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Frailty and mortality: an 18-year follow-up study among Finnish community-dwelling older people
<div><h3>Background</h3><p>There is a lack of agreement about applicable instrument to screen frailty in clinical settings.</p></div><div><h3>Aims</h3><p>To analyze the association between frailty and mortality in Finnish community-dwelling older people.</p></div><div><h3>Methods</h3><p>This was a prospective study with 10- and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood’s frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used.</p></div><div><h3>Results</h3><p>Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10–12.41] in 10-year follow-up, and 6.32 [4.17–9.57] in 18-year follow-up) and FI (5.97 [4.13–8.64], and 3.95 [3.16–4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78–2.69], and 1.69 [1.46–1.96]; FI 1.81[1.25–2.62], and 1.31 [1.07–1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10- (4.41 [3.55–5.34]) and 18-year follow-ups (3.78 [3.19–4.49]).</p></div><div><h3>Discussion</h3><p>Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people.</p></div><div><h3>Conclusions</h3><p>FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.</p></div>...
Pulmonary manifestations and the effectiveness of enzyme replacement therapy in Fabry Disease with the p. Arg227Ter (p.R227*) mutation
<p><strong>Background: </strong>Fabry disease (FD) is caused by a defect in α-galactosidase A gene (GLA) which leads to a progressive accumulation of neutral shingolipids, mainly globotriaosylceramide and its metabolites ...
Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people
<p>Background <br></p><p>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. <br></p><p>Methods <br></p><p>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. <br></p><p>Results <br></p><p>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. <br></p><p>Discussion <br></p><p>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.</p>...
Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study
Background <div>The quality of family-centered care and parental participation in care in neonatal units differ widely across the world. Appropriate education might be an effective way to support medical staff in neonatal ...
Gut microbiota aberrations precede diagnosis of gestational diabetes mellitus
<p>Recent evidence has shown the importance of gut microbiota in human metabolic health [<a href="https://link.springer.com/article/10.1007/s00592-017-1056-0#CR1" title="View reference">1</a>]. Gut microbiota dysbiosis in ...
Dysphagia, hypothyroidism, and osteoradionecrosis after radiation therapy for head and neck cancer
<h3>Objectives</h3><p>To analyze the long-term side effects of radiation therapy (RT) for head and neck cancer (HNC).</p><h3>Methods</h3><p>Retrospective chart analysis of all 688 HNC patients treated during 2010–2015 at Turku University Hospital, Finland. All patients who survived for more than a year after RT/chemoRT were included (n = 233). Intensity modulated RT (IMRT) with standard fractionation was applied in each case.</p><h3>Results</h3><p>One hundred and six patients (45%) reported persisting dysphagia, for which neck RT increased risk. Definitive neck RT to high-risk volume did not increase late toxicity risks compared to elective neck RT. Radiation-induced hypothyroidism (29%, n = 67) was more common among younger patients and females. Osteoradionecrosis (12%, n = 29) was more common in the oral cavity cancer group (20.7%, n = 92) compared to all other subsites.</p><h3>Conclusions</h3><p>Late toxicities of RT for HNC are common. Age, gender, tumor subsite, and neck RT affect susceptibility to long-term side effects.</p><h3>Level of evidence</h3><p>4.</p>...
Defining new clinically derived criteria for high disease activity in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study
<div><div>Objectives</div><p>To redefine criteria for high disease activity (HDA) in JIA, to establish HDA cut-off values for the 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 (cJADAS10) ...
Long-term outcome of biologically guided dose-escalated radiotherapy of localized prostate cancer
<p><strong>Background: </strong>Biologically created subvolumes enable non-uniform dose distributions in prostate cancer radiotherapy (RT) thus potentially improving therapeutic ratio and reducing toxicity. We present the long-term outcome of men receiving focal boosting of carbon-11 acetate (ACE) PET-CT metabolically active areas in prostate carcinoma.</p><p><strong>Material and methods: </strong>Thirty men with hormone naïve localized prostate carcinoma underwent ACE PET/CT for RT planning. There were five low-, 17 intermediate-, and eight high-risk patients. Based on thresholding of the standardized uptake values (SUVs) metabolic target volumes (MTVs) corresponding to intraprostatic lesions (IPLs) were contoured. Two planning target volumes (PTVs) were applied i.e., PTV<sub>low-risk</sub> for the whole prostate with 8-10 mm margin and PTV<sub>high-risk</sub> for the MTV. Pelvic nodes were not irradiated. Late toxicity of biologically guided RT was reviewed after a median of 63 months and outcome after a median follow-up of 124 months.</p><p><strong>Results: </strong>Median doses to PTV<sub>low-risk</sub>, PTV<sub>high-risk,</sub> prostate, and MTV were 72.9 Gy, 79.4 Gy, 76.6 Gy, and 80.4 Gy, respectively, in 38 fractions. The 10-year cancer-specific survival was 86% and the biochemical failure-free ratio 68%, respectively. The median biochemical progression-free survival (PFS) was 37, 108, and 119 months in the high, intermediate, and low-risk groups, respectively, the difference being significant between high and intermediate-risk groups (p = 0.02). One patient (3%) presented with locoregional and 5 (17%) with distant nodal metastases. Five patients (17%) had a biochemical relapse. A larger MTV was associated with shorter PFS (r = -0.41, p = 0.02), but had no influence on OS. No other statistically significant differences in the dose painting parameters were observed between recurrence-free and recurring patients.</p><p><strong>Conclusions: </strong>Biological guidance for dose-escalated prostate RT is feasible with ACE PET/CT. Since a larger MTV may be associated with a higher risk for progression, we encourage further study of dose-escalation to ACE-positive lesions considering the low toxicity of our protocol.</p>...
Premedication with intranasal dexmedetomidine decreases thiopental requirements in sedation of pediatric patients for magnetic resonance imaging: a retrospective study
<div><h3>Background</h3><p>Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation.</p></div><div><h3>Methods</h3><p>We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45–60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded.</p></div><div><h3>Results</h3><p>The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7–6.0) mg/kg/h in the DEX group and 12.4 (9.8–14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95–97) % and 96 (94–97) %, P < 0.001). Supplemental oxygen was delivered to 33% of the patients in the THIO group compared to 2% in the DEX group (P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) (P < 0.001).</p></div><div><h3>Conclusion</h3><p>Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI.</p></div>...