Medcare Foundation

Äänekoski, Finland

Medcare Foundation

Äänekoski, Finland
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Kumpu M.,Valio Ltd | Kekkonen R.A.,Valio Ltd | Kautiainen H.,Medcare Foundation | Kautiainen H.,Central Finland Central Hospital | And 8 more authors.
European Journal of Clinical Nutrition | Year: 2012

Background/Objectives:To determine whether long-term daily consumption of milk containing probiotic Lactobacillus rhamnosus GG (GG) decreases respiratory illness in children.Subjects/Methods:A randomized, double-blind, placebo-controlled trial was conducted with 523 children aged 2-6 years attending day care centers in Finland. Subjects received either normal milk or the same milk with GG on three daily meals for 28 weeks. Daily recording of childrens symptoms was done by parents. Primary outcome data from 501 subjects were available for analysis, and data from 128 subjects were analyzed as completed cases in terms of recovery of GG in fecal samples.Results:Number of days with at least one respiratory symptom in all subjects was 5.03/month (95% confidence interval (CI): 4.92-5.15) in the GG group and 5.17/month (95% CI: 5.05-5.29) in the placebo group incidence rate ratio (IRR) 0.97; 95% CI: 0.94-1.00; P0.098). In the completed cases, the figures were 4.71 days/month (95% CI: 4.52-4.90) in the GG group and 5.67 days/month (95% CI: 5.40-5.94) in the placebo group (IRR 0.83; 95% CI: 0.78-0.88; P0.001).Conclusions:Consumption of GG reduced the occurence of respiratory illness in children attending day care centers in the completed cases subgroup, but not in the total population. Thus, future clinical trials are warranted to clarify the association between fecal recovery of a probiotic and the symptom prevalence. © 2012 Macmillan Publishers Limited All rights reserved.

Rantalaiho V.M.,University of Tampere | Kautiainen H.,Kuopio University Hospital | Jarvenpaa S.,Medcare Foundation | Virta L.,Social Insurance Institution | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objectives: To study whether the work disability (WD) rates in early rheumatoid arthritis (RA) have changed in Finland, where the treatment of RA has long been active but has intensified further since 2000. Methods: All incident non-retired patients with RA of working age (18-64 years) in a nationwide register maintained by the Finnish Social Insurance Institution from 1 January 2000 to 31 December 2007 were identified. Patient cohorts were analysed in 2-year time periods (2000-1, 2002-3, 2004-5, 2006-7) and initial disease-modifying antirheumatic drugs (DMARDs) were elucidated from the drug purchase register. The incidence of continuous WD in the RA cohorts as well as in the entire Finnish population up to 31 December 2008 was analysed. Results: A total of 7831 patients were identified (71% women, 61% rheumatoid factor-positive). Throughout the follow-up period the use of methotrexate and combination DMARDs as the initial treatment of early RA increased. During the first 2 years the incidence of RA-related continuous WD was 8.9%, 9.4%, 7.2% and 4.8% in the year cohorts, respectively (p<0.001 for linearity). Compared with the entire Finnish population, the age- and sex-stratified standardised incidence ratio of a WD pension due to any cause was 3.69, 3.34, 2.77 and 2.80 in the year cohorts, respectively (p<0.001 for linearity). Conclusions: Since 2000 the frequency of continuous WD in early RA has declined in Finland. The present data allow no explanatory analysis but, at the same time, increasingly active treatment strategies have been introduced.

Korhonen P.E.,Central Satakunta Health Federation of Municipalities | Korhonen P.E.,University of Turku | Kivela S.-L.,University of Turku | Kivela S.-L.,Satakunta Hospital District | And 4 more authors.
Journal of Hypertension | Year: 2011

Background: It has been shown that individuals with hypertension have poorer health-related quality of life (HRQoL) than normotensive individuals. However, little is known about the impact of high blood pressure and the awareness to have hypertension on HRQoL. Methods: In this cross-sectional population-based study, we evaluated 901 cardiovascular risk patients aged 45 to 70 years without serious comorbidities. Hypertension was detected in 497 (55%) of the patients, in whom 137 (28%) had previously undiagnosed hypertension confirmed with home blood pressure measurement. Before the diagnosis of hypertension was made, the patients filled Short-Form Health Survey (SF-36) to assess their HRQoL. Glucose homeostasis was assessed with 2 h oral glucose tolerance test. Results: Patients who were aware of their hypertension had lower scores in physical functioning and general health than patients without hypertension and patients who were unaware of hypertension. There were no differences for mental components of SF-36 between these study groups. The prevalence of obesity and newly diagnosed type 2 diabetes was higher in patients with known hypertension than among other study groups. Conclusion: Impaired HRQoL in hypertensive patients might be secondary to the awareness of hypertension, adverse drug effects, newly diagnosed type 2 diabetes or obesity, not high blood pressure per se. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Korhonen P.E.,Satakunta Hospital District | Korhonen P.E.,Central Satakunta Health Federation of Municipalities | Korhonen P.E.,University of Turku | Seppala T.,University of Turku | And 2 more authors.
Quality of Life Research | Year: 2014

Purpose: Obesity is known to be associated with a range of chronic medical comorbidities, but little is known about the impact of overweight and obesity on health-related quality of life (HRQoL) in persons without chronic diseases. The aim of this study was to assess HRQoL, body mass index (BMI) and health behavior patterns in a community sample of subjects who had no long-lasting medical comorbidities Methods: We assessed HRQoL in 1,187 apparently healthy individuals (mean age 57 ± 7 years), of whom 24 % were classified as normal weight, 49 % as overweight, 20 % as obese and 7 % as very obese. Two different instruments of HRQoL were used: the generic Short-Form Health Survey (SF-36) questionnaire and the preference-based instrument EuroQol (EQ-5D). Results: All physical components of the SF-36 decreased linearly according to BMI categories in women. In men, only poorer physical functioning scale showed linearity with rising BMI. Scores on the mental components of the SF-36 did not differ by BMI categories in either gender. The EQ-5D index and EuroQol visual analogue scale scores decreased linearly with rising BMI only in women. Conclusions: In apparently healthy middle-aged subjects, physical HRQoL decreases with increasing level of BMI and more so in women than in men. Mental components of HRQoL do not differ between the categories of BMI in either gender. © 2013 Springer Science+Business Media Dordrecht.

Korhonen P.E.,Central Satakunta Health Federation of Municipalities | Korhonen P.E.,Satakunta Hospital District | Korhonen P.E.,University of Turku | Kautiainen H.,Central Finland Central Hospital | And 3 more authors.
European Journal of Preventive Cardiology | Year: 2014

Background: Little is known about the prevalence of target organ damage in previously undiagnosed hypertension. Design: Cross-sectional population survey. Methods: We measured ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), electrocardiographically determined left ventricular hypertrophy (ECG-LVH), and cardiometabolic risk factors in subjects with previously undiagnosed hypertension (n=138) and normotensive (n=440) risk subjects, who had metabolic syndrome, glucose disorders, body mass index≥30 kg/m2 or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had established cardiovascular or renal disease or previously diagnosed diabetes. Results: There was no difference (p=0.68) among the studied age-groups in the prevalence of previously undiagnosed hypertension, and no interaction (p=0.10) was found between sex and age groups. Evidence of subclinical organ damage defined as ECG-LVH, ABI≤0.90, or eGFR <60 l/min/1.73m2 were found in 22% of the subjects with previously undiagnosed hypertension, and 8% of the non-hypertensive risk persons (p<0.001). The prevalence of renal insufficiency did not differ between the study groups. Majority of the subjects with previously undiagnosed hypertension also have multiple cardiometabolic risk factors. Conclusions: Among subjects with previously undiagnosed hypertension, one in five patients had evidence of subclinical target organ damage, and three in four patients may be regarded as having high cardiovascular risk. © The European Society of Cardiology 2013 Reprints and permissions:

Korhonen P.E.,University of Turku | Seppala T.,Pori Health Center | Kautiainen H.,Kuopio University Hospital | Jarvenpaa S.,Medcare Foundation | And 2 more authors.
European Journal of Preventive Cardiology | Year: 2012

Background: Data from population studies using ankle-brachial index (ABI) measurement to screen patients for peripheral arterial disease (PAD) demonstrate that most patients with PAD have no symptoms or atypical symptoms besides classical intermittent claudication. We aimed at comparing health-related quality of life and ABI in a cohort of cardiovascular risk persons in a general population. Methods: SF-36 questionnaire was completed and ABI measured from 915 individuals aged 45-70 years with hypertension, metabolic syndrome, pre-diabetes, newly detected diabetes, body mass index ≥30 kg/m2, or a 10-year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation (SCORE) system. None of the subjects had symptoms of intermittent claudication. Results: The prevalence of PAD (defined as ABI ≤0.90) and borderline PAD (defined as ABI 0.91-1.00) were 5% (95% CI 4-7%) and 20% (95% CI 18-23%), respectively. Patients with PAD had significantly lower quality of life dimension scores for physical functioning, role-physical, general health, and vitality than subjects with normal ABI. Among those with borderline PAD, quality of life was reduced on the general health perception compared to subjects with normal ABI. Conclusion: Health-related quality of life of individuals with asymptomatic or atypical PAD or borderline PAD is worse than that of individuals with normal ABI. The level of ABI is independently related to physical functioning. © 2011 The European Society of Cardiology.

Rantalaiho V.,University of Tampere | Korpela M.,University of Tampere | Laasonen L.,University of Helsinki | Kautiainen H.,Orton Foundation | And 8 more authors.
Arthritis Research and Therapy | Year: 2010

Introduction: Early treatment of rheumatoid arthritis (RA) has been shown to retard the development of joint damage for a period of up to 5 years. The aim of this study was to evaluate the radiologic progression beyond that time in patients with early RA initially treated with a combination of three disease-modifying antirheumatic drugs (DMARDs) or a single DMARD.Methods: A cohort of 199 patients with early active RA were initially randomized to receive treatment with a combination of methotrexate, sulfasalazine, and hydroxychloroquine with prednisolone (FIN-RACo), or treatment with a single DMARD (initially, sulfasalazine) with or without prednisolone (SINGLE). After 2 years, the drug-treatment strategy became unrestricted, but still targeted remission. The radiographs of hands and feet were analyzed by using the Larsen score at baseline, 2, 5, and 11 years, and the radiographs of large joints, at 11 years.Results: Sixty-five patients in the FIN-RACo and 65 in the SINGLE group had radiographs of hands and feet available at baseline and at 11 years. The mean change from baseline to 11 years in Larsen score was 17 (95% CI, 12 to 26) in the FIN-RACo group and 27 (95% CI, 22 to 33) in the SINGLE group (P = 0.037). In total, 87% (95% CI, 74 to 94) and 72% (95% CI, 58 to 84) of the patients in the FIN-RACo and the SINGLE treatment arms, respectively, had no erosive changes in large joints at 11 years.Conclusions: Targeting to remission with tight clinical controls results in low radiologic progression in most RA patients. Patients treated initially with a combination of DMARDs have less long-term radiologic damage than do those treated initially with DMARD monotherapy. Trial registration: Current Controlled Trials ISRCTN18445519. © 2010 Rantalaiho et al.; licensee BioMed Central Ltd.

Jauhiainen T.,University of Helsinki | Jauhiainen T.,Valio Ltd | Niittynen L.,Nutritionist Leena Niittynen | Orei M.,VTT Technical Research Center of Finland | And 5 more authors.
European Journal of Clinical Nutrition | Year: 2012

Background/objectives:Lactobacillus helveticus LBK-16H-fermented milk products containing tripeptides isoleucine-proline-proline and valine-proline-proline lower blood pressure in hypertensive subjects using office and home blood pressure registration. The present study was aimed to evaluate the effects of two doses of these lactotripeptides on 24-h ambulatory blood pressure and lipidomics profiles in mildly hypertensive subjects.Subjects/methods:In a randomized, double-blind, placebo-controlled parallel group study, 89 mildly hypertensive subjects ingested, after a 1-month run-in period, a fermented milk drink with 5 mg per day of lactotripeptides during 3 months, and a milk drink with 50 mg per day of lactotripeptides for the following 3 months, or a placebo milk drink without lactotripeptides. Ambulatory blood pressure (24 h) was recorded at baseline and at the end of the intervention periods. Lipidomics profiles were characterized before and after the 6-month intervention.Results:After the second intervention period (50 mg per day of lactotripeptides), systolic and diastolic 24-h blood pressures decreased significantly in the peptide, but not in the placebo group. However, the treatment effects 2.6 mm Hg (95% confidence interval (CI): 5.7 to 0.4) in systolic and 1.3 mm Hg (95% CI: 3.4 to 0.8) in diastolic blood pressure did not reach statistic significance. Ingestion of 5 mg per day of lactotripeptides for 3 months did not lower blood pressure. The peptide group was dominated by decrease in multiple phospholipids (PL).Conclusions:Ingestion of fermented milk with daily dose of 50 mg of lactotripeptides appears to lower elevated blood pressure slightly from the baseline, but not significantly compared with the placebo group and to induce significant decreases in multiple PL. © 2012 Macmillan Publishers Limited.

Saxelin M.,Valio Ltd | Lassig A.,University of Helsinki | Karjalainen H.,Valio Ltd | Tynkkynen S.,Valio Ltd | And 7 more authors.
International Journal of Food Microbiology | Year: 2010

Most clinical studies of probiotics use freeze-dried, powdered bacteria or bacteria packed in capsules. However, probiotics are commercially available in various food matrices, which may affect their persistence in the gastrointestinal tract. The objective of the study was to compare oral and faecal recovery during and after administration of a combination of Lactobacillus rhamnosus GG and LC705, Propionibacterium freudenreichii subsp. shermanii JS, and Bifidobacterium animalis subsp. lactis Bb12 as capsules, yoghurt, or cheese. This randomized, parallel-group, open-label trial (n=36) included a 4-week run-in, 2-week intervention, and 3-week follow-up period. Participants consumed 1010cfu/day of probiotic combination and provided saliva and faecal samples before, during, and after the intervention. Strain-specific real-time PCR was used to quantify the strains. L. rhamnosus GG was the only probiotic strain regularly recovered in saliva samples. During the intervention period it was recovered in the saliva of 88% of the volunteers at least once. No difference was found between the yoghurt and cheese groups. At the end of the intervention, L. rhamnosus GG and LC705 counts were high in faecal samples of all product groups (8.08 and 8.67log10 genome copies/g, respectively). There was no matrix effect on strain quantity in faeces or the recovery time after ceasing the intervention. For P. freudenreichii subsp. shermanii JS and B. animalis subsp. lactis Bb12, a matrix effect was found at the end of the intervention (P<0.01 and P<0.001, respectively) and in the recovery time during follow-up (P<0.05 for both). Yoghurt yielded the highest faecal quantity of JS and Bb12 strains (8.01 and 9.89log10 genome copies/g, respectively). The results showed that the administration matrix did not influence the faecal quantity of lactobacilli, but affected faecal counts of propionibacteria and bifidobacteria that were lower when consumed in cheese. Thus, the consumption of probiotics in yoghurt matrix is highly suitable for studying potential health benefits and capsules provide a comparable means of administration when the viability of the strain in the capsule product is confirmed. © 2010 Elsevier B.V.

Asklof T.,University of Helsinki | Kautiainen H.,Central Finland Central Hospital | Jarvenpaa S.,Medcare Foundation | Haanpaa M.,University of Helsinki | And 2 more authors.
Spine | Year: 2014

OBJECTIVE.: To describe the occurrence of spinal disorders (SDs) resulting in disability pension (DP) in Finland during 1990-2010. SUMMARY OF BACKGROUND DATA.: The indirect cost of SD is excessive. The most significant indirect cost is due to DP. There are no nationwide long-term studies of DP trends caused by SDs. METHODS.: The study setting consisted of Finnish working population (20-64 yr). All new cases were identified from the nationwide register maintained by the Finnish Centre of Pensions from the beginning of 1990 to the end of 2010. The data included sex, age group, year of the DP decision, and the main cause of incapacity (diagnosis) leading to DP. Main outcome measure was DPs due to SDs. RESULTS.: A total of 84,375 individuals (40,415 females; 43,960 males) received DP during the study period. Age- and sex-adjusted incidence rate ratio was 0.45 (95% CI: 0.44-0.46) between time periods of 1990-1994 and 2005-2010. In males, crude incidence in 1990-1994 was 21.0 (95% CI: 20.6-21.3) per 10,000 person-years and in 2005-2010, it was 11.1 (10.9 to 11.3). In females, it was 18.8 (95% CI: 18.5-19.1) and 11.4 (95% CI: 11.1-11.6). During the study period, the overall DP rate also decreased. Age- and sex-adjusted incidence rate ratio was 0.66 (95% CI: 0.65-0.67) between the time periods 1990-1994 and 2005-2010. However, the proportion of DPs due to the SDs of all new DPs was higher in the first half of 1990s than in 2005-2010 (adjusted proportion 19.6% [95% CI: 19.4-19.8] vs. 14.4% [95% CI: 14.2-14.6]). CONCLUSION.: The occurrence of DPs due to SDs has decreased significantly during the period of 1990-2010 in Finland. On the basis of the register data, nonmedical factors and legislative reforms may explain the decrease of DPs more than treatments provided by health care. © 2014, Lippincott Williams & Wilkins.

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