Browsing by Subject "mortality"
Now showing items 1-20 of 34
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(2019)2 Abstract 2.1 Purpose To review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist – head and neck surgeons in a single tertiary care center. 2.2 Methods Surgical tracheostomies performed by otolaryngologist – head and neck surgeons at Helsinki University Hospital between Jan 2014 and Feb 2017 were retrospectively reviewed. Patient demographics, surgical data, peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18 months. 2.3 Results Total population was 255, with a majority (n = 181; 71%) of males. The majority of patients (n = 178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9 days (range, 1 - 425). The surgical mortality was 0.4%. 2.4 Conclusion Simultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy-dependent for a prolonged period. Tracheostomy was found to be a safe procedure. 2.5 Key Words Airway, surgical tracheostomy, mortality, ENT 2.6 Level of Evidence 2b
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(2019)2 Abstract 2.1 Purpose To review indications, patient characteristics, frequency, and safety for surgical tracheostomies performed by otolaryngologist – head and neck surgeons in a single tertiary care center. 2.2 Methods Surgical tracheostomies performed by otolaryngologist – head and neck surgeons at Helsinki University Hospital between Jan 2014 and Feb 2017 were retrospectively reviewed. Patient demographics, surgical data, peri- and postoperative mortality information were collected from the hospital charts. Minimum follow-up was 18 months. 2.3 Results Total population was 255, with a majority (n = 181; 71%) of males. The majority of patients (n = 178; 70%) were classified as ASA 3 or 4. A total of 198 (78%) patients suffered from head and neck cancer. Multiple (14 altogether) indications for tracheostomy were identified, and simultaneous major head and neck tumor surgery was common (in 58%). Altogether, 163 (64%) patients were decannulated during follow-up with a median cannulation period of 9 days (range, 1 - 425). The surgical mortality was 0.4%. 2.4 Conclusion Simultaneously performed major tumor surgery was the most common indication for a tracheostomy. A notable number of patients had impaired physical status, but relatively insignificant comorbidities. Almost two thirds of the patients were decannulated during follow-up, although some patients remained tracheostomy-dependent for a prolonged period. Tracheostomy was found to be a safe procedure. 2.5 Key Words Airway, surgical tracheostomy, mortality, ENT 2.6 Level of Evidence 2b
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(2020)Oil spillages represent a serious environmental hazard for flora and fauna of marine and coastal ecosystems. Though marine oil spills have decreased since the 1970s, the increasing production of petroleum goods remains a potential source of pollution due to its use and transportation. When aquatic organisms, including fish, are exposed to toxic oil compounds, this can cause sublethal morphological changes and increase mortality. In this context, herring have been frequently studied, and results suggest that particularly herrings eggs and larvae are highly susceptible to oil toxicity. In this thesis, a Bayesian meta-analysis was conducted to investigate the effects of crude and fuel oil on the mortality of herring eggs from the genus Clupea. Observations from laboratory studies, collected during a literature review, served as input for the statistical analysis. To this end, Bayesian inference modeling was applied to generate posterior probability distributions for additional mortality caused by exposure to oil mixtures. Also, oil concentration, oil type, exposure time, and temperature were analyzed to study possible correlations with mortality impacts. The results of this study suggest that acute mortality of exposed herring eggs is similar to mortality observed for individuals exposed to only small concentrations or none at all. Of all evaluated oil types, medium grade crude oil caused the most significant change in instantaneous mortality with increasing oil concentration. Generally, distinct oil types had a greater influence on mortality outcomes than temperatures at the given concentrations. For the lowest temperatures, some correlations for increased mortality were found. Overall, the unexplained variability between the reviewed studies has a relatively small influence on mortality outcomes. In conclusion, the mortality of exposed herrings eggs is most likely delayed due to sublethal effects, rather than immediate, at the modeled concentrations. Altogether, uncertainty amongst the posterior probability distributions is high, indicating a wide possibility range for the monitored parameters' actual values. The reasons for elevated uncertainty likely stem from diverse experimental setups, biological differences between tested species, relatively small sample sizes, and model-related issues. Thus, future research could consider additional variables, information from observational studies and other fish species to reduce uncertainty in mortality outcomes.
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(2020)Oil spillages represent a serious environmental hazard for flora and fauna of marine and coastal ecosystems. Though marine oil spills have decreased since the 1970s, the increasing production of petroleum goods remains a potential source of pollution due to its use and transportation. When aquatic organisms, including fish, are exposed to toxic oil compounds, this can cause sublethal morphological changes and increase mortality. In this context, herring have been frequently studied, and results suggest that particularly herrings eggs and larvae are highly susceptible to oil toxicity. In this thesis, a Bayesian meta-analysis was conducted to investigate the effects of crude and fuel oil on the mortality of herring eggs from the genus Clupea. Observations from laboratory studies, collected during a literature review, served as input for the statistical analysis. To this end, Bayesian inference modeling was applied to generate posterior probability distributions for additional mortality caused by exposure to oil mixtures. Also, oil concentration, oil type, exposure time, and temperature were analyzed to study possible correlations with mortality impacts. The results of this study suggest that acute mortality of exposed herring eggs is similar to mortality observed for individuals exposed to only small concentrations or none at all. Of all evaluated oil types, medium grade crude oil caused the most significant change in instantaneous mortality with increasing oil concentration. Generally, distinct oil types had a greater influence on mortality outcomes than temperatures at the given concentrations. For the lowest temperatures, some correlations for increased mortality were found. Overall, the unexplained variability between the reviewed studies has a relatively small influence on mortality outcomes. In conclusion, the mortality of exposed herrings eggs is most likely delayed due to sublethal effects, rather than immediate, at the modeled concentrations. Altogether, uncertainty amongst the posterior probability distributions is high, indicating a wide possibility range for the monitored parameters' actual values. The reasons for elevated uncertainty likely stem from diverse experimental setups, biological differences between tested species, relatively small sample sizes, and model-related issues. Thus, future research could consider additional variables, information from observational studies and other fish species to reduce uncertainty in mortality outcomes.
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(2017)Aims: Atrial fibrillation (AF) is the most common long-standing arrhythmia in the adult population. This study aimed to assess which factors increase the likelihood of developing AF, and whether AF is associated with worsened survival in the new millennium. Methods: 6299 participants from a nationally representative Finnish health cohort were followed from 2000 to 2014. The mortality and risk of developing AF were analyzed using Cox regression and logistic regression models. Results: The overall prevalence of AF in baseline ECG was 1.5%. During the 13 year follow- up, 16.9% of those without baseline AF and as many as 85% of those with AF at baseline died. AF increased the risk of dying 5-fold in unadjusted and 1.86-fold in adjusted analysis. In addition, age, gender, hypertension, heart failure, chronic obstructive pulmonary disease (COPD), diabetes and smoking were associated with increased mortality in the Cox regression model. During the first 10 years of follow-up, male gender, age, BMI and alcohol consumption were associated with developing AF. Conclusion: AF is clearly linked with mortality even after the emergence of modern anticoagulation therapy. BMI and alcohol consumption were the only modifiable health factors associated with the development of AF.
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(2009)Anticholinergic medicines are commonly used to treat e.g. incontinence. These medicines have side effects, which may cause and also exacerbate e.g. dryness of the mouth, increased heart rate, and even cognitive impairment. Older people may be more at risk for these side effects as they may be experiencing similar symptoms as a natural effect of aging, and because they may be using several medicines causing these effects. Older people often have a high medicine burden and also a high disease burden. Measuring anticholinergic effects to change medicine regimens and to reduce the symptoms is difficult as there is no golden standard method. This thesis investigated the published methods available for estimating anticholinergic burden in the literature review part, and used one anticholinergic scoring system, the Anticholinergic Risk Scale, in a cross-sectional study to test the effects of anticholinergics on mortality in 1004 older institutionalised patients from Helsinki area public hospitals. Cross-tabulations and Kruskal-Wallis or Chi square methods were used to detect differences between variables such as nutritional status or certain diagnoses when the patients were stratified according to their anticholinergic use. Cox Proportional Hazard regression, the logrank test and Kaplan-Meier curve were used to investigate the effects of anticholinergics on 5-year all-cause mortality. An in vitro serum assay and seven anticholinergic scoring systems were identified in the literature search. Also, 17 anticholinergic lists were identified, which covered 278 medicines, of which 21 appeared on at least eight of the lists. In the empirical study, the women's (n = 745) mean (± SD) age was 83.35 (± 9.99) years, and they were older than the men (n = 241, mean age ± SD 75.11 ± 11.48, p < 0.001). The 1004 patients (response rate 70 %) were using a mean (± SD) number of 7.1 ± 3.4 regular medicines (range 0-20). 455 patients used no anticholinergics, 363 had some anticholinergic burden (score 1 or 2), and 186 had a high burden, with anticholinergic scores of 3 or more. The mean ARS score (± SD) was 1.2 ± 1.5 (range 0-10). When three anticholinergic lists were compared, all three lists identified only 280/791 of patients who were anticholinergic users according to at least one list. No association was found between anticholinergic medicine use and mortality. There are several methods available for measuring anticholinergic burden, but there is a need for a consensus method. This was highlighted by the lack of agreement on medicines on different lists and when three anticholinergic lists tested identified different patients when compared to each other. Anticholinergic use was common in this frail, older patient sample, but no effect on mortality was shown in this study setting. The cross-sectional nature of the data limits the reliability of the study, and any conclusions beyond older patients in Helsinki area must be done very cautiously. Future research should define anticholinergics better and investigate their possible effect on mortality in a prospective, randomised, and controlled setting.
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(2020)The fact that individuals with type 1 diabetes (T1D) are at greater risk for cardiovascular disease and premature death, can only partly be explained by traditional risk factors. Interestingly, T1D is accompanied by arterial stiffening that correlates with microvascular and macrovascular complications. The aim of this study was to find out whether arterial stiffness predicts all-cause mortality in individuals with T1D. Augmentation index (AIx), a measure of arterial pulse wave reflections, is used to estimate stiffness in the resistance arteries and can be determined non-invasively from pulse wave analysis by applanation tonometry. The data consisted of 906 individuals with T1D from the FinnDiane Study that have been examined for arterial stiffness, cardiovascular risk factors and diabetic complications at baseline between 2001 and 2015. After a median follow-up of 8.2 (5.7-9.7) years, 67 individuals had died according to mortality data from Statistics Finland. They had higher baseline AIx (28 [21-33] vs. 19 [9-27] %, P < 0.001) compared to those alive. This association was independent of related risk factors (age, sex, BMI, HbA1c, triglycerides, renal function and past cardiovascular events) in Cox regression analysis (hazard ratio 1.042 [1.007-1.078], P = 0.017). Arterial stiffness estimated by AIx independently predicted all-cause mortality in T1D. Promising pharmacological agents counteracting arterial stiffness include inhibitors of the renin-angiotensin-aldosterone system and sodium-glucose co-transporter 2, and research data on their effect in individuals with T1D is constantly growing. Our finding suggests that detecting early arterial stiffening individuals with T1D could be useful in targeting a more aggressive treatment for high-risk individuals.
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(2016)Liberal use of oxygen after brain insults remains controversial. We studied whether high arterial oxygen tension (PaO2) is associated with decreased long-term survival in patients with spontaneous intracerebral hemorrhage (ICH) treated in the intensive care unit (ICU). Adult patients treated for ICH in Finnish ICUs in 2003-2012 were included in the study. Patients were divided into high (>150mmHg), intermediate (97.5-150mmHg), and low (<97.5mmHg) PaO2 groups according to the lowest measured PaO2/FiO2-ratio during the first 24 hours after ICU admission. In univariate analysis, patients in the high PaO2 group had a significantly increased risk of six-month death compared with the low group (OR 1.82; 95%CI,1.36–2.42;p<0.001), but this statistically significant relation was lost after controlling for case mix in multivariate analysis (OR 1.10; 95%CI,0.76–1.60;p=0.598). No significant relation between PaO2 levels and long-term mortality was found. The clinical role of hyperoxemia in ICU-treated ICH patients remains controversial and warrants further studies.
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(2021)Goals Length of human lifespan is an important measure of societal welfare. Mortality is largely linked to physical health, but psychological well-being has also been shown to predict mortality, happier people living longer lives. Psychological well-being can be construed as both subjective well-being (SWB) and eudaimonic well-being (EWB), and measures belonging to both of these constructs have been shown to individually predict mortality. No study to date has, however, compared these differing measures of psychological well-being as predictors of mortality. This study compares measures of life satisfaction (a part of SWB) and purpose in life (a part of EWB) as predictors of mortality. Methods The data used in this study comes from the Midlife in the US (MIDUS) survey, a large-scale longitudinal study spanning almost 20 years. MIDUS includes measures for life satisfaction and purpose in life, as well as data on mortality and many health behaviors with a sample of N=3768. Effects of life satisfaction and purpose in life on mortality were analysed with multiple Cox proportional hazards models. Results Life satisfaction predicts mortality when modeled alone, as does purpose in life. When modeled together, only purpose in life predicts mortality. This finding stands when additional health behavior variables are controlled, but when the sample is stratified by sex, the relation between life satisfaction and mortality also reaches marginal significance for women but not men. Conclusions This study shows that purpose in life might be a better predictor of mortality compared to life satisfaction. The results also give preliminary support for a hypothesis that purpose, and by proxy EWB, is closer to the evolutionary and physiological core of psychological well-being.
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(2021)Goals Length of human lifespan is an important measure of societal welfare. Mortality is largely linked to physical health, but psychological well-being has also been shown to predict mortality, happier people living longer lives. Psychological well-being can be construed as both subjective well-being (SWB) and eudaimonic well-being (EWB), and measures belonging to both of these constructs have been shown to individually predict mortality. No study to date has, however, compared these differing measures of psychological well-being as predictors of mortality. This study compares measures of life satisfaction (a part of SWB) and purpose in life (a part of EWB) as predictors of mortality. Methods The data used in this study comes from the Midlife in the US (MIDUS) survey, a large-scale longitudinal study spanning almost 20 years. MIDUS includes measures for life satisfaction and purpose in life, as well as data on mortality and many health behaviors with a sample of N=3768. Effects of life satisfaction and purpose in life on mortality were analysed with multiple Cox proportional hazards models. Results Life satisfaction predicts mortality when modeled alone, as does purpose in life. When modeled together, only purpose in life predicts mortality. This finding stands when additional health behavior variables are controlled, but when the sample is stratified by sex, the relation between life satisfaction and mortality also reaches marginal significance for women but not men. Conclusions This study shows that purpose in life might be a better predictor of mortality compared to life satisfaction. The results also give preliminary support for a hypothesis that purpose, and by proxy EWB, is closer to the evolutionary and physiological core of psychological well-being.
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(2020)This thesis examines direct-to-physician pharmaceutical marketing in the United States of America. In 2013, about 78 opioid prescriptions were being written for every 100 people, and 17,000 people in the United States died from an opioid overdose. This study asks, what is the relationship, if any, between contemporary direct-to-physician pharmaceutical marketing practices and opioid mortality in the United States? Contained within an expansive piece of U.S. federal legislation, the Patient Protection and Affordable Care Act of 2010 is a provision which mandates pharmaceutical manufacturers to report marketing payments made to physicians, hospitals, and other relevant healthcare providers. By connecting marketing payments to mortality data at several geospatial levels, the study finds that there is a plausible relationship between the direct-to-physician pharmaceutical marketing and mortality.
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(2020)This thesis examines direct-to-physician pharmaceutical marketing in the United States of America. In 2013, about 78 opioid prescriptions were being written for every 100 people, and 17,000 people in the United States died from an opioid overdose. This study asks, what is the relationship, if any, between contemporary direct-to-physician pharmaceutical marketing practices and opioid mortality in the United States? Contained within an expansive piece of U.S. federal legislation, the Patient Protection and Affordable Care Act of 2010 is a provision which mandates pharmaceutical manufacturers to report marketing payments made to physicians, hospitals, and other relevant healthcare providers. By connecting marketing payments to mortality data at several geospatial levels, the study finds that there is a plausible relationship between the direct-to-physician pharmaceutical marketing and mortality.
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Effect of decompressive craniectomy on outcome after traumatic brain injury : A single center review (2015)The role of decompressive craniectomy as a cure in traumatic brain injuries has been widely been discussed. Therefore our aim was to assess the independent effect of decompressive craniectomy the outcome and mortality of the patient. We conducted an open-cohort retrospective study on adult blunt TBI patients. Patients were divided into three groups; conservative treatment, acute craniotomy and mass lesion evacuation (craniotomy) and decompressive craniectomy. Outcome was assessed using Glasgow Outcome Scale and overall mortality six months after the operation. The adjusted multivariate analysis did not show an independent association between decompressive craniectomy and mortality. Decompressive craniectomy prooved to be an independent risk factor for poor neurological outcome with an OR of 3.06. In conclusion, operating TBI patients with decompressive craniectomy was found to be a life-saving intervention for patients who in other cases were destined to die. For stronger evidence this subject needs more research of a prospective type.
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(2019)Tyypin 1 diabetesta esiintyy Suomessa eniten maailmassa. Tärkeimmät estettävissä olevat lisäsairastavuutta aiheuttavat tekijät ovat sairauden mikro- ja makrovaskulaariset komplikaatiot. The Finnish Diabetic Nephropathy Study eli FinnDiane -seurantatutkimus selvittää näiden lisäsairauksien syntymekanismeja, erityisesti munuaissairauden (nefropatia) osalta, joka tunnetaan merkittävänä kuolleisuuden riskitekijänä. Diabeettinen nefropatia lisää huomattavasti sydän- ja verisuonisairastavuutta, mikä on diabetesta sairastavien potilaiden johtava kuolinsyy. Pulssipaine on systolisen ja diastolisen verenpaineen erotus. Se on noninvasiivinen tapa mitata valtimoiden jäykkyyttä, ja esimerkiksi valtimoiden keskiverenpaineeseen verrattuna huomioi paremmin sekä systolisen että diastolisen verenpaineen vaihtelun. Aiemmassa tutkimuksessamme on osoitettu diabetesta sairastavien kiihtyneestä valtimoiden jäykistymisestä johtuva varhaisempi pulssipaineen nousu jo nuoremmalla iällä. Tässä tutkimuksessa halusimme selvittää, ennustaako kohonnut pulssipaine kuolleisuutta tyypin 1 diabetesta sairastavilla henkilöillä. Tutkimusaineisto koostui 4439 FinnDiane-tutkimukseen osallistuneesta aikuispotilaasta, joilla diabetes oli todettu alle 40-vuotiaana ja joiden insuliinihoito oli aloitettu vuoden sisään diagnoosista. Tiedot kerättiin kyselylomakkeella, jota täydennettiin vastaanotolla. Tiedot kuolemasta saatiin Tilastokeskuksen kuolinrekisteristä. Tietoa kerättiin vuosien 1994-2014 välisenä aikana. Seuranta-ajan mediaani oli 14 vuotta. 713 kuoli seuranta-aikana. Jaoimme potilaat pulssipaineen suhteen neljänneksiin, joita vertailimme Coxin regressio –menetelmää käyttäen. Kolmen matalimman neljänneksen välillä ei saatu merkittävää eroa kuolleisuudessa, mutta korkeimman pulssipaineen neljänneksessä kuolleisuus oli 1,4-kertainen edellisiin verrattuna. Lisäksi analysoimme aineistoa pulssipaineen mediaanin suhteen kahtia jaettuna. Korkeampi pulssipaine liittyi yhdenmukaisesti suurempaan kuolleisuuteen. Muita pulssipaineeseen liittyvän kuolleisuuden riskitekijöitä olivat nefropatia, miessukupuoli ja huono glukoositasapaino.
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(2019)Tyypin 1 diabetesta esiintyy Suomessa eniten maailmassa. Tärkeimmät estettävissä olevat lisäsairastavuutta aiheuttavat tekijät ovat sairauden mikro- ja makrovaskulaariset komplikaatiot. The Finnish Diabetic Nephropathy Study eli FinnDiane -seurantatutkimus selvittää näiden lisäsairauksien syntymekanismeja, erityisesti munuaissairauden (nefropatia) osalta, joka tunnetaan merkittävänä kuolleisuuden riskitekijänä. Diabeettinen nefropatia lisää huomattavasti sydän- ja verisuonisairastavuutta, mikä on diabetesta sairastavien potilaiden johtava kuolinsyy. Pulssipaine on systolisen ja diastolisen verenpaineen erotus. Se on noninvasiivinen tapa mitata valtimoiden jäykkyyttä, ja esimerkiksi valtimoiden keskiverenpaineeseen verrattuna huomioi paremmin sekä systolisen että diastolisen verenpaineen vaihtelun. Aiemmassa tutkimuksessamme on osoitettu diabetesta sairastavien kiihtyneestä valtimoiden jäykistymisestä johtuva varhaisempi pulssipaineen nousu jo nuoremmalla iällä. Tässä tutkimuksessa halusimme selvittää, ennustaako kohonnut pulssipaine kuolleisuutta tyypin 1 diabetesta sairastavilla henkilöillä. Tutkimusaineisto koostui 4439 FinnDiane-tutkimukseen osallistuneesta aikuispotilaasta, joilla diabetes oli todettu alle 40-vuotiaana ja joiden insuliinihoito oli aloitettu vuoden sisään diagnoosista. Tiedot kerättiin kyselylomakkeella, jota täydennettiin vastaanotolla. Tiedot kuolemasta saatiin Tilastokeskuksen kuolinrekisteristä. Tietoa kerättiin vuosien 1994-2014 välisenä aikana. Seuranta-ajan mediaani oli 14 vuotta. 713 kuoli seuranta-aikana. Jaoimme potilaat pulssipaineen suhteen neljänneksiin, joita vertailimme Coxin regressio –menetelmää käyttäen. Kolmen matalimman neljänneksen välillä ei saatu merkittävää eroa kuolleisuudessa, mutta korkeimman pulssipaineen neljänneksessä kuolleisuus oli 1,4-kertainen edellisiin verrattuna. Lisäksi analysoimme aineistoa pulssipaineen mediaanin suhteen kahtia jaettuna. Korkeampi pulssipaine liittyi yhdenmukaisesti suurempaan kuolleisuuteen. Muita pulssipaineeseen liittyvän kuolleisuuden riskitekijöitä olivat nefropatia, miessukupuoli ja huono glukoositasapaino.
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(2023)Tausta Olkavarren murtumat ovat vammoina verrattain yleisiä ja niitä luokitellaan murtuman sijainnin sekä murtuman morfologian mukaan. Epidemiologiset katsaukset auttavat ymmärtämään vammojen taustalla olevia tekijöitä sekä luovat perustaa tulevaisuuden tutkimustyölle. Toistaiseksi laajoja olkavarren murtumiin kohdistuvia epidemiologisia tutkimuksia on julkaistu vain muutamia. Aineisto ja menetelmät Analysoimme retrospektiivisesti vuosina 2006–2016 Töölön sairaalassa hoidossa olleiden olkavarren murtuman saaneiden aikuispotilaiden sairauskertomukset. Me keräsimme potilastietojärjestelmistä potilaita koskevia taustatietoja ja murtumaan liittyen vammamekanismin ja -ajan, liitännäisvammat sekä laskimme kuolleisuuden vuoden kuluessa vammasta. Löydökset 11 vuoden aikana Töölön sairaalassa hoidettiin 914 potilasta (489 naispotilasta, mediaani-ikä 61,4 vuotta; 425 miespotilasta, mediaani-ikä 50,4 vuotta), joilla oli yhteensä 936 olkavarren murtumaa. Yli 60 % näistä murtumista johtui kaatumisesta samalla tasolla. Potilaiden ikäjakauma oli kaksihuippuinen: eniten murtumia esiintyi iäkkäissä naisissa sekä nuorissa miehissä. Jaoimme olkavarren murtumat 1) tyypillisiin traumaattisiin murtumiin, 2) periproteettisiin sekä 3) patologisiin murtumiin. 872:sta tyypillisestä murtumasta 3,0 % oli avoimia murtumia. Periproteettisia murtumia oli 24 (2,6 %) ja patologisia murtumia 40 (4,3 %). 24 %:lla murtumapotilaista oli liitännäisvammoja, joista yleisin oli primaarinen radiaalihermon halvaus (10 %). Primaarinen radiaalihermon halvaus oli yleisempää distaalisen olkavarren murtumissa sekä korkeaenergisissä vammoissa verrattuna muihin murtumiin. Murtuman jälkeinen ensimmäisen vuoden kuolleisuus oli 9,2 %. Pohdinta Tutkimuksemme mukaan olkavarren murtuma johtuu useimmin kaatumisesta samalla tasolla. Yleisin liitännäisvamma oli primaarinen radiaalihermon halvaus. Toteamamme olkavarren murtumien kaksihuippuinen ikäjakauma on yhdenmukainen aiemman kirjallisuuden kanssa.
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(2023)Tausta Olkavarren murtumat ovat vammoina verrattain yleisiä ja niitä luokitellaan murtuman sijainnin sekä murtuman morfologian mukaan. Epidemiologiset katsaukset auttavat ymmärtämään vammojen taustalla olevia tekijöitä sekä luovat perustaa tulevaisuuden tutkimustyölle. Toistaiseksi laajoja olkavarren murtumiin kohdistuvia epidemiologisia tutkimuksia on julkaistu vain muutamia. Aineisto ja menetelmät Analysoimme retrospektiivisesti vuosina 2006–2016 Töölön sairaalassa hoidossa olleiden olkavarren murtuman saaneiden aikuispotilaiden sairauskertomukset. Me keräsimme potilastietojärjestelmistä potilaita koskevia taustatietoja ja murtumaan liittyen vammamekanismin ja -ajan, liitännäisvammat sekä laskimme kuolleisuuden vuoden kuluessa vammasta. Löydökset 11 vuoden aikana Töölön sairaalassa hoidettiin 914 potilasta (489 naispotilasta, mediaani-ikä 61,4 vuotta; 425 miespotilasta, mediaani-ikä 50,4 vuotta), joilla oli yhteensä 936 olkavarren murtumaa. Yli 60 % näistä murtumista johtui kaatumisesta samalla tasolla. Potilaiden ikäjakauma oli kaksihuippuinen: eniten murtumia esiintyi iäkkäissä naisissa sekä nuorissa miehissä. Jaoimme olkavarren murtumat 1) tyypillisiin traumaattisiin murtumiin, 2) periproteettisiin sekä 3) patologisiin murtumiin. 872:sta tyypillisestä murtumasta 3,0 % oli avoimia murtumia. Periproteettisia murtumia oli 24 (2,6 %) ja patologisia murtumia 40 (4,3 %). 24 %:lla murtumapotilaista oli liitännäisvammoja, joista yleisin oli primaarinen radiaalihermon halvaus (10 %). Primaarinen radiaalihermon halvaus oli yleisempää distaalisen olkavarren murtumissa sekä korkeaenergisissä vammoissa verrattuna muihin murtumiin. Murtuman jälkeinen ensimmäisen vuoden kuolleisuus oli 9,2 %. Pohdinta Tutkimuksemme mukaan olkavarren murtuma johtuu useimmin kaatumisesta samalla tasolla. Yleisin liitännäisvamma oli primaarinen radiaalihermon halvaus. Toteamamme olkavarren murtumien kaksihuippuinen ikäjakauma on yhdenmukainen aiemman kirjallisuuden kanssa.
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(2019)Astmaa sairastavilla aikuisilla havaittiin suurentunut kokonaiskuolleisuus verrattuna kaltaistettuihin verrokkihenkilöihin. Tutkimuksessa käytettiin vuonna 1997 tehtyä kyselytutkimusta, jossa kartoitettiin aikuisiän astmaan liittyviä riskitekijöitä kuten esimerkiksi ammattia, tupakointia, lapsuuden elinympäristöä ja lemmikkieläimiä. Kyselytutkimusta täydennettiin Tilastokeskuksen keräämillä kuolinsyyrekisteritiedoilla yli 15 vuoden ajalta. Tutkimukseen osallistui 1052 yli 30-vuotiasta astmaatikkoa ja 1889 sukupuolen, iän ja asuinpaikan mukaan kaltaistettua verrokkia. Kuolleisuutta ja kuolinsyytä selittävissä malleissa ryhmien välillä vakioitiin ikä, sukupuoli, tupakointi, painoindeksi ja koulutustaso. Keskimäärin 15,6 vuoden pituisena seuranta-aikana astmaa sairastavista aikuisista kuoli 221 ja verrokeista 335 henkilöä. Astmaa sairastavilla oli suurentunut kokonaiskuolleisuus (vakioitu HR 1.25; 95% CI 1.05-1.49, P=0.011). Sydän- ja verisuonisairaudet olivat yleisin kuolinsyy molemmissa ryhmissä, mutta astmaa sairastavien ja verrokkien välillä ei ollut tilastollisesti merkitsevää eroa sydänkuolleisuudessa (vakioitu HR 1.23, 0.93–1.63, P=0.145). Kuolinsyinä keuhkoahtaumatauti (vakioitu HR 12.0, 4.18–34.2, P<0.001) ja hengityselinten syövät (vakioitu HR 2.35, 1.25–4.42, P=0.008) olivat yleisempiä astmaatikoilla. Astmaa sairastavilla tupakointi ja vaikeat astmaoireet olivat yhteydessä lisääntyneeseen kuolemanriskiin ja allerginen nuha ja/tai silmätulehdus vähentyneeseen kuolemanriskiin. Verrokeilla tupakointi ja ylipaino lisäsivät yleistä kuolleisuutta, kun taas naissukupuoli vähensi kuolleisuusriskiä. Tupakoinnin lopettaminen alentaa kokonaiskuolleisuutta sekä astmaa sairastavilla että astmaa sairastamattomilla. Allerginen nuha ja/tai silmätulehdus liittyy alentuneeseen kuolleisuuteen vain astmaa sairastavilla, mikä saattaa johtua tupakoimattomuudesta tai vähemmän letaalista allergisesta astmatyypistä.
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(2017)This thesis joins the eternal process of reaching for the unreachable, mysterious space of non-existence. Instead of defining anything or offering any answers, it makes portraits of a particular phenomenon: the question of remembrance and death in a context of today. What kind of scenarios have been offered for our digital afterlife? How do we want to be remembered after death as our lives become more difficult to grasp physically? We will meet a man who travels around the world with an uncanny robot, and listen to an artist in the process of inventing an interactive form for expressing grief through metaphysical dialogue. We will explore ideas of an entrepreneur who offers you a chance to live (symbolically) forever as an avatar, and we will focus on a hybrid eternity project, transforming rituals of memorising into forms that may speak more accurately to the mortals of the digital world. We will imagine a never-ending conversation between two lovers. Behind this curiosity towards the immortal enigma, there lies a wider question of whether our ’less physical’ lives could make us re-imagine, and possibly even notice changes in our beliefs and thoughts about death and remembering. The methodology of this work trusts in the power of human conversation. Through semi-structured, qualitative interviews with a limited amount of people, the thesis searches for scenarios of alternative futures for the culturally shifting rites of passage. Inspired by narrative approach to research and life, stories are valued as ever-changing material through which we construct our realities – and ourselves. What kind of narratives do the present-day technologies encourage us to create? How might our increasingly digital lives be changing the way we memorise and mourn? This work offers a speculative theoretical meditation to a few alternative futures of remembering: apocalyptic self-narratives that make the border between fiction and fact seem obscure.
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(2023)Tutkielmassa selvitetään, onko kilpirauhasen subkliinisillä toimintahäiriöillä yhteyttä lisääntyneeseen sydänkuolleisuuteen. Kilpirauhanen on umpieritteinen rauhanen, jonka erittämillä kilpirauhashormoneilla on tärkeä rooli ihmisen peruselintoimintojen säätelyssä. Kilpirauhasen toimintahäiriöllä tarkoitetaan tilaa, jossa kilpirauhanen tuottaa ja erittää liiallisia tai riittämättömiä määriä kilpirauhashormoneja. Toimintahäiriöiden subkliiniset muodot viittaavat lievempiin häiriöihin, joissa laboratoriokokein määritellyt plasman kilpirauhashormonipitoisuudet ovat normaalit, mutta kyseisten hormonien eritystä säätelevän tyreotropiini-hormonin pitoisuudet ovat poikkeavat. Kilpirauhasen toimintahäiriöt ovat yleisiä ja iskeemiset sydänkuolemat ovat olleet pitkään yleisin yksittäinen kuolinsyy Suomessa, joten mikäli yhteys näiden välillä löytyy, voi sen vaikutus väestötasolla olla merkittävä. Suomessa on käynnissä CARING-tutkimus (CAncer Risk and INsulin analoGues), joka koostuu diabetesta sairastavista henkilöistä ja heidän verrokeistaan. Tämän opinnäytetyön aineisto on anonymisoitu osa-aineisto CARING-tutkimuksesta. Kansaneläkelaitokselta on pyydetty tiedot tutkittavien reseptilääkeostoista ja erityiskorvausoikeuksista sekä HUSilta heidän laboratoriomittauksia ja niiden tuloksia. Tilastokeskuksesta on pyydetty tiedot kuolinsyistä. Kilpirauhasen toiminnan vaikutusta iskeemiseen sydänkuolleisuuteen analysoitiin käyttämällä Poissonin regressiomallia. Tutkielman tulokset viittaavat siihen, että kilpirauhasen subkliininen vajaa- ja liikatoiminta lisäävät molemmat iskeemisen sydänkuoleman riskiä. Subkliinisen vajaatoiminnan osalta riski kasvaa tutkimuksen perusteella lähes 50 %, mikä on merkittävää ottaen huomioon iskeemisten sydänkuolemien ja kilpirauhasen toimintahäiriöiden yleisyyden Suomessa. Tutkimuksen perusteella ei voi arvioida kilpirauhasen subkliinisten toimintahäiriöiden hoidon hyötyjä, ja jatkotutkimukset tämän suhteen olisivatkin tarpeellisia.
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