Publications by authors named "Tero Vahlberg"

299 Publications

A practical laboratory index to predict institutionalization and mortality - an 18-year population-based follow-up study.

BMC Geriatr 2021 Feb 25;21(1):139. Epub 2021 Feb 25.

Department of Clinical Medicine, Faculty of Medicine, Unit of Clinical Chemistry, Turku University, 20521, Turku, Finland.

Background: Previously, several indexes based on a large number of clinical and laboratory tests to predict mortality and frailty have been produced. However, there is still a need for an easily applicable screening tool for every-day clinical practice.

Methods: A prospective study with 10- and 18-year follow-ups. Fourteen common laboratory tests were combined to an index. Cox regression model was used to analyse the association of the laboratory index with institutionalization and mortality.

Results: The mean age of the participants (n = 1153) was 73.6 (SD 6.8, range 64.0-100.0) years. Altogether, 151 (14.8%) and 305 (29.9%) subjects were institutionalized and 422 (36.6%) and 806 (69.9%) subjects deceased during the 10- and 18-year follow-ups, respectively. Higher LI (laboratory index) scores predicted increased mortality. Mortality rates increased as LI scores increased both in unadjusted and in age- and gender-adjusted models during both follow-ups. The LI did not significantly predict institutionalization either during the 10- or 18-year follow-ups.

Conclusions: A practical index based on routine laboratory tests can be used to predict mortality among older people. An LI could be automatically counted from routine laboratory results and thus an easily applicable screening instrument in clinical settings.
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http://dx.doi.org/10.1186/s12877-021-02077-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905906PMC
February 2021

Monthly variation in univentricular heart and transposition of the great arteries - 10-year national population-based cohort study.

Eur J Obstet Gynecol Reprod Biol 2021 Mar 29;258:418-423. Epub 2021 Jan 29.

Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objective: Monthly variation in the total prevalence of the univentricular heart (UVH) and dextro-transposition of the great arteries (d-TGA) at gestational age 7 + 0 weeks was assessed to determine potential environmental factors, such as viral or bacterial infections, underlying the variation.

Study Design: The nationwide retrospective ten-year population-based cohort consisted of 592 733 births and 2764 terminated pregnancies due to fetal anomaly. The pre- or postnatally diagnosed cases of UVH (n = 440) and simple d-TGA (n = 127) from five national registers included live births, stillbirths, and pregnancy terminations due to fetal anomaly. We evaluated the variation in the monthly total prevalence of UVH and d-TGA at gestational age 7 + 0 weeks. The monthly variation of UVH and d-TGA was also compared with monthly variation in reported viral and bacterial infections.

Results: In the UVH and d-TGA, we observed significant monthly variation in total prevalence. However, we observed no correlations in the studied viral or bacterial infections and the number of cases.

Conclusions: Assessing monthly variation in total prevalence at early pregnancy, including pregnancy terminations and stillbirths, and using first-trimester timing provides the most accurate information on the variation. The reasons for monthly variation remain unclear, but we observed no associations with specific viral or bacterial infections.
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http://dx.doi.org/10.1016/j.ejogrb.2021.01.040DOI Listing
March 2021

Foundations of Human Consciousness: Imaging the Twilight Zone.

J Neurosci 2021 Feb 28;41(8):1769-1778. Epub 2020 Dec 28.

Turku PET Centre, University of Turku and Turku University Hospital, FI-20521 Turku, Finland

What happens in the brain when conscious awareness of the surrounding world fades? We manipulated consciousness in two experiments in a group of healthy males and measured brain activity with positron emission tomography. Measurements were made during wakefulness, escalating and constant levels of two anesthetic agents (experiment 1, = 39), and during sleep-deprived wakefulness and non-rapid eye movement sleep (experiment 2, = 37). In experiment 1, the subjects were randomized to receive either propofol or dexmedetomidine until unresponsiveness. In both experiments, forced awakenings were applied to achieve rapid recovery from an unresponsive to a responsive state, followed by immediate and detailed interviews of subjective experiences during the preceding unresponsive condition. Unresponsiveness rarely denoted unconsciousness, as the majority of the subjects had internally generated experiences. Unresponsive anesthetic states and verified sleep stages, where a subsequent report of mental content included no signs of awareness of the surrounding world, indicated a disconnected state. Functional brain imaging comparing responsive and connected versus unresponsive and disconnected states of consciousness during constant anesthetic exposure revealed that activity of the thalamus, cingulate cortices, and angular gyri are fundamental for human consciousness. These brain structures were affected independent from the pharmacologic agent, drug concentration, and direction of change in the state of consciousness. Analogous findings were obtained when consciousness was regulated by physiological sleep. State-specific findings were distinct and separable from the overall effects of the interventions, which included widespread depression of brain activity across cortical areas. These findings identify a central core brain network critical for human consciousness. Trying to understand the biological basis of human consciousness is currently one of the greatest challenges of neuroscience. While the loss and return of consciousness regulated by anesthetic drugs and physiological sleep are used as model systems in experimental studies on consciousness, previous research results have been confounded by drug effects, by confusing behavioral "unresponsiveness" and internally generated consciousness, and by comparing brain activity levels across states that differ in several other respects than only consciousness. Here, we present carefully designed studies that overcome many previous confounders and for the first time reveal the neural mechanisms underlying human consciousness and its disconnection from behavioral responsiveness, both during anesthesia and during normal sleep, and in the same study subjects.
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http://dx.doi.org/10.1523/JNEUROSCI.0775-20.2020DOI Listing
February 2021

The Effects of School-based Mindfulness Intervention on Executive Functioning in a Cluster Randomized Controlled Trial.

Dev Neuropsychol 2020 12 11;45(7-8):469-484. Epub 2020 Dec 11.

Public Health Research Programme, Folkhälsan Research Center , Helsinki, Finland.

Executive functions (EFs) are essential for student's learning and classroom functioning. The current cluster randomized controlled trial examines the effects of mindfulness intervention vs. active control program (i.e., relaxation) focusing on the main EFs (i.e., working memory, response inhibition, cognitive processing, cognitive flexibility and verbal fluency). A total of 131 students from 6th grade and 8th grade (median age 12 and 15) from four comprehensive schools participated. The schools were to equal shares randomized to intervention and active control groups, i.e., groups who underwent a 9-week mindfulness practice or relaxation program, respectively. Participants completed a cognitive test-package at baseline/pre-intervention, post-intervention at 9 weeks and follow-up at 6 months. Both intervention and active relaxation-based control groups improved on a majority of EF measures at both 9 weeks and 6 months. There was no significant difference between the mindfulness intervention group and the active control program in EFs. The current study suggests that mindfulness intervention and active control program do not differ in their effects to EFs, although both may have positive outcomes. Further research with both active and inactive control groups is needed to map the potential benefits of similar programs for cognitive functioning.
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http://dx.doi.org/10.1080/87565641.2020.1856109DOI Listing
December 2020

Consistent practice for pressure ulcer prevention in long-term older people care: A quasi-experimental intervention study.

Scand J Caring Sci 2020 Nov 8. Epub 2020 Nov 8.

Department of Nursing Science, University of Turku, Turku, Finland.

Background: Consistent practice, an agreed clinical practice based on evidence, has been considered as a base for effective provision of quality and safety of care. As a result, patients have an equal quality of care regardless of the organisation or worker. However, despite the international guidelines, pressure ulcer prevention practices vary in long-term older people care.

Aim: To develop, implement and evaluate the impact of renewed, consistent practice for pressure ulcer prevention, in long-term older people care.

Design: A quasi-experimental intervention study.

Methods: Two long-term older people care facilities chosen with convenience sampling were randomly allocated to intervention or comparison group. Registered and practical nurses, in total 141/112, participated in the study. The renewed consistent practice based on international guidelines for pressure ulcer prevention was developed and implemented using the Operational Model for Evidence-Based Practices (OMEBP). Frequencies and agreement of PU prevention practices in line with international guidelines in the care facilities were measured using the PUPreP instrument.

Results: In the intervention facility, improvement in line with international guidelines was seen in the frequency of PU prevention practices in risk assessment, nutrition, pressure-relieving devices and documentation. Furthermore, improvement was seen in the intervention facility in all six areas of agreement on practices.

Conclusions: The results of this study support the implementation of PU prevention guidelines in long-term older people care (LOPC) and more widely in healthcare settings for older people to promote consistent practice, and safety and equal quality of care.
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http://dx.doi.org/10.1111/scs.12917DOI Listing
November 2020

Knowledge of patient observation among critical care nurses.

Nurs Crit Care 2020 Nov 4. Epub 2020 Nov 4.

The Department of Nursing Science, University of Turku, Turku, Finland.

Background: The clinical observations made by critical care nurses are vital for maintaining patient safety and making appropriate decisions in the care of patients who are critically ill. Evaluating the reliability of observations and applying analytical thinking are essential elements of patient observation. Previous studies of critical care nurses' knowledge have focused either on specific aspects of patient observation or on critical care nursing in general; therefore, the findings are not comprehensive.

Aim: The aim of this study was to evaluate critical care nurses' level of knowledge in patient observation and to explore the factors that are associated with it.

Study Design: A cross-sectional knowledge test survey with critical care nurses in Finland was used.

Methods: Data were collected in seven adult intensive care units in all five university hospitals in Finland between September 2017 and January 2018 by using a knowledge test (20 items) developed for this study. All critical care nurses were eligible to participate. The data were analysed using descriptive and inferential statistics.

Results: Altogether, 372 nurses responded (response rate 49%). Their average scores in the knowledge test were 77% (mean 15.29/20, SD 2.41) for correct answers, 75% (mean 8.2/11, SD 1.54) in the sum-variable "Evaluating the reliability of observation" and 79% (mean 7.08, SD 1.45) for "Analytical thinking." A higher knowledge level was associated with education in special tasks in an intensive care unit.

Conclusion: The critical care nurses' knowledge level was considered to be suboptimal. There is a need for improving knowledge of patient observation among Finnish critical care nurses to ensure safe and good quality care.

Relevance To Clinical Practice: Finnish critical care nurses' knowledge of patient observation could be improved by providing specific continuing education for new nurses entering intensive care units and for experienced critical care nurses throughout their career.
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http://dx.doi.org/10.1111/nicc.12573DOI Listing
November 2020

Weight gain and body composition during pregnancy: a randomised pilot trial with probiotics and/or fish oil.

Br J Nutr 2020 Nov 4:1-11. Epub 2020 Nov 4.

Institute of Biomedicine, Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.

We evaluated the effects of fish oil and/or probiotic supplementation in a randomised placebo-controlled intervention pilot trial on gestational weight gain (GWG) and body composition. Additionally, the influence of gestational diabetes (GDM) on GWG and body composition was assessed. We randomised 439 overweight women into intervention groups: fish oil + placebo, probiotics + placebo, fish oil + probiotics and placebo + placebo (fish oil: 1·9 g DHA and 0·22 g EPA and probiotics: Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). GDM was diagnosed with oral glucose tolerance test. Body composition was measured with air displacement plethysmography at randomisation (mean 13·9) and in late pregnancy (mean 35·2 gestational weeks). Intervention did not influence mean GWG or change in body fat mass/percentage (P > 0·17). Body composition in early pregnancy did not differ between the women who did or did not develop GDM (adjusted P > 0·23). Compared with the normoglycaemic women (n 278), women diagnosed with GDM (n 119) gained less weight (7·7 (sd 0·4) v. 9·3 (sd 0·4) kg, adjusted mean difference -1·66 (95 % CI -2·52, -0·80) and fat mass (0·4 (sd 0·4) v. 1·8 (sd 0·3) kg, adjusted mean difference -1·43 (95 % CI -2·19, -0·67) during the follow-up. In conclusion, adiposity of pregnant overweight women was not affected by supplementation with fish oil and/or probiotics, nor did it predict the development of GDM. However, adiposity was reduced in women with GDM compared with normoglycaemic women irrespective of the dietary intervention.
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http://dx.doi.org/10.1017/S0007114520004407DOI Listing
November 2020

Relationship of Edoxaban Plasma Concentration and Blood Coagulation in Healthy Volunteers Using Standard Laboratory Tests and Viscoelastic Analysis.

J Clin Pharmacol 2020 Oct 7. Epub 2020 Oct 7.

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland.

The capability of viscoelastic measurement parameters to screen anticoagulation activity of edoxaban in relation to its plasma concentrations was evaluated in 15 healthy male volunteers. Blood samples were drawn before the oral administration of edoxaban 60 mg and 2, 4, 6, 8, and 24 hours after administration. At each time, standard coagulation tests were performed, blood viscoelastic properties were measured with a thromboelastometry device ROTEM delta analyzer (Instrumentation Laboratory, Werfen, Barcelona, Spain), and edoxaban plasma concentrations were measured. Our primary interest was the possible correlation between edoxaban plasma concentrations and values for ROTEM ExTEM, and FibTEM. We also studied the correlation of edoxaban plasma concentrations with the results of standard coagulation tests. We saw the effect of a single dose of edoxaban most clearly in clotting time (CT) of ROTEM ExTEM and FibTEM. Changes in these parameters correlated significantly with edoxaban plasma concentrations up to 6 hours from the ingestion of the drug. Activated partial thromboplastin time, prothrombin time, and anti-factor Xa were also affected. Peak changes were observed 2 and 4 hours after administration of edoxaban. The changes were mostly reversed after 8 hours. In conclusion, ROTEM CT correlates significantly with edoxaban plasma concentrations and can be used to estimate the effect of edoxaban. ROTEM should be considered as part of the assessment of coagulation, with the big advantage of being readily available on site.
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http://dx.doi.org/10.1002/jcph.1758DOI Listing
October 2020

Anaesthesia nursing competence: Self-assessment of nursing students.

Nurse Educ Today 2020 Nov 3;94:104575. Epub 2020 Sep 3.

Department of Nursing Science, University of Turku, 20014 Turku, Finland; Turku University Hospital, 20521 Turku, Finland. Electronic address:

Background: The importance of competence assessment in anaesthesia nursing education has increased since nurse educators and anaesthesia care employers have identified the gap between nursing education and nursing practice. In order to ensure nursing students' preparedness for entry into anaesthesia nursing practice, it is necessary to measure whether nursing students have achieved the required competence to practice as anaesthesia care providers.

Objectives: To assess the anaesthesia nursing competence of nursing students and to describe factors related to their anaesthesia nursing competence. This study will provide new knowledge to support the curricula of nursing education and new nurses' practice in anaesthesia care.

Design: Cross-sectional survey design.

Methods: Data from a sample of Finnish nursing students (n = 205) were collected by using an on-line/paper and pencil survey (the Anaesthesia Nursing Competence Scale, 7 categories) in 2017. The assessment was based on self-assessment and used a Visual Analogue Scale (0-100). Descriptive statistics, a Pearson correlation coefficient, independent sample t-tests and a multivariable regression were used to analyse the data.

Results: The self-assessed overall competence of graduating nursing students was 59 (range 43-73). Approximately half of the students reached an acceptable level (60≤) and half did not. The highest self-assessed category was collaboration within patient care, and the lowest was knowledge of anaesthesia patient care. The number of credits, anaesthesia courses, and experience of clinical practice in anaesthesia nursing were significantly related to anaesthesia nursing competence.

Conclusions: Competence development in the knowledge of anaesthesia patient care should be considered in general nursing education. Student nurses' competence could be developed by providing more opportunities for theoretical studies and clinical practice in anaesthesia nursing. A specialised post-registration education in anaesthesia nursing might be one solution to overcome the limitations in the competence that general nursing education is not fully able to cover for anaesthesia nursing.
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http://dx.doi.org/10.1016/j.nedt.2020.104575DOI Listing
November 2020

Leadership and administrative support for interprofessional collaboration in a cancer center.

J Health Organ Manag 2020 Sep;ahead-of-print(ahead-of-print)

Department of Nursing Science, University of Turku, Turku, Finland.

Purpose: The interprofessional collaboration is a key practice for providing cancer care. However, the realization of collaboration requires effective leadership and administrative support. In this study, the aim was to analyze healthcare professionals' perceptions of leadership and administrative support (strategic and management) in interprofessional collaboration for developing practices in cancer care.

Design/methodology/approach: A descriptive survey design was used to collect data from healthcare professionals ( = 350, response rate 33.3%), including nurses, physicians and other professionals participating in patient care in one Finnish cancer center (out of five) in 05/2018-10/2018. The data were analyzed using descriptive and inferential statistics. The instrument focused on leadership in the work unit and administrative support including organization strategy and organizational management.

Findings: Healthcare professionals perceived leadership in the work unit, organization strategy and management for the support of interprofessional collaboration as weak. However, the ratings of male respondents and those in leading positions were more positive. The findings indicate that healthcare professionals in the cancer care setting are dissatisfied with the leadership and administrative support.

Research Limitations/implications: Interprofessional collaboration, including its leadership, requires systematic and constant evaluation and development.

Originality/value: Healthcare leaders in the cancer care setting can use the results to identify factors that might be in need of attention and development in the field of interprofessional collaboration.
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http://dx.doi.org/10.1108/JHOM-01-2020-0007DOI Listing
September 2020

Long-term Quality of Life After Treatment of Oropharyngeal Squamous Cell Carcinoma.

Laryngoscope 2020 Aug 25. Epub 2020 Aug 25.

Department of Otorhinolaryngology-Head and Neck Surgery, Turku University and Turku University Hospital, Turku, Finland.

Objectives: To analyze the long-term quality of life (QOL) among oropharyngeal squamous cell carcinoma (OPSCC) survivors.

Study Design: Retrospective chart analysis and patient response to European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Core Module (EORTC QLQ-C30), Head and Neck Module (EORTC QLQ-H&N35), and M.D. Anderson Dysphagia Inventory (MDADI) survey questionnaires.

Methods: All survivors of OPSCC diagnosed and treated between 2000 and 2009 in Finland were included. There were 263 survivors (44.2% of all curatively treated patients), of which a total of 164 participated in this study (62.4%). Median follow-up was 11.79 years (range = 8.59-18.53 years, interquartile range [IQR] = 4.64 years). The mean age of the participants was 67.9 years (standard deviation = 8.0 years) at QOL follow-up.

Results: Most survivors reported a good QOL. The EORTC QLQ-C30 global health status median was 75.00 (IQR = 31.25). The single modality treatment group had significantly better QOL outcomes than the combined treatment group. Nonsmokers and previous smokers had significantly better QOL outcomes than patients who smoked at the time of diagnosis. A history of heavy alcohol use resulted in significantly worse QOL outcomes. The p16-positive cancer patients had significantly better QOL outcomes than p16-negative patients. Percutaneous endoscopic gastrostomy (PEG) tube-dependent patients reported a significantly worse QOL than patients without a PEG tube.

Conclusions: Long-term QOL in OPSCC survivors is generally good. In line with previous literature, single modality treatment was superior to combined treatment in long-term QOL outcomes, and it should be pursued whenever possible.

Level Of Evidence: 4 Laryngoscope, 2020.
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http://dx.doi.org/10.1002/lary.29042DOI Listing
August 2020

Alpha band frontal connectivity is a state-specific electroencephalographic correlate of unresponsiveness during exposure to dexmedetomidine and propofol.

Br J Anaesth 2020 10 7;125(4):518-528. Epub 2020 Aug 7.

Department of Anesthesiology, Center for Consciousness Science, University of Michigan Medical School, Ann Arbor, MI, USA.

Background: Coherent alpha electroencephalogram (EEG) rhythms in the frontal cortex have been correlated with the hypnotic effects of propofol and dexmedetomidine, but less is known about frontal connectivity as a state-specific correlate of unresponsiveness as compared with long-range connectivity. We aimed to distinguish dose- and state-dependent effects of dexmedetomidine and propofol on EEG connectivity.

Methods: Forty-seven healthy males received either dexmedetomidine (n=23) or propofol (n=24) as target-controlled infusion with stepwise increments until loss of responsiveness (LOR). We attempted to arouse participants during constant dosing (return of responsiveness [ROR]), and the target concentration was then increased 50% to achieve presumed loss of consciousness. We collected 64-channel EEG data and prefrontal-frontal and anterior-posterior functional connectivity in the alpha band (8-14 Hz) was measured using coherence and weighted phase lag index (wPLI). Directed connectivity was measured with directed phase lag index (dPLI).

Results: Prefrontal-frontal EEG-based connectivity discriminated the states at the different drug concentrations. At ROR, prefrontal-frontal connectivity reversed to the level observed before LOR, indicating that connectivity changes were related to unresponsiveness rather than drug concentration. Unresponsiveness was associated with emergence of frontal-to-prefrontal dominance (dPLI: -0.13 to -0.40) in contrast to baseline (dPLI: 0.01-0.02). Coherence, wPLI, and dPLI had similar capability to discriminate the states that differed in terms of responsiveness and drug concentration. In contrast, anterior-posterior connectivity in the alpha band did not differentiate LOR and ROR.

Conclusions: Local prefrontal-frontal EEG-based connectivity reflects unresponsiveness induced by propofol or dexmedetomidine, suggesting its utility in monitoring the anaesthetised state with these agents.

Clinical Trial Registration: NCT01889004.
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http://dx.doi.org/10.1016/j.bja.2020.05.068DOI Listing
October 2020

Distinct Metabolomic Profile Because of Gestational Diabetes and its Treatment Mode in Women with Overweight and Obesity.

Obesity (Silver Spring) 2020 09 24;28(9):1637-1644. Epub 2020 Jul 24.

Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.

Objective: Whether the presence of gestational diabetes (GDM) and its treatment mode influence the serum metabolic profile in women with overweight or obesity was studied.

Methods: The serum metabolic profiles of 352 women with overweight or obesity participating in a mother-infant clinical study were analyzed with a targeted NMR approach (at 35.1 median gestational weeks). GDM was diagnosed with a 2-hour 75-g oral glucose tolerance test.

Results: The metabolomic profile of the women with GDM (n = 100) deviated from that of women without GDM (n = 252). Differences were seen in 70 lipid variables, particularly higher concentrations of very low-density lipoprotein particles and serum triglycerides were related to GDM. Furthermore, levels of branched-chain amino acids and glycoprotein acetylation, a marker of low-grade inflammation, were higher in women with GDM. Compared with women with GDM treated with diet only, the women treated with medication (n = 19) had higher concentrations of severalizes of VLDL particles and their components, leucine, and isoleucine, as well as glycoprotein acetylation.

Conclusions: A clearly distinct metabolic profile was detected in GDM, which deviated even more if the patient was receiving medical treatment. This suggests a need for more intense follow-up and therapy for women with GDM during pregnancy and postpartum to reduce their long-term adverse health risks.
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http://dx.doi.org/10.1002/oby.22882DOI Listing
September 2020

Perinatal and perioperative factors associated with mortality and an increased need for hospital care in infants with transposition of the great arteries: A nationwide 11-year population-based cohort.

Acta Obstet Gynecol Scand 2020 12 23;99(12):1728-1735. Epub 2020 Jul 23.

Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Introduction: Newborn infants with transposition of the great arteries (d-TGA) need immediate care for an optimal outcome. This study comprised a nationwide 11-year population-based cohort of d-TGA infants, and assessed whether the implementation of a nationwide systematic fetal screening program, or other perinatal, or perioperative factors, are associated with mortality or an increased need for hospital care.

Material And Methods: The national cohort consisted of all live-born infants with simple d-TGA (TGA ± small ventricular septal defect, n = 127) born in Finland during 2004-2014. Data were collected from six national registries. Prenatal diagnosis and perinatal and perioperative factors associated with mortality and length of hospitalization were evaluated.

Results: Preoperative mortality was 7.9%, and the total mortality was 8.7%. The prenatal detection rate increased after introducing systematic fetal anomaly screening from 5.0% to 37.7% during the study period (P < .0001), but the total mortality rate remained unchanged. All prenatally diagnosed infants (n = 27) survived. Lower gestational age (odds ratio 0.68, P = .012) and higher maternal age at birth (odds ratio 1.16, P = .036) were associated with increased mortality in multivariable analysis. Older infant age at time of operation (P = .002), longer aortic clamp time (P < .001), and higher maternal body mass index (P = .027) were associated with longer initial hospital stay. An extended need for hospital care during the first year of life was multi-factorial.

Conclusions: In our cohort, none of the prenatally diagnosed d-TGA infants died. As a result of the limited prenatal detection rates, however, the sample size was insufficient to reach statistical significance. The d-TGA infants born with lower gestational age and to older mothers had increased mortality.
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http://dx.doi.org/10.1111/aogs.13953DOI Listing
December 2020

Clinical correlates of rhinovirus infection in preschool asthma.

Allergy 2021 01 21;76(1):247-254. Epub 2020 Jul 21.

Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.

Background: Investigation of preschool asthma is important since not all children outgrow their illness during this age. Data are scarce on the role of rhinovirus (RV) infections in this patient group.

Objectives: To investigate the role of RV infections in preschool asthma: (i) susceptibility factors, (ii) clinical course, and (iii) medium-term outcome.

Methods: A total of 130 asthmatic children aged 4-6 years from the multinational PreDicta cohort were prospectively followed for a 12-month period. Allergy tests and a standard health questionnaire were carried out at study entry. Respiratory virus presence in nasopharyngeal washes was studied at illness visits and at 3 scheduled visits.

Results: At study entry, mean age of the children was 5.3 years. Of 571 visits, 54% were positive for any virus and 39% for RV. Patient characteristics were only assessed with RV infection due to low number of other viruses. The use of supplementary vitamin D was inversely associated with RV infection (P < .05). RV infection was associated with more severe course of acute illness in terms of more severe nighttime coughing, more sleep disturbances, and more days with runny nose (all P < .05). RV infection was also associated with more severe disease course during the 12-month follow-up in terms of more nights with awakenings and more days of exercise-related symptoms (both P < .05).

Conclusions: Vitamin D supplementation may have an anti-rhinovirus effect. Both short- and medium-term outcomes suggest RV infection to be an important clinical marker of instable preschool asthma.
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http://dx.doi.org/10.1111/all.14479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818397PMC
January 2021

Effects of anaesthesia method and tourniquet use on recovery following total knee arthroplasty: a randomised controlled study.

Br J Anaesth 2020 11 30;125(5):762-772. Epub 2020 Jun 30.

Department of Anaesthesiology, Intensive Care and Pain Medicine, Peijas Hospital, HUS Helsinki University Hospital, Helsinki, Finland. Electronic address:

Background: We investigated the effects of spinal and general anaesthesia and surgical tourniquet on acute pain and early recovery after total knee arthroplasty (TKA).

Methods: Patients (n=413) were randomised to four parallel groups: spinal anaesthesia with or without tourniquet, and general anaesthesia with or without tourniquet. The primary outcome was patient-controlled i.v. oxycodone consumption over 24 postoperative hours.

Results: Results from 395 subjects were analysed. Median i.v. oxycodone consumption did not differ between the four groups (spinal anaesthesia without [36.6 mg] and with tourniquet [38.0 mg], general anaesthesia without [42.3 mg] and with tourniquet [42.5 mg], P=0.42), between spinal (37.7 mg) and general anaesthesia (42.5 mg) groups (median difference -3.1, 95% confidence interval [CI] -7.4 to 1.2, P=0.15) and between tourniquet and no-tourniquet groups (40.0 vs 40.0 mg, median difference -0.8, CI -5.1 to 3.5, P=0.72). Vomiting incidence was higher with spinal than with general anaesthesia (21% [42/200] vs 13% [25/194], CI 1.05 to 3.1, P=0.034). The mean haemoglobin decrease was greater without than with tourniquet (-3.0 vs -2.5 g dl, mean difference -0.48, CI -0.65 to -0.32, P<0.001). No differences were observed in pain, pain management, incidences of blood transfusions, in-hospital complications, or length of hospital stay.

Conclusions: For TKA, spinal and general anaesthesia with or without tourniquet did not differ in 24-h postoperative opioid consumption, pain management, blood transfusions, in-hospital complications, and length of hospital stay. Vomiting incidence was higher in the spinal than in the general anaesthesia group. Tourniquet use caused smaller decreases in haemoglobin levels.

Clinical Trial Registration: EudraCT 2016-002035-15.
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http://dx.doi.org/10.1016/j.bja.2020.03.036DOI Listing
November 2020

Cerebral autoregulation after aneurysmal subarachnoid haemorrhage. A preliminary study comparing dexmedetomidine to propofol and/or midazolam.

Acta Anaesthesiol Scand 2020 10 15;64(9):1278-1286. Epub 2020 Jul 15.

Division of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, Turku, Finland.

Background: Cerebral autoregulation is often impaired after aneurysmal subarachnoid haemorrhage (aSAH). Dexmedetomidine is being increasingly used, but its effects on cerebral autoregulation in patients with aSAH have not been studied before. Dexmedetomidine could be a useful sedative in patients with aSAH as it enables neurological assessment during the infusion. The aim of this preliminary study was to compare the effects of dexmedetomidine on dynamic and static cerebral autoregulation with propofol and/or midazolam in patients with aSAH.

Methods: Ten patients were recruited. Dynamic and static cerebral autoregulation were assessed using transcranial Doppler ultrasound during propofol and/or midazolam infusion and then during three increasing doses of dexmedetomidine infusion (0.7, 1.0 and 1.4 μg/kg/h). Transient hyperaemic response ratio (THRR) and strength of autoregulation (SA) were calculated to assess dynamic cerebral autoregulation. Static rate of autoregulation (sRoR)% was calculated by using noradrenaline infusion to increase the mean arterial pressure 20 mm Hg above the baseline.

Results: Data from nine patients were analysed. Compared to baseline, we found no statistically significant changes in THRR or sROR%. THRR was (mean ± SD) 1.20 ± 0.14, 1.17 ± 0.13 (P = .93), 1.14 ± 0.09 (P = .72) and 1.19 ± 0.18 (P = 1.0) and sROR% was 150.89 ± 84.37, 75.22 ± 27.75 (P = .08), 128.25 ± 58.35 (P = .84) and 104.82 ± 36.92 (P = .42) at baseline and during 0.7, 1.0 and 1.4 μg/kg/h dexmedetomidine infusion, respectively. Dynamic SA was significantly reduced after 1.0 μg/kg/h dexmedetomidine (P = .02).

Conclusions: Compared to propofol and/or midazolam, dexmedetomidine did not alter static cerebral autoregulation in aSAH patients, whereas a significant change was observed in dynamic SA. Further and larger studies with dexmedetomidine in aSAH patients are warranted.
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http://dx.doi.org/10.1111/aas.13663DOI Listing
October 2020

Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study.

Eur Geriatr Med 2020 10 4;11(5):745-751. Epub 2020 Jun 4.

City of Turku, Welfare Division/Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.

Purpose: To examine the effect of predictive factors on institutionalization among older patients.

Methods: The participants were older (aged 75 years or older) home-dwelling citizens evaluated at Urgent Geriatric Outpatient Clinic (UrGeriC) for the first time between the 1st of September 2013 and the 1st of September 2014 (n = 1300). They were followed up for institutionalization for 3 years. Death was used as a competing risk in Cox regression analyses.

Results: The mean age of the participants was 85.1 years (standard deviation [SD] 5.5, range 75-103 years), and 74% were female. The rates of institutionalization and mortality were 29.9% and 46.1%, respectively. The mean age for institutionalization was 86.1 (SD 5.6) years. According to multivariate Cox regression analyses, the use of home care (hazard ratio 2.43, 95% confidence interval 1.80-3.27, p < 0.001), dementia (2.38, 1.90-2.99, p < 0.001), higher age (≥ 95 vs. 75-84; 1.65, 1.03-2.62, p = 0.036), and falls during the previous 12 months (≥ 2 vs. no falls; 1.54, 1.10-2.16, p = 0.012) significantly predicted institutionalization during the 3-year follow-up.

Conclusion: Cognitive and/or functional impairment mainly predicted institutionalization among older patients of UrGeriC having health problems and acute difficulties in managing at home.
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http://dx.doi.org/10.1007/s41999-020-00338-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7550301PMC
October 2020

Medication of comorbidities in females with sleep-disordered breathing during long-term CPAP therapy.

Respir Med 2020 08 12;169:106014. Epub 2020 May 12.

Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital, PO Box 52, FIN-20520, Turku, Finland; Department of Pulmonary Diseases and Clinical Allergology, University of Turku, PO Box 52, FIN-20520, Turku, Finland; Sleep Research Centre, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Lemminkäisenkatu 3b, 20520, TURKU, Finland. Electronic address:

Background: Treating sleep disordered breathing (SDB) with nasal continuous positive airway pressure (CPAP) may reduce mortality, but the studies on the effect on medication use are few. Women tend to have more mild sleep apnoea and partial airway obstruction and are therefore expected to have less co-morbidity. The purpose of this study was to evaluate the effect of CPAP therapy on medication use in women as overall medication, and in different subcategories of diseases, and to evaluate the impact of nocturnal airway obstruction type as partial or complete.

Methods: From the database of the Department of Pulmonary Diseases in Turku University Hospital from 1994 to 1998, 601 consecutive females with SDB were enrolled, and the type of SDB was evaluated. All were offered CPAP therapy. The medication use measured as defined daily doses (DDD) in overall medication and in nine subcategories were collected three years before and three years after CPAP initiation.

Results: In final analyses, 182 women were included. In CPAP users (n = 66), comorbidities were more frequent and DDDs higher overall, in asthma, in chronic obstructive pulmonary disease, and in severe mental disorders, both before and after CPAP initiation. The medication use was similar regardless of the type of SDB. The change in medication use was similar as in controls.

Conclusions: CPAP therapy did not decrease medication use in three-year follow-up. However, possibly continuous rise in medication use was prevented, as the change in medication use was similar in controls. Complete and partial obstruction had similar effects.
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http://dx.doi.org/10.1016/j.rmed.2020.106014DOI Listing
August 2020

Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people.

Aging Clin Exp Res 2020 Apr 18. Epub 2020 Apr 18.

Faculty of Medicine, Department of Clinical Medicine, Unit of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, 20700, Turku, Finland.

Background: In clinical practice, there is a need for an instrument to screen older people at risk of institutionalization.

Aims: To analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people.

Methods: In this prospective study with 10- and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization.

Results: The mean age of the participants was 73.0 (range 64.0‒97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age- and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up.

Discussion: Simple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up.

Conclusions: In clinical practice, self-reported walking ability and SRH could be used to screen those at risk.
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http://dx.doi.org/10.1007/s40520-020-01551-xDOI Listing
April 2020

Psychosocial resources related to survival among non-robust community-dwelling older people: an 18-year follow-up study.

Eur Geriatr Med 2020 06 5;11(3):475-481. Epub 2020 Mar 5.

Department of Geriatrics, Faculty of Medicine, Turku City Hospital, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.

Purpose: Psychosocial resources have been considered to be associated with survival among frail older adults but the evidence is scarce. The aim was to investigate whether psychosocial resources are related to survival among non-robust community-dwelling older people.

Methods: This is a prospective study with 10- and 18-year follow-ups. Participants were 909 non-robust (according to Rockwood's Frailty Index) older community-dwellers in Finland. Psychosocial resources were measured with living circumstances, education, satisfaction with friendship and life, visiting other people, being visited by other people, having someone to talk to, having someone who helps, self-rated health (SRH) and hopefulness about the future. To assess the association of psychosocial resources for survival, Cox regression analyses was used.

Results: Visiting other people more often than once a week compared to that of less than once a week (hazard ratio 0.61 [95% confidence interval 0.44-0.85], p = 0.003 in 10-year follow-up; 0.77 [0.62-0.95], p = 0.014 in 18-year follow-up) and good SRH compared to poor SRH (0.65 [0.44-0.97], p = 0.032; 0.68 [0.52-0.90], p = 0.007, respectively) were associated with better survival in both follow-ups. Visiting other people once a week (compared to that of less than once a week) (0.77 [0.62-0.95], p = 0.014) was only associated with better 18-year survival.

Conclusions: Psychosocial resources, such as regularly visiting other people and good self-rated health, seem to be associated with better survival among non-robust community-dwelling Finnish older people. This underlines the importance of focusing also on psychosocial well-being of frail older subjects to remain or promote their resilience.
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http://dx.doi.org/10.1007/s41999-020-00300-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280471PMC
June 2020

Repeated cobalt and chromium ion measurements in patients with bilateral large-diameter head metal-on-metal ReCap-M2A-Magnum total hip replacement.

Acta Orthop 2020 08 14;91(4):378-382. Epub 2020 Apr 14.

Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku.

Background and purpose - Whole-blood (WB) chromium (Cr) and cobalt (Co) measurements are vital in the follow-up of metal-on-metal total hip replacement (MoM THR) patients. We examined whether there is a substantial change in repeated WB, Co, and Cr levels in patients with bilateral ReCap-M2A-Magnum THR. We also specified the number of patients exceeding the safe upper limit (SUL) of WB Co and Cr in the repeated measurement.Patients and methods - We identified 141 patients with bilateral ReCap-M2A-Magnum THR operated in our institution. 61 patients had repeated WB metal ion measurements with bilateral MoM implants still in situ in the second measurement. The mean time elapsing from the first measurement (initial measurement) to the second (control measurement) was 1.9 years (SD = 0.6, range 0.2-3.5). We used earlier established SUL levels for bilateral implants by Van Der Straeten et al. (2013).Results - The median (range) Co and Cr values decreased in the repeated measurement from 2.7 (0.6-25) to 2.1 (0.5-21) and 2.6 (0.8-14) to 2.1 (0.5-18) respectively. In 13% of the patients Co levels exceeded the SUL in the initial measurement and the proportion remained constant, at 13%, in the repeated measurement. In 5% of the patients, Cr levels were above SUL in the initial measurement and an equal 5% in the control measurement.Interpretation - Repeated WB metal ion levels did not increase in patients with bilateral ReCap-M2A-Magnum THR with a mean 1.9-year measurement interval. Long-term development of WB metal ion levels is still unclear in these patients.
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http://dx.doi.org/10.1080/17453674.2020.1751940DOI Listing
August 2020

Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up.

BMC Geriatr 2020 03 30;20(1):120. Epub 2020 Mar 30.

Faculty of Medicine, Department of Geriatrics, University of Turku, Turku City Hospital, Kunnallissairaalantie 20, FI-20700, Turku, Finland.

Background: Despite a non-specific nature of self-rated health (SRH), it seems to be a strong predictor of mortality. The aim of this study is to assess the association of SRH and objective health status (OH) with all-cause mortality in 70-year-old community-dwelling older people in Finland.

Methods: A prospective study with 5-, 10- and 27-year follow-ups. SRH (n = 1008) was assessed with a single question and OH (n = 962) by the Rockwood's Frailty Index (FI). To assess the association of SRH and OH with mortality, Cox regression model was used.

Results: Of the 1008 participants, 138 (13.7%), 319 (31.6%), and 932 deceased (86.3%) during the 5-, 10- and 27-year follow-ups, respectively. In unadjusted models, subjects with poor SRH had almost eightfold risk for mortality compared to those with good SRH during the 5-year follow-up; among those with poor OH, the risk was fourfold compared to those with good OH. In the 10-year-follow up, both poor SRH and poor OH predicted about fourfold risk for mortality compared to those with good health. During the 27-year follow-up, OH was a stronger predictor of mortality than SRH. Poor SRH, compared to good SRH, showed 95% sensitivity and 34% specificity for 5-year mortality; corresponding figures for OH were 54 and 80%, respectively.

Conclusions: Single-item SRH seems to be able to capture almost the same as OH in predicting a short-term (less than 10 years) mortality risk among older adults in clinical settings. The use of SHR may also enhance the focus on patient-centered care.
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http://dx.doi.org/10.1186/s12877-020-01516-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106830PMC
March 2020

Recurrent depression in childhood and adolescence and low childhood socioeconomic status predict low cardiorespiratory fitness in early adulthood.

J Affect Disord 2020 04 11;266:782-792. Epub 2019 Nov 11.

Research Center for Child Psychiatry, University of Turku, Finland; INVEST Research Flagship, University of Turku, Finland (Principal Investigator).

Background: Cardiorespiratory fitness (CRF) strongly influences health, but very little is known about the childhood determinants of adult CRF. Our longitudinal study investigated whether childhood psychopathology and socioeconomic status (SES) were related to adult CRF in 1647 Finnish male military conscripts.

Methods: Childhood psychopathology was assessed at the age of eight using the Rutter and Children's Depression Inventory questionnaires. Parental education and family structure were used to assess childhood SES. In late adolescence, depressive symptoms were assessed with the Beck Depression Inventory and smoking with a questionnaire. CRF in early adulthood was examined with the Cooper's 12-minute run test.

Results: General linear models showed that low parental education (p=0.001), depressive symptoms in childhood (p=0.035) and late adolescence, smoking, underweight, and overweight/obesity (all p<0.001) independently predicted lower CRF. The interaction between depressive symptoms in childhood and adolescence was significant (p=0.003). In adolescents with depressive symptoms, childhood depressive symptoms (p=0.001) and overweight/obesity (p<0.001) predicted lower CRF. In adolescents without depressive symptoms, conduct problems in childhood predicted lower CRF in the initial models, but the effect disappeared after taking into account smoking and body mass index. Mediational analysis confirmed these results.

Limitations: We lacked data on physical activity and only studied males at three time-points.

Conclusions: Recurrent depression in childhood and adolescence and low SES in childhood predict lower adult CRF. Conduct problems in childhood predict lower CRF, but the effect is mediated by overweight/obesity and smoking. Psychiatric treatment for children and adolescents should promote physical activity, particularly for children with low SES.
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http://dx.doi.org/10.1016/j.jad.2019.11.029DOI Listing
April 2020

Group A streptococcal bacteremias in Southwest Finland 2007-2018: epidemiology and role of infectious diseases consultation in antibiotic treatment selection.

Eur J Clin Microbiol Infect Dis 2020 Jul 25;39(7):1339-1348. Epub 2020 Feb 25.

Department of Infectious Diseases, Turku University Hospital, University of Turku, Turku, Finland.

The incidence of invasive group A streptococcal (GAS) infections has shown a fluctuating but increasing trend in Finland. The impact of infectious diseases specialist consultation (IDSC) on the antimicrobial therapy of GAS bacteremia has not been studied earlier. A retrospective study on adult GAS bacteremia in The Hospital District of Southwest Finland (HDSWF) was conducted from 2007 to 2018. Data on incidence of bacteremic GAS cases were gathered from the National Infectious Disease Register. Clinical data were obtained by reviewing the electronic patient records. The overall incidence of GAS bacteremia in HDSWF was 3.52/100,000, but year-to-year variation was observed with the highest incidence of 7.93/100,000 in 2018. A total of 212 adult GAS bacteremia cases were included. A record of IDSC was found (+) in 117 (55.2%) cases, not found (-) in 71 (33.5%) cases and data were not available in 24 (11.3%) cases. Among IDSC+ cases, 57.3% were on penicillin G treatment whereas in the group IDSC- only 22.5%, respectively (OR = 4.61, 95% CI 2.37-8.97; p < 0.001). The use of clindamycin as adjunctive antibiotic was more common among IDSC+ (54.7%) than IDSC- (21.7%) (OR = 4.51, 95% CI 2.29-8.87; p < 0.001). There was an increasing trend in incidence of GAS bacteremia during the study period. Narrow-spectrum beta-lactam antibiotics were chosen, and adjunctive clindamycin was more commonly used, if IDSC took place. This highlights the importance of availability of IDSC but calls for improved practice among infectious diseases specialists by avoiding combination therapy with clindamycin in non-severe invasive GAS infections.
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http://dx.doi.org/10.1007/s10096-020-03851-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303095PMC
July 2020

Incidence and risk factors of hyperemesis gravidarum: A national register-based study in Finland, 2005-2017.

Acta Obstet Gynecol Scand 2020 08 20;99(8):1003-1013. Epub 2020 Feb 20.

Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland.

Introduction: Hyperemesis gravidarum is the most common reason for hospitalization in early pregnancy in pregnancies resulting in delivery. Several associative factors indicate that the etiology is likely to be multifactorial. To assess this, we used a unique procedure to compare hyperemetic pregnancies with non-hyperemetic pregnancies both in different women and in the same women's different pregnancies.

Material And Methods: Data about all pregnancies resulting in delivery in Finland in 2005-2017 were retrieved from healthcare registers. Women who had a diagnosis of hyperemesis gravidarum in any pregnancy in the Finnish Hospital Discharge Register were chosen as cases (n = 9315) and other women (n = 428 150) as the reference group. The incidence of hyperemesis gravidarum was calculated and associations between hyperemesis and maternal, environmental and pregnancy-related factors were analyzed in a novel setting by comparing case women's pregnancies diagnosed with hyperemesis to (1) reference group women's pregnancies and (2) case women's non-hyperemetic pregnancies.

Results: Of the 437 465 women who had at least one pregnancy resulting in delivery during the study period, 9315 women had at least one hyperemetic pregnancy. The total number of pregnancies resulting in delivery was 741 387 and 9549 of those were diagnosed with hyperemesis gravidarum; thus the incidence of hyperemesis gravidarum was 1.3%. In comparison (1), case women's hyperemetic pregnancies vs reference group's pregnancies, younger maternal age, higher gravidity, underweight and overweight were associated with increased risk of hyperemesis; in contrast, in comparison (2), case women's hyperemetic pregnancies vs their non-hyperemetic pregnancies, higher age and obesity were associated with higher risk of hyperemesis, whereas the risk was lower as gravidity and parity increased. In both comparisons, smoking was associated with lower risk, whereas higher municipality population, assisted reproductive technology, multiple gestation and female sex of the fetus were associated with increased risk of hyperemesis.

Conclusions: Our novel study setting provided new insights about risk factors: hyperemetic pregnancies differ both from pregnancies of women who had never been diagnosed with hyperemesis and from hyperemetic women's non-hyperemetic pregnancies. The incidence of hyperemesis gravidarum in Finland was comparable to that in other countries.
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http://dx.doi.org/10.1111/aogs.13820DOI Listing
August 2020

Metabolic syndrome is not associated with erectile dysfunction in apparently healthy men.

Prim Care Diabetes 2020 10 6;14(5):460-463. Epub 2020 Jan 6.

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

Aims: To investigate whether metabolic syndrome (MetS) is associated with erectile dysfunction (ED) among apparently healthy men when depressive symptoms and serum testosterone levels are taken into account.

Methods: A study population of 549 men at risk for cardiovascular disease or type 2 diabetes was drawn from the participants of a population survey, the Harmonica Project. MetS was diagnosed with the United States National Cholesterol Education Program Third Adult Treatment Panel (ATPIII) 2005 definition, the International Diabetes Federation (IDF) 2005 definition and the Harmonization 2009 definition. ED was evaluated by the International Index of Erectile Function (IIEF-5) questionnaire. Depressive symptoms were assessed with Beck's Depression Inventory (BDI).

Results: Of the 549 men (mean age 58.4 ± 6.7 years), 56.5 % reported ED. The prevalence of MetS was 48.6%, 35.5%, and 50.6% according to the IDF, the ATPIII, and the Harmonization criteria, respectively. We found no difference in the prevalence of ED between men with or without MetS. In a multivariate analysis, age, presence of depressive symptoms and lower education were significant predictors of ED.

Conclusions: The prevalence of ED is quite high even in apparently healthy men. Depressive symptoms are a critical component to consider in men suffering from ED.
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http://dx.doi.org/10.1016/j.pcd.2019.12.008DOI Listing
October 2020

Longitudinal changes in plasma hemopexin and alpha-1-microglobulin concentrations in women with and without clinical risk factors for pre-eclampsia.

PLoS One 2019 16;14(12):e0226520. Epub 2019 Dec 16.

Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, University of Helsinki, Finland.

Recent studies have shown increased concentration of fetal hemoglobin (HbF) in pre-eclamptic women. Plasma hemopexin (Hpx) and alpha-1-microglobulin (A1M) are hemoglobin scavenger proteins that protect against toxic effects of free heme released in the hemoglobin degradation process. We used an enzyme-linked immunosorbent assay to analyze maternal plasma Hpx and A1M concentrations at 12-14, 18-20 and 26-28 weeks of gestation in three groups: 1) 51 women with a low risk for pre-eclampsia (LRW), 2) 49 women with a high risk for pre-eclampsia (PE) who did not develop PE (HRW) and 3) 42 women with a high risk for PE who developed PE (HRPE). The study had three aims: 1) to investigate whether longitudinal differences exist between study groups, 2) to examine if Hpx and A1M concentrations develop differently in pre-eclamptic women with small for gestational age (SGA) fetuses vs. pre-eclamptic women with appropriate for gestational age fetuses, and 3) to examine if longitudinal Hpx and A1M profiles differ by PE subtype (early-onset vs. late-onset and severe vs. non-severe PE). Repeated measures analysis of variance was used to analyze differences in Hpx and A1M concentrations between the groups. We found that the differences in longitudinal plasma Hpx and A1M concentrations in HRW compared to HRPE and to LRW may be associated with reduced risk of PE regardless of clinical risk factors. In women who developed PE, a high A1M concentration from midgestation to late second trimester was associated with SGA. There were no differences in longitudinal Hpx and A1M concentrations from first to late second trimester in high-risk women who developed early-onset or. late-onset PE or in women who developed severe or. non-severe PE.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0226520PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913989PMC
April 2020

Healthcare professionals' perceptions of the pre-requisites and realisation of interprofessional collaboration in cancer care.

Eur J Cancer Care (Engl) 2020 Jan 9;29(1):e13197. Epub 2019 Dec 9.

Department of Nursing Science, University of Turku, Turku, Finland.

Objective: The purpose of this study is to describe the pre-requisites and realisation of interprofessional collaboration as perceived by healthcare professionals working in the cancer care setting and to produce knowledge to support the development of collaborative practices.

Methods: This study employed a descriptive survey design. The data were collected in one Finnish cancer centre between May and October 2018 from nurses, physicians and other healthcare professionals using an electronic survey (n = 350). The survey focused on the pre-requisites of interprofessional collaboration (appreciation and competence) and its realisation in cancer care. The data were analysed using descriptive and interferential statistics.

Results: The pre-requisites of interprofessional collaboration were perceived as good and the collaboration was well realised in the cancer centre. The perceptions of pre-requisites and realisation were associated with each other. Male respondents, physicians and professionals belonging to interprofessional teams had more positive perceptions of the pre-requisites and realisation of interprofessional collaboration than others.

Conclusion: The findings indicate that the pre-requisites of interprofessional collaboration and its realisation seem to be well implemented in the cancer care setting. However, the ongoing evaluation of interprofessional collaboration requires further attention from healthcare administration and professionals to support the systematic development of collaborative practices.
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http://dx.doi.org/10.1111/ecc.13197DOI Listing
January 2020

The influence of dexmedetomidine and propofol on circulating cytokine levels in healthy subjects.

BMC Anesthesiol 2019 12 5;19(1):222. Epub 2019 Dec 5.

Department of Perioperative Services, Intensive Care and Pain Medicine, Turku University Hospital, POB 52, 20521, Turku, Finland.

Background: Surgery and diseases modify inflammatory responses and the immune system. Anesthetic agents also have effects on the human immune system but the responses they induce may be altered or masked by the surgical procedures or underlying illnesses. The aim of this study was to assess how single-drug dexmedetomidine and propofol anesthesia without any surgical intervention alter acute immunological biomarkers in healthy subjects.

Methods: Thirty-five healthy, young male subjects were anesthetized using increasing concentrations of dexmedetomidine (n = 18) or propofol (n = 17) until loss of responsiveness (LOR) was detected. The treatment allocation was randomized. Multi-parametric immunoassays for the detection of 48 cytokines, chemokines and growth factors were used. Concentrations were determined at baseline and at the highest drug concentration for each subject.

Results: The changes in the concentration of eotaxin (decrease after dexmedetomidine) and platelet-derived growth factor (PDGF, increase after propofol) were statistically significantly different between the groups. Significant changes were detected within both groups; the concentrations of monocyte chemotactic protein 1, chemokine ligand 27 and macrophage migration inhibitory factor were lower in both groups after the drug administration. Dexmedetomidine decreased the concentration of eotaxin, interleukin-18, interleukin-2Rα, stem cell factor, stem cell growth factor and vascular endothelial growth factor, and propofol decreased significantly the levels of hepatocyte growth factor, IFN-γ-induced protein 10 and monokine induced by IFN-γ, and increased the levels of interleukin-17, interleukin-5, interleukin-7 and PDGF.

Conclusions: Dexmedetomidine seemed to have an immunosuppressive effect on the immune system whereas propofol seemed to induce mixed pro- and anti-inflammatory effects on the immune system. The choice of anesthetic agent could be relevant when treating patients with compromised immunological defense mechanisms.

Trial Registration: Before subject enrollment, the study was registered in the European Clinical Trials database (EudraCT number 2013-001496-21, The Neural Mechanisms of Anesthesia and Human Consciousness) and in ClinicalTrials.gov (Principal Investigator: Harry Scheinin, number NCT01889004, The Neural Mechanisms of Anesthesia and Human Consciousness, Part 2, on the 23rd of June 2013).
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http://dx.doi.org/10.1186/s12871-019-0895-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894489PMC
December 2019