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Saarni S.I.,Finnish National Institute for Health and Welfare | Saarni S.I.,University of Helsinki | Anttila H.,Finnish National Institute for Health and Welfare | Saarni S.E.,Finnish National Institute for Health and Welfare | And 4 more authors.
Obesity Surgery | Year: 2011

New surgical technologies may challenge societal values, and their adoption may lead to ethical challenges. Despite proven cost-effectiveness, obesity (bariatric) surgery and its public funding have been questioned on ethical arguments relating to, for example, the self-inflicted or non-disease nature of obesity. Our aim was to analyze the ethical issues relevant to bariatric surgery. A comprehensive health technology assessment was conducted on bariatric surgery for morbid obesity using the EUnetHTA method, including a fully integrated ethical analysis. The ethical arguments suggesting that obesity should not be surgically treated because it is self-inflicted were rejected. Medicalization of obesity may have both positive and negative effects that impact the various stakeholders differently, thus being difficult to balance. Informing bariatric surgery patients and actively supporting their autonomy is exceptionally important, as the benefits and harms of both obesity and bariatric surgery are complex, and the outcome depends on how well the patient understands and adheres to the life-long changes in eating habits required. Justice considerations are important in organizing surgical treatment of obesity, as the obese are discriminated against in many ways and obesity is more common in socioeconomically disadvantaged populations who might have problems of access to treatments. Obesity should be treated like other diseases in health care, and obesity surgery rationed like other cost-effective treatments. Positive actions to ensure patient autonomy and just access to surgical treatments may be warranted. © 2011 Springer Science + Business Media, LLC. Source

Pitkala K.H.,University of Helsinki | Poysti M.M.,University of Helsinki | Poysti M.M.,Social Insurance Institution of Finland | Laakkonen M.-L.,University of Helsinki | And 6 more authors.
JAMA Internal Medicine | Year: 2013

Importance: Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD). Objectives: To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services. Design: A randomized controlled trial. Setting and Participants: A total of 210 home-dwelling patients with AD living with their spousal caregiver. Interventions: The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care. Main Outcome Measures: The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services. Results: All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were -7.1 (95% CI, -3.7 to -10.5), -10.3 (95% CI, -6.7 to -13.9), and -14.4 (95% CI, -10.9 to -18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25 112 (95% CI, $17 642 to $32 581) (P = .13 for comparison with the CG), $22 066 in the GE group ($15 931 to $28 199; P = .03 vs CG), and $34 121 ($24 559 to $43 681) in the CG. Conclusions and Relevance: An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects. Trial Registration: anzctr.org.au Identifier: ACTRN12608000037303 ©2013 American Medical Association. All rights reserved. Source

Tseveenjav B.,University of Helsinki | Tseveenjav B.,City of Helsinki Health Center | Suominen A.L.,Finnish National Institute for Health and Welfare | Suominen A.L.,University of Eastern Finland | And 3 more authors.
European Journal of Oral Sciences | Year: 2012

The aim of this study was to assess oral health-related behaviours among dentate adults. As part of the comprehensive Finnish Health 2000 Survey, this study included dentate subjects, 30-64yr of age (n=4,417). Based on interview and questionnaire data, information on nine oral health-related habits was elicited. On average, study subjects reported 4.4 (SD=1.5) oral health-promoting behaviours among the nine behaviours investigated, the mean number differing according to subjects' gender, educational level, marital status, and employment status. Older age, higher level of education, cohabiting, and being employed were indications of higher numbers of oral health-promoting habits than were younger age, lower levels of education, being single, or being unemployed. Oral health-promotion activities should be tailored and targeted in terms of adults' socio-economic and demographic characteristics, and directed especially towards men, those with lower education, and those who are single or unemployed. © 2012 Eur J Oral Sci. Source

Pitkala K.,University of Helsinki | Savikko N.,University of Helsinki | Poysti M.,University of Helsinki | Poysti M.,The Social Insurance Institution of Finland | And 3 more authors.
Experimental Gerontology | Year: 2013

Numerous trials have shown that physical activity and exercise training have beneficial effects in general older populations. However, few have studied its effectiveness among people with dementia. The aim of this systematic review is to examine the efficacy of trials using a rigorous randomised, controlled design and including physical activity or exercise as a major component of intervention on the physical functioning, mobility and functional limitations of people with dementia. We found 20 randomised controlled trials that included a total of 1378 participants. Of these, only three were of high methodological quality, and six of moderate quality. Nevertheless, these studies consistently show that intensive physical rehabilitation enhances mobility and, when administered over a long period, may also improve the physical functioning of patients with dementia. © 2012 Elsevier Inc. Source

Suhonen S.,University of Helsinki | Suhonen S.,City of Helsinki Health Center | Tikka M.,University of Helsinki | Kivinen S.,University of Helsinki | And 2 more authors.
Contraception | Year: 2011

Background: We studied whether it is possible to predict severity of pain during medical abortion. We also studied how well medical staff recognizes the pain perceived by these women. Study Design: Fifty-four women (mean age 26 years, range 18-42 years) undergoing medical abortion before the 64th day of gestation (mean 47 days, range 32-63 days) were asked to estimate their menstrual pain and the pain perceived during medical abortion by visual analogue scale (VAS). Both the intensity and unpleasantness of pain were evaluated separately. The nurses observing the women undergoing medical abortion at the outpatient clinic were asked to estimate by VAS scores their perception of the intensity of pain of the women. Results: Higher age (magnitude r=-0.30; unpleasantness r=-0.28), increasing number of previous pregnancies (r=-0.34; r=-0.36) and deliveries (r=-0.57; r=-0.60) correlated negatively and advanced gestational length (r=0.31; r=0.32) positively with magnitude and unpleasantness of pain evoked by abortion. Twenty-eight (51.8%) of the women were nulliparous. Pain during medical abortion correlates positively (magnitude r=0.34; unpleasantness r=.0.41) with pain during menstruation. There was no difference between either the intensity or unpleasantness of pain during menstruation and pain during medical abortion. Medical staff accurately assessed the pain women experienced during medication abortion (magnitude r=0.83; unpleasantness r=0.79). Conclusion: Pain during medical abortion correlates with the pain during menstruation. This finding makes counseling of women choosing medical abortion easier and helps in planning the pain relief needed. © 2011 Elsevier Inc. Source

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