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Astrup A.,Copenhagen University | Carraro R.,University Hospital la Princesa | Finer N.,University College London | Harper A.,Novo Nordisk AS | And 8 more authors.
International Journal of Obesity | Year: 2012

Objective: Having demonstrated short-term weight loss with liraglutide in this group of obese adults, we now evaluate safety/tolerability (primary outcome) and long-term efficacy for sustaining weight loss (secondary outcome) over 2 years.Design:A randomized, double-blind, placebo-controlled 20-week study with 2-year extension (sponsor unblinded at 20 weeks, participants/ investigators at 1 year) in 19 European clinical research centers.Subjects:A total of 564 adults (n90-98 per group; body mass index 30-40 kg m2) enrolled, 398 entered the extension and 268 completed the 2-year trial. Participants received diet (500 kcal deficit per day) and exercise counseling during 2-week run-in, before being randomly assigned (with a telephone or web-based system) to once-daily subcutaneous liraglutide (1.2, 1.8, 2.4 or 3.0 mg, n90-95), placebo (n98) or open-label orlistat (120 mg × 3, n95). After 1 year, liraglutide/placebo recipients switched to liraglutide 2.4 mg, then 3.0 mg (based on 20-week and 1-year results, respectively). The trial ran from January 2007-April 2009 and is registered with Clinicaltrials.gov, number NCT00480909. Results: From randomization to year 1, liraglutide 3.0 mg recipients lost 5.8 kg (95% confidence interval 3.7-8.0) more weight than those on placebo and 3.8 kg (1.6-6.0) more than those on orlistat (P=0.0001; intention-to-treat, last-observation-carried-forward). At year 2, participants on liraglutide 2.4/3.0 mg for the full 2 years (pooled group, n184) lost 3.0 kg (1.3-4.7) more weight than those on orlistat (n95; P=0.001). Completers on liraglutide 2.4/3.0 mg (n92) maintained a 2-year weight loss of 7.8 kg from screening. With liraglutide 3.0 mg, 20-week body fat decreased by 15.4% and lean tissue by 2.0%. The most frequent drug-related side effects were mild to moderate, transient nausea and vomiting. With liraglutide 2.4/3.0 mg, the 2-year prevalence of prediabetes and metabolic syndrome decreased by 52 and 59%, with improvements in blood pressure and lipids.Conclusion:Liraglutide is well tolerated, sustains weight loss over 2 years and improves cardiovascular risk factors. © 2012 Macmillan Publishers Limited All rights reserved.


Nieminen K.,University of Tampere | Nieminen K.,Central Hospital of Kanta Hme | Hiltunen R.,Central Hospital of South Ostrobothnia | Takala T.,Central Hospital of Pijt Hme | And 4 more authors.
American Journal of Obstetrics and Gynecology | Year: 2010

Objective: The objective of the study was to compare anterior colporrhaphy with and without a mesh. Study Design: Two hundred two women with anterior prolapse were assigned to undergo colporrhaphy alone or reinforced with a tailored polypropylene mesh. Before and 2, 12, 24, and 36 months after surgery, the outcome was assessed by examination and standard questions. The primary endpoint was anatomic recurrence of anterior vaginal prolapse. Secondary outcomes were symptom resolution, reoperation, and mesh exposure. Results: Recurrences of anterior vaginal prolapse were noted in 40 of the 97 (41%) in the colporrhaphy group and 14 of 105 (13%) in the mesh group (P < .0001). The number needed to treat was thus 4. The proportion of symptomatic patients, including those with dyspareunia, did not differ between the groups. The mesh erosion rate was 19%. Conclusion: At 3 year follow-up, anterior colporrhaphy with mesh reinforcement significantly reduced anatomic recurrences of anterior vaginal prolapse, but no difference in symptomatic recurrence were noted and the mesh erosion rate was high. The use of mesh was not associated with an increase in dyspareunia. © 2010 Mosby, Inc. All rights reserved.


Axelin A.,University of Turku | Kirjavainen J.,Central Hospital of Central Finland | Salantera S.,University of Turku | Lehtonen L.,University of Turku
European Journal of Pain | Year: 2010

Background: This study was conducted to gain better understanding of the prolonged effects of pain and pain management on preterm infants' sleep. Aim: The hypothesis was that the sleep structure in very preterm infants is different after painful procedures with pain management (facilitated tucking by parents (FTP), oral glucose, and oxycodone) than without pain management (oral water as placebo). Methods: A prospective randomized placebo-controlled cross-over trial design was used. Thirteen-hour polysomnographic recordings were conducted when the study infants (n = 18) were at a post-conceptional age of 28-32 weeks. During the recordings, the standardized nursing care periods were carried out with different forms of pain management administered at 3-h intervals. Sleep structure was analyzed before and after the interventions. The main hypothesis was analyzed using mixed models. Results: During the first post-intervention hour, the amount of rapid eye movement (REM) sleep decreased after all interventions regardless of pain management (p < 0.001). However, the oxycodone treatment further reduced the amount of REM sleep to 48.0% (SD 14.9) compared to other interventions: oral glucose to 64.4% (SD 12.8), (p < 0.001); placebo to 62.9% (SD 16.1), (p < 0.001); and FTP to 61.6% (SD 1.9), (p = 0.004). In addition, sleep onset comprised non-rapid eye movement (NREM) sleep more frequently after oxycodone (50%) compared to placebo (6%, p = 0.006), oral glucose (11%, p = 0.019) or FTP (17%, p = 0.056). Conclusion: Pain management with oxycodone markedly altered the structure of the subsequent sleep period. This reduced amount of REM sleep may have consequences for brain development in preterm infants. © 2009 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.


Helenius K.K.,University of Turku | Helenius K.K.,Central Hospital of Central Finland | Laine M.K.,University of Turku | Tahtinen P.A.,University of Turku | And 2 more authors.
Pediatric Infectious Disease Journal | Year: 2012

BACKGROUND: Tympanometry can indicate middle ear effusion in children referred for tympanostomy tube placement. In outpatient setting, objective adjunctive tools are needed to diagnose the otitis media spectrum. METHODS: We enrolled and followed 515 children aged 6-35 months at primary care level. We compared tympanometry with pneumatic otoscopy and evaluated the proportions of type A, C1, C2, Cs and B tympanograms in relation to specific otoscopic diagnoses in 2206 and 1006 examinations at symptomatic and asymptomatic visits, respectively. RESULTS: At symptomatic visits, different peaked tympanograms were associated with a healthy middle ear as follows: type A in 78%, type C1 in 62%, type C2 in 54% and type Cs in 18% of examinations. In contrast, any peaked tympanogram was related to healthy middle ear in 67% of examinations. Flat (type B) tympanogram was related to otitis media with effusion in 44% and to acute otitis media in 56% of examinations, respectively. At asymptomatic visits, the peaked tympanograms together were associated with a healthy middle ear in 87% of otoscopic examinations. Flat tympanogram indicated otitis media with effusion as well in 87% of examinations. CONCLUSIONS: Tympanometry is not a useful tool in detecting specific otoscopic diagnoses because it cannot distinguish between otitis media with effusion and acute otitis media. However, among outpatients all peaked tympanograms suggest a healthy middle ear and a flat tympanogram is useful in detecting any middle ear effusion. Thus, tympanometry can be used as an adjunctive tool, but accurate diagnosis requires careful pneumatic otoscopy. Copyright © 2012 by Lippincott Williams &Wilkins.


Torronen R.,University of Eastern Finland | Kolehmainen M.,University of Eastern Finland | Sarkkinen E.,University of Eastern Finland | Sarkkinen E.,Foodfiles Ltd. | And 3 more authors.
American Journal of Clinical Nutrition | Year: 2012

Background: Sucrose induces high postprandial glucose and insulin responses. In vitro studies suggest that berries may reduce the digestion and absorption of sucrose and thereby suppress postprandial glycemia, but the evidence in humans is limited. Objective: We investigated the effects of sucrose ingested with blackcurrants (Ribes nigrum) and lingonberries (Vaccinium vitisidaea) on postprandial glucose, insulin, and free fatty acid responses. Design: Twenty healthy women participated in a randomized, controlled, crossover meal study. They consumed whole blackcurrants or lingonberries (150 g served as purées) or blackcurrant or lingonberry nectars (300 mL), each with 35 g added sucrose. Sucrose alone (35 g in 300 mL water) was used as a reference. Blood samples were collected at 0, 15, 30, 45, 60, 90, and 120 min. Results: In comparison with sucrose alone, ingestion of sucrose with whole berries resulted in reduced glucose and insulin concentrations during the first 30 min and a slower decline during the second hour and a significantly improved glycemic profile. Berries prevented the sucrose-induced late postprandial hypoglycemic response and the compensatory free fatty acid rebound. Nearly similar effects were observed when sucrose was consumed with berry nectars. The improved responses were evident despite the higher content of available carbohydrate in the berry and nectar meals, because of the natural sugars present in berries. Conclusions: Blackcurrants and lingonberries, as either whole berries or nectars, optimize the postprandial metabolic responses to sucrose. The responses are consistent with delayed digestion of sucrose and consequent slower absorption of glucose. This trial was registered at clinicaltrials.gov as NCT01580150. © 2012 American Society for Nutrition.


Saari J.M.,University of Helsinki | Saari J.M.,Central Hospital of Central Finland
Open Ophthalmology Journal | Year: 2014

Purpose. To study the population-based annual incidence rates of exudative, dry and all cases of symptomatic age-related macular degeneration (AMD) in different age and sex groups. Methods. This is a one year, prospective, population-based study on all consecutive new patients with AMD in the hospital district of Central Finland. The diagnosis was confirmed in all patients with slit lamp biomicroscopy, optical coherence tomography (OCT) using a Spectralis HRA + OCT device, and the Heidelberg Eye Explorer 1.6.2.0 program. Fluorescein angiograms were taken when needed. Results. The population-based annual incidence rates of all cases of symptomatic AMD increased from 0.03% (95% CI, 0.01-0.05%) in the age group 50-59 years to 0.82% (95% CI, 0.55-1.09%) in the age group 85-89 years and were 0.2% (95% CI, 0.17-0.24%) in exudative, 0.11% (95% CI, 0.09-0.14%) in dry, and 0.32% (95% CI, 0.28-0.36%) in all cases of AMD in the age group 60 years and older. During the next 20 years in Central Finland the population-based annual incidence rates can be estimated to increase to 0.27% (95% CI, 0.24-0.30%) in exudative, to 0.13% (95% CI, 0.11-0.15%) in dry, and to 0.41% (95% CI, 0.37-0.45%) in all cases of AMD in the age group 60 years and older. The population-based annual incidence of AMD did not show statistically significant differences between males and females (p>0.1). Conclusion: The population-based age-group specific annual incidence rates of symptomatic AMD of this study may help to plan health care provision for patients of AMD. © Jukka M. Saari; Licensee Bentham Open.


Thiel A.,University of Helsinki | Mrena J.,University of Helsinki | Mrena J.,Central Hospital of Central Finland | Ristimaki A.,University of Helsinki
Cancer and Metastasis Reviews | Year: 2011

Gastric cancer remains a leading cause of cancer-related deaths worldwide, although its incidence has been steadily declining during recent decades. Expression of cyclooxygenase-2 (COX-2) is elevated in gastric carcinomas and in their precursor lesions. COX-2 expression associates with reduced survival in gastric cancer patients, and it has also been shown to be an independent factor of poor prognosis. Several molecular mechanisms are involved in the regulation of COX-2 expression in gastric cancer cell lines, including signal transduction pathways activated by Helicobacter pylori. In gastric tumor models in vivo the role of COX-2 seems to be predominantly to facilitate tumor promotion and growth. © 2011 Springer Science+Business Media, LLC.


Kellokumpu I.H.,Central Hospital of Central Finland | Kairaluoma M.I.,Central Hospital of Central Finland | Nuorva K.P.,Central Hospital of Central Finland | Kautiainen H.J.,Central Hospital of Central Finland | And 2 more authors.
Diseases of the Colon and Rectum | Year: 2012

BACKGROUND: Laparoscopic resection for rectal cancer has remained controversial because of the lack of level 1 evidence regarding oncologic safety and long-term survival. OBJECTIVES: The aim of this study was to assess the impact of laparoscopic versus open resection for rectal cancer on clinical and oncologic outcome in the multimodal setting. DESIGN: This is a review of prospectively gathered data from a single-institution rectal cancer database. SETTINGS: This study was conducted in the Central Hospital of Central Finland. PATIENTS: From January 1999 to December 2006, 191 selected patients were included. INTERVENTIONS: One hundred patients underwent laparoscopic resection, and 91 patients, also suitable for laparoscopic surgery, underwent open major rectal resection in the multimodal setting. MAIN OUTCOME MEASURES: The main measures of outcome were early recovery and short- and long-term morbidity; local recurrence and survival were secondary outcomes. LIMITATIONS: This is not a randomized study. RESULTS: The study groups were balanced for baseline characteristics. Conversion rate to open surgery was 22%. Laparoscopic surgery resulted in significantly less bleeding (175 mL vs 500 mL, p < 0.001), 1 day earlier recovery of normal diet (3 days vs 4 days, p = 0.001), and shorter postoperative hospital stay (7 days vs 9 days, p < 0.001). Postoperative 30-day mortality (1% vs 3%), morbidity (31% vs 43%), readmission (11% vs 15%), and reoperation (6% vs 9%) rates were similar in the 2 groups, but significantly fewer patients in the laparoscopic group had long-term complications (19% vs 36%, p = 0.033). The 5-year disease-free survival (78% vs 80%, p = 0.74) and local recurrence (5% vs 6%, p = 0.66) rates were similar in the laparoscopic and open group for those 175 patients treated for cure. CONCLUSION: Laparoscopic surgery resulted in faster postoperative recovery and fewer long-term complications than open surgery without apparently compromising the long-term oncologic outcome. Our results indicate that laparoscopic rectal resection is an acceptable alternative to open surgery in selected patients with rectal cancer. © The ASCRS 2012.


Parssinen O.,Central Hospital of Central Finland | Kauppinen M.,Central Hospital of Central Finland | Viljanen A.,Central Hospital of Central Finland
Acta ophthalmologica | Year: 2014

PURPOSE: To examine myopic progression and factors connected with myopic progression.METHODS: Myopic schoolchildren, with no previous spectacles, 119 boys and 121 girls, were recruited during 1983-1984 to a randomized 3-year clinical trial of bifocal treatment of myopia with a subsequent 20-year follow-up. Participants' mean age at Baseline was 10.9, ranging from 8.7 to 12.8 years. An ophthalmological examination was carried out annually for 3 years and twice thereafter at ca. 10-year intervals. Additional refraction values were received from prescriptions issued by different ophthalmologists and opticians. Altogether, 1915 refraction values were available. Reading distance and accommodation were measured at each control visit. Data on parents' myopia, daily time spent on reading and close work, outdoor activities and watching television were gathered with a structured questionnaire.RESULTS: Using bifocals (+1.75 add) or reading without glasses or accommodation stimulus during the 3-year period in childhood did not correlate with adulthood refraction. Short reading distance in childhood predicted higher adulthood myopia among females. The factors predicting faster myopic progression were parents' myopia and less time spent on sports and outdoor activities at childhood. Time spent on reading and close work in childhood was related to myopic progression during the first 3 years but did not predict adulthood myopia. Myopia throughout follow-up was higher among those who watched television <3 hr daily than those who spent more time watching television. Mean myopic progression 8 years after age 20-24 was -0.45 D ± 0.71 (SD), and in 45% of cases, progression was ≥0.5 D.CONCLUSIONS: In nearly half of the cases, myopia beginning at school continued to progress into adulthood. Higher adulthood myopia was mainly related to parents' myopia and less time spent on sports and outdoor activities in childhood. © 2014 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.


Parssinen O.,Central Hospital of Central Finland
Acta Ophthalmologica | Year: 2012

Purpose: To study change in the prevalence of myopia in Finland during the 20th century. Methods: A review of the literature on the prevalence of myopia in Finland. Results: During the 20th century, the prevalence of myopia among 7- to 8-year-old schoolchildren did not increase in Finland and varied between 0.5% and 1.9%. Among 14- to 15-year-old school children, myopia doubled to about 21%. Among adults born during the first three decades of the 20th century, the prevalence of myopia was <10%, whereas among those born during the second half of the 20th century, the prevalence rose to 21-30%. The change in mean refraction was towards myopia. Conclusions: During the course of the 20th century, myopia among teenagers and adults in Finland significantly increased and the mean change in refraction was towards myopia. Increased education is proposed as the main reason behind these changes. © 2011 The Author. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

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