardiovascular risk in primary health care.

Scand J Prim Health Care 2012 Jun;30(2):101-6

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland. [email protected] mnet.fi

Objective: This study aimed at investigating whether cardiovascular risk factors and their impact on total risk estimation differ between men and women.

Design: Cross-sectional cohort study.

Subjects: Finnish cardiovascular risk subjects (n = 904) without established cardiovascular disease, renal disease, or known diabetes.

Main Outcome Measures: Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), oral glucose tolerance test, and total cardiovascular risk using SCORE risk charts.

Results: According to the SCORE risk charts, 27.0% (95% CI 23.1-31.2) of the women and 63.1% (95% CI 58.3-67.7) of the men (p < 0.001) were classified as high-risk subjects. Of the women classified as low-risk subjects according to SCORE, 25% had either subclinical peripheral arterial disease or renal insufficiency.

Conclusions: The SCORE system does not take into account cardiovascular risk factors typical in women, and thus underestimates their total cardiovascular risk. Measurement of ABI and eGFR in primary care might improve cardiovascular risk assessment. especially in women.
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http://dx.doi.org/10.3109/02813432.2012.675564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377999PMC
June 2012

Estimating glomerular filtration rate in hypertensive subjects: comparison of the chronic kidney disease epidemiology collaboration (CKD-EPI) and modification of diet in renal disease (MDRD) study equations.

Ann Med 2012 Aug 12;44(5):487-93. Epub 2011 Dec 12.

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland. [email protected] mnet.fi

Background: The Modification of Diet in Renal Disease (MDRD) Study equation is the most commonly used formula for estimation of glomerular filtration rate (eGFR). Recently, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) developed a new equation to provide a more accurate estimate of GFR among individuals with normal or mildly reduced renal function.

Aim: To compare the MDRD and CKD-EPI equations in hypertensive population treated in general practice.

Methods: The MDRD and CKD-EPI equations were applied to a cohort of 994 hypertensive subjects aged 45-70 years without cardiovascular or renal disease or previously known diabetes.

Results: The prevalence of CKD stage 3 (eGFR 30-59 mL/min per 1.73 m(2)) was 6.7% (95% CI 5.3-8.5) (67/994) according to the MDRD formula and 3.7% (95% CI 2.6-5.1) (37/994) according to the CKD-EPI formula. Of the 67 subjects classified as having CKD stage 3 according to the MDRD equation, 30 (44.8%) were reclassified as 'no-CKD' by the CKD-EPI equation. These subjects were mostly women 26/30 (87.7%).

Conclusion: Using the CKD-EPI equation leads to lower prevalence estimates for CKD than the MDRD equation in a hypertensive population treated in general practice.
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http://dx.doi.org/10.3109/07853890.2011.580775DOI Listing
August 2012

Ankle-brachial index and health-related quality of life.

Eur J Prev Cardiol 2012 Oct 11;19(5):901-7. Epub 2011 Aug 11.

University of Turku, Turku, Finland.

Background: Data from population studies using ankle-brachial index (ABI) measurement to screen patients for peripheral arterial disease (PAD) demonstrate that most patients with PAD have no symptoms or atypical symptoms besides classical intermittent claudication. We aimed at comparing health-related quality of life and ABI in a cohort of cardiovascular risk persons in a general population.

Methods: SF-36 questionnaire was completed and ABI measured from 915 individuals aged 45-70 years with hypertension, metabolic syndrome, pre-diabetes, newly detected diabetes, body mass index ≥ 30 kg/m(2), or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had symptoms of intermittent claudication.

Results: The prevalence of PAD (defined as ABI ≤ 0.90) and borderline PAD (defined as ABI 0.91-1.00) were 5% (95% CI 4-7%) and 20% (95% CI 18-23%), respectively. Patients with PAD had significantly lower quality of life dimension scores for physical functioning, role-physical, general health, and vitality than subjects with normal ABI. Among those with borderline PAD, quality of life was reduced on the general health perception compared to subjects with normal ABI.

Conclusion: Health-related quality of life of individuals with asymptomatic or atypical PAD or borderline PAD is worse than that of individuals with normal ABI. The level of ABI is independently related to physical functioning.
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http://dx.doi.org/10.1177/1741826711420346DOI Listing
October 2012

Mortality and cause of death in hip fracture patients aged 65 or older: a population-based study.

BMC Musculoskelet Disord 2011 May 20;12:105. Epub 2011 May 20.

Department of Surgery, City Hospital of Pori, Pori, Finland.

Background: The high mortality of hip fracture patients is well documented, but sex- and cause-specific mortality after hip fracture has not been extensively studied. The purpose of the present study was to evaluate mortality and cause of death in patients after hip fracture surgery and to compare their mortality and cause of death to those in the general population.

Methods: Records of 428 consecutive hip fracture patients were collected on a population-basis and data on the general population comprising all Finns 65 years of age or older were collected on a cohort-basis. Cause of death was classified as follows: malignant neoplasms, dementia, circulatory disease, respiratory disease, digestive system disease, and other.

Results: Mean follow-up was 3.7 years (range 0-9 years). Overall 1-year postoperative mortality was 27.3% and mortality after hip fracture at the end of the follow-up was 79.0%. During the follow-up, age-adjusted mortality after hip fracture surgery was higher in men than in women with hazard ratio (HR) 1.55 and 95% confidence interval (95% CI) 1.21-2.00. Among hip surgery patients, the most common causes of death were circulatory diseases, followed by dementia and Alzheimer's disease. After hip fracture, men were more likely than women to die from respiratory disease, malignant neoplasm, and circulatory disease. During the follow-up, all-cause age- and sex-standardized mortality after hip fracture was 3-fold higher than that of the general population and included every cause-of-death category.

Conclusion: During the study period, the risk of mortality in hip fracture patients was 3-fold higher than that in the general population and included every major cause of death.
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http://dx.doi.org/10.1186/1471-2474-12-105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3118151PMC
May 2011

Endothelial function in a cardiovascular risk population with borderline ankle-brachial index.

Vasc Health Risk Manag 2011 23;7:97-101. Epub 2011 Feb 23.

Department of Surgery, Satakunta Hospital District, Pori, Finland

Introduction: The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle-brachial index (ABI). Traditionally ABI values > 1.00-1.40 have been considered normal and ABI ≤ 0.90 defines PAD. Recent studies, however, have shown that individuals with ABI values between 0.90-1.00 are also at risk of cardiovascular events. We studied this cardiovascular risk population subgroup in order to determine their endothelial function using peripheral arterial tonometry (PAT).

Methods: We selected 66 individuals with cardiovascular risk and borderline ABI. They all had hypertension, newly diagnosed glucose disorder, metabolic syndrome, obesity, or a ten year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System (SCORE). Subjects with previously diagnosed diabetes or cardiovascular disease were excluded. Endothelial function was assessed by measuring the reactive hyperemia index (RHI) from fingertips using an Endo-PAT device.

Results: The mean ABI was 0.95 and mean RHI 2.11. Endothelial dysfunction, defined as RHI < 1.67, was detected in 15/66 (23%) of the subjects. There were no statistically significant differences in RHI values between subjects with different cardiovascular risk factors. The only exception was that subjects with impaired fasting glucose (IFG) had slightly lower RHI values (mean RHI 1.91) than subjects without IFG (mean RHI 2.24) (P = 0.02).

Conclusions: In a cardiovascular risk population with borderline ABI nearly every fourth subject had endothelial dysfunction, indicating an elevated risk of cardiovascular events. This might point out a subgroup of individuals in need of more aggressive treatment for their risk factors.
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http://dx.doi.org/10.2147/VHRM.S17249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049545PMC
June 2011

The assessment of total cardiovascular risk in hypertensive subjects in primary care.

Ann Med 2010 Apr;42(3):187-95

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Background: Recently published guidelines emphasize that detection of any subclinical target organ damage in hypertensive subjects should be regarded as a sign of high cardiovascular risk.

Aim: To assess the ability of conventional multivariable cardiovascular disease risk prediction tools and high-sensitivity C-reactive protein (hs-CRP) to identify hypertensive subjects with target organ damage.

Methods: Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and base-line variables were measured in hypertensive subjects aged 45-70 years without established cardiovascular or renal disease or known diabetes.

Results: Of the 495 subjects, 123 (24.8% (95% CI 21.1-28.9)) had ABI <1.00, 81 (16.4% (95% CI 13.2-19.9)) had ECG-LVH, and 41 (8.3% (95% CI 6.0-11.1)) had eGFR <60 mL/min/1.73 m(2). In patients with SCORE <5% or Framingham risk <20%, any sign of target organ damage was found in 46% and 49% of patients, respectively.

Conclusion: Assessment of ECG-LVH, ABI, and eGFR reclassifies a significant number of hypertensive patients to the high-risk category as compared to SCORE and Framingham risk prediction tools only.
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http://dx.doi.org/10.3109/07853890903521088DOI Listing
April 2010

One-time counselling decreases the use of benzodiazepines and related drugs among community-dwelling older persons.

Age Ageing 2010 May 20;39(3):313-9. Epub 2010 Jan 20.

Department of Geriatrics, Satakunta Hospital District, Pori, Sairaalantie 3 FI 28500, Finland.

Background: evidence about possibilities to help older persons to withdraw the long-term use of benzodiazepines (BZD) is scarce. Effective and practicable methods are needed.

Objective: the study aimed to assess the persistence of one-time counselling by a geriatrician to reduce psychotropic drugs, especially BZD and related drugs (RD).

Design: a prospective randomised controlled trial with a 12-month follow-up was conducted.

Subjects: five hundred ninety-one community-dwelling people aged 65 or older participated in the study.

Methods: instructions to withdraw, reduce or change psychotropic drugs were given to the intervention group. A 1-h lecture about these drugs and their adverse effects was given later on. No changes in the drug therapy were suggested for the controls.

Results: the number of regular users of BZD and RD decreased by 35% (12/34) (odds ratios (OR) = 0.61, 95% confidence interval (95% CI) 0.44-0.86) in the intervention group while it increased by 4% (2/46) (OR = 1.05, 95% CI 0.81-1.36) in the controls (P = 0.012). No significant changes in the users of other types of psychotropics were found.

Conclusion: one-time counselling of psychotropics and other fall-risk-increasing drugs by a geriatrician followed with a 1-h lecture about adverse effects of these drugs had positive effects in decreasing the number of regular users of BZD and RD, and these effects persisted for the total 12-month intervention period.
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http://dx.doi.org/10.1093/ageing/afp255DOI Listing
May 2010

Effects of potent anticholinergics, sedatives and antipsychotics on postoperative mortality in elderly patients with hip fracture: a retrospective, population-based study.

Drugs Aging 2009 ;26(11):963-71

Department of Surgery, Pori City Hospital, Pori, Finland.

Background: Concomitant use of several medications for somatic and mental disorders is common in elderly people and increases the risk of falls, with hip fracture being the most serious consequence.

Objective: The objective of this study was to describe relationships between use of sedatives, antipsychotics or potent anticholinergics and postoperative mortality in patients with hip fractures.

Methods: A retrospective analysis was conducted on population-based data collected during a 2-year period from 1999 to 2000 on 461 hip fracture surgery patients aged > or = 65 years in Finland. Information on co-morbidities and intake of sedatives, antipsychotics and potent anticholinergics was obtained from the original patient records. Information on deaths was obtained from the official death statistics in Finland.

Results: In men, use of potent anticholinergics was associated with excess age-adjusted mortality at 30 days, 3 months, 6 months and 3 years, but not in women at any timepoint.

Conclusion: Use of potent anticholinergic drugs emerged as an independent predictor of excess mortality in men at 3 months and 3 years. Presence of cardiovascular disease and chronic lung disease were independent risk factors for excess mortality at 6 months and 3 years in men. In addition, chronic lung disease independently predicted excess mortality at 30 days. Use of potent anticholinergics should be evaluated critically after hip fracture surgery, especially in men with cardiovascular or chronic lung diseases.
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http://dx.doi.org/10.2165/11317660-000000000-00000DOI Listing
January 2010

Ankle-brachial index is lower in hypertensive than in normotensive individuals in a cardiovascular risk population.

J Hypertens 2009 Oct;27(10):2036-43

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Background: Hypertension is an established risk factor for peripheral arterial disease (PAD), but the prevalence of this condition in hypertensive patients without comorbidities is unknown.

Methods: In this study, we assess the prevalence and factors associated with PAD, and the usefulness of ankle-brachial index (ABI) in evaluating cardiovascular risk in hypertensive patients without cardiovascular or renal disease or previously known diabetes mellitus. We measured ABI in 972 nonclaudicant patients with hypertension, newly diagnosed glucose disorders, metabolic syndrome, obesity or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System.

Results: The prevalence of PAD (defined as ABI < or =0.90) and borderline PAD (defined as ABI 0.91-1.00) in hypertensive patients was 7.3% (39/532) and 23.7% (126/532), respectively. In a multivariate model, hypertension remained an independent factor associated with PAD (adjusted odds ratio 3.20; 95% confidence interval 1.56-6.58). There was no association between PAD and metabolic risk factors. SBP and pulse pressure increased linearly across subgroups of ABI (normal 0.91-1.00 and < or =0.90) in hypertensive patients (P < 0.001).

Conclusion: Subclinical PAD is common in hypertensive patients even without comorbidities. The measurement of ABI is an efficient method to identify patients with increased cardiovascular risk and worth performing to hypertensive patients, particularly those with pulse pressure above 65 mmHg. Uniform criterions of defining PAD and borderline PAD would aid physicians in clinical decision-making.
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http://dx.doi.org/10.1097/HJH.0b013e32832f4f54DOI Listing
October 2009

Effect of a risk-based multifactorial fall prevention program on the incidence of falls.

J Am Geriatr Soc 2009 Apr;57(4):612-9

Department of Family Medicine, Institute of Clinical Medicine, University of Turku, Turku, Finland.

Objectives: To evaluate the effects of a multifactorial fall prevention program on falls and to identify the subgroups that benefit the most.

Design: Randomized controlled trial.

Setting: Community-dwelling subjects who had fallen at least once during the previous 12 months.

Participants: Five hundred ninety-one subjects randomized into intervention (IG) (n=293) and control (CG) (n=298) groups.

Intervention: A multifactorial 12-month fall prevention program.

Measurements: Incidence of falls.

Results: The intervention did not reduce the incidence of falls overall (incidence rate ratio (IRR) for IG vs CG=0.92, 95% confidence interval (CI)=0.72-1.19). In subgroup analyses, significant interactions between subgroups and groups (IG and CG) were found for depressive symptoms (P=.006), number of falls during the previous 12 months (P=.003), and self-perceived risk of falling (P=.045). The incidence of falls decreased in subjects with a higher number of depressive symptoms (IRR=0.50, 95% CI=0.28-0.88), whereas it increased in those with a lower number of depressive symptoms (IRR=1.20, 95% CI=0.92-1.57). The incidence of falls decreased also in those with at least three previous falls (IRR=0.59, 95% CI=0.38-0.91) compared to those with one or two previous falls (IRR=1.28, 95% CI=0.95-1.72). The intervention was also more effective in subjects with high self-perceived risk of falling (IRR=0.77, 95% CI=0.55-1.06) than in those with low self-perceived risk (IRR=1.28, 95% CI=0.88-1.86).

Conclusion: The program was not effective in reducing falls in the total sample of community-dwelling subjects with a history of falling, but the incidence of falls decreased in participants with a higher number of depressive symptoms and in those with at least three falls.
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http://dx.doi.org/10.1111/j.1532-5415.2009.02176.xDOI Listing
April 2009

Effects of risk-based multifactorial fall prevention program on maximal isometric muscle strength in community-dwelling aged: a randomized controlled trial.

Aging Clin Exp Res 2008 Oct;20(5):487-93

Institute of Clinical Medicine, Family Medicine, University of Turku, Turku, FI-20014, Finland.

Background And Aims: The aim of this study was to assess the effects of risk-based multifactorial fall prevention program on maximal isometric strength in the community-dwelling aged.

Methods: 591 subjects were randomized in two age groups (65-74 and > or = 75 yrs), intervention group (IG) (n=293) and control group (CG) (n=298). A 12-month program consisted of individual geriatric assessment, individual guidance on fall prevention, home hazards assessment, physical exercises in groups, lectures, psychosocial activity groups, and home exercises. Strength was measured on an adjustable dynamometer chair.

Results: Among women, the extension strength of the left knee increased by 7% in IG and 2% in CG (p=0.006), and that of the right knee by 7% and 4% (p=0.057), respectively. Subgroup analyses in the two age groups revealed a significant difference between groups among men aged 65-74 yrs, in favour of CG subjects, whose flexion strength of the left knee increased by 14% whereas the corresponding increase in IG was only 1% (p=0.042). Among women aged 65-74 yrs, the extension strength of right (increase of 8% in IG, 4% in CG) (p=0.046) and left knees (9% and 3%) (p=0.008) and flexion strength of right (10% and 4%) (p=0.042) and left knees (10% and 4%) (p=0.041) increased more in IG than in CG.

Conclusions: The 12-month fall prevention program increased maximal isometric muscle strength among women only, especially those aged 65-74 years. We suggest that more intensive exercise, including the use of extra weights or resistance, is needed to increase muscle strength in men.
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http://dx.doi.org/10.1007/BF03325156DOI Listing
October 2008

Waist circumference home measurement--a device to find out patients in cardiovascular risk.

Eur J Public Health 2009 Jan 16;19(1):95-9. Epub 2008 Oct 16.

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Background: New strategies are needed to prevent the global epidemic of diabetes and subsequent rise in cardiovascular diseases. We describe a community-based, two-stage screening strategy using home waist circumference measurement and a risk factor questionnaire as a primary screening tool.

Methods: We mailed a tape for measurement of waist and a risk factor questionnaire to every inhabitant aged 45-70 years living in the rural town of Harjavalta in Finland. Thereafter we performed an oral glucose tolerance test, anthropometric variables and blood pressure of subjects having at least one risk factor for type 2 diabetes or cardiovascular disease. People with previously known diabetes or vascular disease were excluded.

Results: Seventy-three percent (2085/2856) of the invited inhabitants participated, and 84% of the respondents had at least one pre-specified risk factor. Waist circumference >or=80 cm in women and >or=94 cm in men (n = 1168), positive metabolic syndrome criteria of the International Diabetes Federation (n = 681) or the Finnish Diabetes Risk Score questionnaire >or=12 points (n = 697) identified 95, 92 and 63% of the new cases of type 2 diabetes and 84, 75 or 62% of pre-diabetes, respectively.

Conclusion: The International Diabetes Federation criteria for elevated waist circumference are very sensitive but lack specificity in diagnosing glucose disorders. The criteria for metabolic syndrome and the Finnish Diabetes Risk Score questionnaire are more efficient tools for the selection of patients for further risk stratification in general practise.
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http://dx.doi.org/10.1093/eurpub/ckn090DOI Listing
January 2009

Predictors of fractures among the aged: a population-based study with 12-year follow-up in a Finnish municipality.

Aging Clin Exp Res 2008 Jun;20(3):242-52

Department of Family Medicine, University of Turku, 20014 Turku, Finland.

Background And Aims: The incidence of fractures is high in older populations. More information is needed about long-term predictors of fractures, for preventive measures. The aim of this study was to analyze gender-specific predictors of fractures among persons aged 65 years or older during a 12- year follow-up.

Methods: A true cohort study in the municipality of Lieto, southwestern Finland, started in October 1990. Baseline data and information about fractures in 1177 subjects (482 men, 695 women), mean age 73 years (range 65-97), were obtained individually from health care registers during 1991-2002. The mean follow-up period was 8.5 years. Subjects having sustained at least one fracture (n=295) were compared with subjects with no fractures during the follow-up. Predictors of fractures were analyzed using a Poisson regression model, separately by gender.

Results: In multivariate Poisson regression analyses, the following predictors of fractures during the 12-year follow-up were identified: reduced handgrip strength (RR 1.6, 95% CI 1.1-2.3 in middle quartiles, RR 2.2, 95% CI 1.4-3.5 in lowest quartile) and body mass index (BMI) 25-29.9 (RR 1.9, 95% CI 1.3-2.7) or BMI <25 (RR 2.0, 95% CI 1.4-2.9) compared with BMI 30 or over among women, and a large number of depressive symptoms (RR 2.1, 95% CI 1.2-3.6) among men. A compression fracture in one or more thoracic or upper lumbar vertebrae on chest radiography at baseline was associated with fractures in both women (RR 2.0, 95% CI 1.3- 3.0) and men (RR 3.5, 95% CI 1.9-6.7).

Conclusions: The predictors of fractures among aged persons varied by gender, and were associated with both risk factors of falling and bone fragility.
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http://dx.doi.org/10.1007/BF03324780DOI Listing
June 2008

Glucose homeostasis in hypertensive subjects.

Hypertension 2008 Apr 19;51(4):945-9. Epub 2008 Feb 19.

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

The objective of this study was to estimate the prevalence of undiagnosed impaired glucose homeostasis in hypertensive subjects in the general population. The most reasonable screening strategy for glucose disorders was also assessed. We carried out an oral glucose tolerance test for 1106 hypertensive subjects aged 45 to 70 years without previously diagnosed diabetes or cardiovascular disease. Blood pressure, waist circumference, body mass index, and plasma lipids were also measured. Type 2 diabetes was found in 66 (6%) of the subjects, impaired glucose tolerance in 220 (20%), and impaired fasting glucose in 167 (15%). If we had carried out an oral glucose tolerance test only for those hypertensive subjects with fasting plasma glucose >or=5.6 mmol/L, we would have missed approximately 40% of the patients with impaired glucose tolerance. The International Diabetes Federation criteria of metabolic syndrome identified 96% of all the cases of type 2 diabetes and 88% of all the cases of impaired glucose tolerance. The prevalence of central obesity was alarming: 90% of the women and 82% of the men had a waist circumference >or=80 cm or >or=94 cm, respectively. Impaired glucose homeostasis and central obesity are common in hypertensive subjects. An oral glucose tolerance test is reasonable to carry out at least for the hypertensive subjects with metabolic syndrome. Weight stabilization is an important goal to treat hypertensive patients.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.104869DOI Listing
April 2008

Borderline peripheral arterial disease.

Int J Angiol 2008 ;17(4):175-7

Central Satakunta Health Federation of Municipalities, Harjavalta, Finland.

Peripheral arterial disease (PAD), along with coronary artery disease and cerebrovascular disease, is a manifestation of systemic atherosclerosis. These cardiovascular diseases (CVDs) are the leading cause of death in the world, representing 30% of all global deaths. Although population-based studies indicate that PAD has a relatively benign course in the legs, patients with PAD show more cardiovascular comorbidity and have at least twofold risk of fatal coronary artery disease and cerebrovascular accidents compared with the general population. These studies suggest that noninvasive testing using the ankle-brachial index (ABI) is also an accurate marker of subclinical CVD and thus may hold promise for early identification of individuals at the greatest risk for major CVD events.The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) defines a cutoff ABI value of 0.90 or less for diagnosing PAD at rest. This threshold value has been reported to be 95% sensitive in detecting angiogram-positive PAD and almost 100% specific in identifying apparently healthy individuals. In persons without PAD, arterial pressures increase with greater distance from the heart, resulting in higher systolic blood pressures at the ankle than at the the brachial arteries. Thus, persons without atherosclerosis typically have an ABI greater than 1.00. But what is the significance of ABI values between 0.91 to 1.00, which are conventionally regarded as 'no disease'? The present article gives an overview of current knowledge of borderline PAD (ie, an ABI of 0.91 to 1.00).
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http://dx.doi.org/10.1055/s-0031-1278304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2728920PMC
April 2012

Single-center experience with foam sclerotherapy without ultrasound guidance for treatment of varicose veins.

Dermatol Surg 2007 Nov;33(11):1334-9; discussion 1339

Department of Surgery, Satakunta Central Hospital, Pori; and Department of Vascular Surgery, Tampere University Hospital, Tampere, Finland.

Background: Varicose veins are a common disorder and many treatment methods are available.

Objective: The aim of this study was to evaluate the short-term efficacy of foam sclerotherapy and the safety of performing the treatment in an outpatient clinic without ultrasound guidance. METHODS This was a prospective, nonrandomized study with foam sclerotherapy. All the patients were assessed before and after the procedure with a CEAP (Clinical, Etiology, Anatomy, Pathology) class and clinical score. At the same visit, duplex scanning was performed to evaluate the anatomic distribution of the varicose disease. The mean age of the patients was 49.2 years (SD,+/-10.6 years; median, 50.0 years). Altogether 41% of the legs had undergone a previous operation and 24% were recurrences. The follow-up time was 3 months.

Results: Twenty-five patients with 27 legs were treated successfully using foam sclerotherapy without ultrasound guidance. Twenty-one cases (78%) involved the great saphenous vein and 6 cases (22%) involved the small saphenous vein. The mean bandage time was 7.7 days (SD,+/-2.50 days; median, 8.50 days). The CEAP score decreased 73% after the procedure from 2.61 (SD,+/-0.80; median, 2.0) to 0.71 (SD,+/-0.95; median, 0; p<.001). and the mean clinical score decreased 45% from 4.45 (SD,+/-1.96; median, 4.0) to 2.46 (SD,+/-1.50; median, 2.0; p<.001), respectively. Three months after the treatment, duplex scanning showed saphenofemoral reflux in 63% of the legs and saphenopopliteal reflux in 40% of the legs. The most common complication was postoperative thrombophlebitis (66%). Other minor complications included pain (38%) and hematoma (4%). There were no major complications. Subjectively, 71% of the patients assessed the procedure as good or excellent and 29% as acceptable or poor.

Conclusion: Foam sclerotherapy is also an effective and safe procedure when performed without duplex guidance. Thrombophlebitis is frequent when using a high concentration of polidocanol and a short bandage time. The high frequency of saphenofemoral and saphenopopliteal junction reflux after the procedure can have a negative effect on the long-term results.
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http://dx.doi.org/10.1111/j.1524-4725.2007.33285.xDOI Listing
November 2007

Effects of risk-based multifactorial fall prevention on postural balance in the community-dwelling aged: a randomized controlled trial.

Arch Gerontol Geriatr 2009 Jan-Feb;48(1):22-7. Epub 2007 Oct 24.

Institute of Clinical Medicine, Department of Family Medicine, Lemminkäisenkatu 1, University of Turku, FI-20014 Turku, Finland.

The purpose of the study was to assess the effects of 12-month risk-based multifactorial fall prevention program on postural control of the aged. Five hundred and ninety-one (97%) eligible subjects were randomized into an intervention group (IG) (n=293) and a control group (CG) (n=298). The effects of the program were measured on standing, dynamic, and functional balance. In standing balance, the velocity moment of semi-tandem standing decreased in IG (median change -0.54 mm(2)/s) but increased in CG (+3.84 mm(2)/s) among all women (p=0.011) and among the women aged 65-74 years (-1.65 mm(2)/s and +2.80 mm(2)/s, correspondingly) (p=0.008). In a dynamic test, performance distance tended to decrease in IG (-26.54 mm) and increase in CG (+34.10mm) among all women (p=0.060). The women aged 75 years or over, showed marginally significant differences between the groups as regards changes in performance time (-2.66 s and -0.90 s) (p=0.068) and distance (-92.32 mm and +76.46 mm) (p=0.062) of the dynamic balance test in favor of IG. Men showed no significant differences in the changes between the groups in any balance measures.
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http://dx.doi.org/10.1016/j.archger.2007.09.006DOI Listing
April 2009

Incidence of fractures and changes over time among the aged in a Finnish municipality: a population-based 12-year follow-up.

Aging Clin Exp Res 2007 Aug;19(4):269-76

Department of Family Medicine, University of Turku, FI-20014 Turku, Finland.

Background And Aims: The incidence of fractures is high in older populations. The aim of this study was to describe the incidence of different fractures and to analyse the changes in age-adjusted yearly incidences among older persons.

Methods: A prospective true cohort design. Information about fractures in 482 men and 695 women aged 65 or over living in the municipality of Lieto, south-western Finland, was collected from 1991 until 2002. Poisson's regression model was used to analyse changes in yearly incidences.

Results: During 10,040 person years (PY) of follow-up, 307 (26%) persons sustained 425 fractures. The total incidence rate of fractures was 53.4 per 1000 PY (95% confidence intervals: 47.9-59.5) in women, and 24.9 per 1000 PY (20.4-30.4) in men. The age-specific incidence of fractures increased with age in both genders. Rates of hip and wrist fractures tended to be higher in women. 7.2% subjects sustained two or more fractures during follow- up. The majority of fractures resulted from a fall, and only 3.5% were caused by extremely serious accidents. No significant changes in the age-adjusted incidences of all fractures were found in either gender during follow-up.

Conclusion: Fractures are common in the aged population, and the incidence of most types of fracture is associated with increasing age. Only a minority of fractures are caused by extremely serious accidents. No significant changes in the age-adjusted yearly incidences of fractures were observed in this aged cohort during a 12-year follow-up.
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http://dx.doi.org/10.1007/BF03324701DOI Listing
August 2007

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial.

Health Qual Life Outcomes 2007 Apr 26;5:20. Epub 2007 Apr 26.

Institute of Clinical Medicine, Family Medicine, University of Turku, Turku, Finland.

Background: This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months.

Methods: The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression.

Results: In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group.

Conclusion: Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women.
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http://dx.doi.org/10.1186/1477-7525-5-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868017PMC
April 2007

Experiences of using the EndoAssist-robot in surgery.

Stud Health Technol Inform 2007 ;125:161-3

Tampere University of Technology, Pori, Finland.

EndoAssist is a robotic camera-holding device controlled by the operator's head movements. Operations on forty-nine patients undergoing laparoscopic surgery were made using the robotic assistant. The aim of our project was to find out how using an EndoAssist-robot influences the operating times in contrast to using human assistant. A further aim was to collect the surgeons' experiences of using the robot. In this paper we describe the results of our project.
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May 2007
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