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Jyväskylä, Finland

McDonnell J.,Evaluation Research Support Unit | Barnes A.,Arnhem Land Progress Aboriginal Corporation | Dhurrkay J.G.,YaluMarnggithinyaraw Center | Bailie R.S.,Primary Health Care Unit
Medical Journal of Australia | Year: 2010

Objective: To examine the impact of a government income management program on store sales. Design and setting: An interrupted time series analysis of sales data in 10 stores in 10 remote Northern Territory communities during 1 October 2006 to 30 September 2009, which included an 18-month period before income management; a 4-6-month period after the introduction of income management; a 3-month period that coincided with a government stimulus payment; and the remaining income-management period. Main outcome measures: Trends in (i) total store sales; (ii) total food and beverage sales; (iii) fruit and vegetables sales; (iv) soft drink sales; and v) tobacco sales. Results: Modest monthly increases indicative of inflation were found for all outcome measures before the introduction of income management, except for soft drink sales, which remained constant. No change from the increasing rate of monthly sales before income management was seen in the first 4-6 months of income management or for the income-management period thereafter for total store sales, food and beverage sales, fruit and vegetable sales and tobacco sales. The rate of soft drink sales declined significantly with the introduction of income management and then increased significantly thereafter. The 3-month government stimulus payment period (during the period of income management) was associated with a significant increase in the rate of sales for all outcome measures. Conclusion: Income management independent of the government stimulus payment appears to have had no beneficial effect on tobacco and cigarette sales, soft drink or fruit and vegetable sales.

Tinderholt Myrhaug H.,Oslo University College | Ostensjo S.,Oslo University College | Larun L.,Primary Health Care Unit | Odgaard-Jensen J.,Global Health Unit | Jahnsen R.,University of Oslo
BMC pediatrics | Year: 2014

BACKGROUND: Young children with cerebral palsy (CP) receive a variety of interventions to prevent and/or reduce activity limitations and participation restrictions. Some of these interventions are intensive, and it is a challenge to identify the optimal intensity. Therefore, the objective of this systematic review was to describe and categorise intensive motor function and functional skills training among young children with CP, to summarise the effects of these interventions, and to examine characteristics that may contribute to explain the variations in these effects.METHODS: Ten databases were searched for controlled studies that included young children (mean age less than seven years old) with CP and assessments of the effects of intensive motor function and functional skills training. The studies were critically assessed by the Risk of bias tool (RoB) and categorised for intensity and contexts of interventions. Standardised mean difference were computed for outcomes, and summarised descriptively or in meta-analyses.RESULTS: Thirty-eight studies were included. Studies that targeted gross motor function were fewer, older and with lower frequency of training sessions over longer training periods than studies that targeted hand function. Home training was most common in studies on hand function and functional skills, and often increased the amount of training. The effects of constraint induced movement therapy (CIMT) on hand function and functional skills were summarised in six meta-analyses, which supported the existing evidence of CIMT. In a majority of the included studies, equal improvements were identified between intensive intervention and conventional therapy or between two different intensive interventions.CONCLUSIONS: Different types of training, different intensities and different contexts between studies that targeted gross and fine motor function might explain some of the observed effect variations. Home training may increase the amount of training, but are less controllable. These factors may have contributed to the observed variations in the effectiveness of CIMT. Rigorous research on intensive gross motor training is needed.SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42013004023.

Salminen P.,University of Turku | Paajanen H.,Mikkeli Central Hospital | Paajanen H.,University of Eastern Finland | Rautio T.,University of Oulu | And 13 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

IMPORTANCE: An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis. OBJECTIVE: To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS: The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland. The trial enrolled 530 patients aged 18 to 60 years with uncomplicated acute appendicitis confirmed by a CT scan. Patients were randomly assigned to early appendectomy or antibiotic treatment with a 1-year follow-up period. INTERVENTIONS: Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500mg once daily) and metronidazole (500mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy. MAIN OUTCOMES AND MEASURES: The primary end point for the surgical interventionwas the successful completion of an appendectomy. The primary end point for antibiotic-treated patients was discharge from the hospital without the need for surgery and no recurrent appendicitis during a 1-year follow-up period. RESULTS: Therewere 273 patients in the surgical group and 257 in the antibiotic group.Of 273 patients in the surgical group, all but 1 underwent successful appendectomy, resulting in a success rate of 99.6%(95%CI, 98.0%to 100.0%). In the antibiotic group, 70patients (27.3%; 95%CI, 22.0%to 33.2%) underwent appendectomy within 1 year of initial presentation for appendicitis. Of the 256 patients available for follow-up in the antibiotic group, 186 (72.7%; 95%CI, 66.8%to 78.0%)did not require surgery. The intention-to-treat analysis yielded a difference in treatment efficacy between groups of -27.0%(95%CI, -31.6%to ∞) (P =.89). Given the prespecified noninferiority margin of 24%, wewere unable to demonstrate noninferiority of antibiotic treatment relative to surgery. Of the 70patients randomized to antibiotic treatmentwho subsequently underwent appendectomy, 58 (82.9%; 95%CI, 72.0% to 90.8%) had uncomplicated appendicitis,7(10.0%;95%CI,4.1% to 19.5%) had complicated acute appendicitis, and 5 (7.1%; 95%CI, 2.4% to 15.9%) did not have appendicitis but received appendectomy for suspected recurrence. Therewere no intra-abdominal abscesses or other major complications associated with delayed appendectomy in patients randomized to antibiotic treatment. CONCLUSIONS AND RELEVANCE: Among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the prespecified criterion for noninferiority compared with appendectomy. Most patients randomized to antibiotic treatment for uncomplicated appendicitis did not require appendectomy during the 1-year follow-up period, and those who required appendectomy did not experience significant complications. Copyright © 2015 American Medical Association. All rights reserved.

Mattila K.,University of Turku | Buttgereit F.,Charite - Medical University of Berlin | Tuominen R.,University of Turku | Tuominen R.,Primary Health Care Unit
Rheumatology International | Year: 2014

Work disability remains a considerable problem for many patients with rheumatoid arthritis (RA). Morning stiffness is a symptom of RA associated with early retirement from work and with impaired functional ability. We aimed to explore the patient’s perception of the impact of morning stiffness on the working life of patients with RA. A survey was conducted in 11 European countries. Patients of working age, with RA for ≥6 months and morning stiffness ≥3 mornings a week, were interviewed by telephone using a structured questionnaire. Responses were assessed in the total sample and in subgroups defined by severity and duration of morning stiffness and by country. A total of 1,061 respondents completed the survey, 534 were working, 224 were retired and the rest were, i.e. homemakers and unemployed. Among the 534 working respondents, RA-related morning stiffness affected work performance (47 %), resulted in late arrival at work (33 %) and required sick leave in the past month (15 %). Of the 224 retired respondents, 159 (71 %) stopped working earlier than their expected retirement age, with 64 % giving RA-related morning stiffness as a reason. There was a differential impact of increasing severity and increasing duration of morning stiffness on the various parameters studied. There were notable inter-country differences in the impact of RA-related morning stiffness on ability to work and on retirement. This large survey showed that from the patient’s perspective, morning stiffness reduces the ability to work in patients with RA and contributes to early retirement. © 2014, The Author(s).

Miettinen M.E.,Finnish National Institute for Health and Welfare | Kinnunen L.,Finnish National Institute for Health and Welfare | Leiviska J.,Finnish National Institute for Health and Welfare | Keinanen-Kiukaanniemi S.,University of Oulu | And 13 more authors.
PLoS ONE | Year: 2014

Objectives: Low serum 25-hydroxyvitamin D (25OHD) level has been associated with an increased risk of several chronic diseases. Our aim was to determine lifestyle and clinical factors that are associated with 25OHD level and to investigate connection of 25OHD level with metabolic and cardiovascular disease markers. Design: In total, 2868 Finnish men and women aged 45-74 years participated in FIN-D2D population-based health survey in 2007. Participants that had a serum sample available (98.4%; n = 2822) were included in this study. 25OHD was measured with chemiluminescent microparticle immunoassay method. Results: The mean 25OHD level was 58.2 nmol/l in men (n = 1348) and 57.1 nmol/l in women (n = 1474). Mean 25OHD level was lower in the younger age groups than in the older ones (p<0.0001 both in men and women). This study confirmed that low physical activity (p<0.0001 both in men and women), smoking (p = 0.0002 in men and p = 0.03 in women) and high BMI (p<0.0001 in women) are factors that independently associate with low 25OHD level. Of the metabolic and cardiovascular disease markers high triglyceride concentration (p = 0.02 in men and p = 0.001 in women) and high apolipoprotein B/ apolipoprotein A1 ratio (p = 0.04 in men and p = 0.03 in women) were independently associated with low 25OHD level. Conclusions: Higher age did not predict lower 25OHD level in this study population of aged 45-74 years which may derive from a healthy life-style of "active pensioners". Low physical activity and smoking came up as independent lifestyle factors associated with low 25OHD level. Defining the molecular mechanisms behind the associations of 25OHD with low physical activity and smoking are important objective in future studies. The association of 25OHD with BMI, high triglyceride concentration and apolipoprotein B/apolipoprotein A1 ratio may be related to the role of vitamin D in inflammation, but more detailed studies are needed. © 2014 Miettinen et al.

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