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Harjavalta, Finland

Dimitrow M.S.,University of Helsinki | Airaksinen M.S.A.,University of Helsinki | Kivela S.-L.,University of Turku | Kivela S.-L.,Satakunta Hospital District | And 3 more authors.
Journal of the American Geriatrics Society | Year: 2011

Because inappropriate prescribing is prevalent in individuals aged 65 and older, various criteria to assess it have been developed. This study's aim was to systematically review articles that describe criteria for assessing inappropriate prescribing in individuals aged 65 and older and to define the circumstances of their use (explicit/implicit), origins, development processes, and content. A systematic search was conducted on MEDLINE and PubMed (1990-2010) and augmented with a manual search. Original articles written in English were included if they described the development of the criteria and were aimed at people aged 65 and older. Articles that described criteria applicable only in hospital settings, specific drugs, or a particular disease or condition were excluded. Sixteen of 535 articles met the inclusion criteria. They described 14 criteria, half originating in the United States. The English-language restriction limited the search results. Most criteria were explicit, consensus validated, based totally or partly on Beers criteria, and focused on pharmacological appropriateness of prescribing and some were old. Drug- and disease-oriented explicit criteria require regular updating and are country specific. Implicit, person-specific criteria are universal and do not need updating, although their use requires up-to-date professional skills. Unlike explicit criteria, implicit criteria have been validated in people. Some of the 14 criteria were noncomprehensive, mainly because of the intended purpose. To conclude, different criteria exist for optimizing prescribing for individuals aged 65 and older. Possible deficiencies must be recognized and trade-offs made when selecting criteria for use. In the future, more-comprehensive and -timely criteria are needed. © 2011, The American Geriatrics Society.

Korhonen P.,Satakunta Hospital District | Korhonen P.,University of Turku | Kautiainen H.,University of Helsinki | Aarnio P.,Satakunta Hospital District
Journal of Human Hypertension | Year: 2014

Ankle-brachial index (ABI) measurement offers an easily available method to diagnose peripheral artery disease (PAD) and systemic atherosclerosis in early stage and thus to identify high-risk individuals for preventive interventions. The objective of this study was to assess the most practical criteria for the measurement of ABI in subjects with high cardiovascular risk. We examined 972 asymptomatic, middle-aged high-risk subjects without manifested cardiovascular disease or previously diagnosed diabetes. The prevalence of PAD (defined as ABI≤0.90) and borderline PAD (0.91-1.00) were 5% (95% confidence interval (CI) 4-7%) (49/972) and 20% (95% CI 18-23%) (192/972), respectively. In multivariate analysis, female gender (odds ratio (OR) 0.71 (95% CI 0.53-0.97)), current smoking (OR 2.14 (95% CI 1.47-3.11)) and pulse pressure (OR 1.03 for each increase of 1 mm Hg (95% CI 1.01-1.04)) were associated with low ABI. Measuring ABI in subjects who smoke or have pulse pressure >65 mm Hg seems to be worthwhile. © 2014 Macmillan Publishers Limited. All rights reserved.

Syvanen K.,Satakunta Hospital District | Korhonen P.,Central Satakunta Health Federation of Municipalities | Partanen A.,University of Turku | Aarnio P.,Satakunta Hospital District
Vascular Health and Risk Management | Year: 2011

Introduction: The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle-brachial index (ABI). Traditionally ABI values > 1.00-1.40 have been considered normal and ABI ≤ 0.90 defines PAD. Recent studies, however, have shown that individuals with ABI values between 0.90-1.00 are also at risk of cardiovascular events. We studied this cardiovascular risk population subgroup in order to determine their endothelial function using peripheral arterial tonometry (PAT). Methods: We selected 66 individuals with cardiovascular risk and borderline ABI. They all had hypertension, newly diagnosed glucose disorder, metabolic syndrome, obesity, or a ten year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System (SCORE). Subjects with previously diagnosed diabetes or cardiovascular disease were excluded. Endothelial function was assessed by measuring the reactive hyperemia index (RHI) from fingertips using an Endo-PAT device. Results: The mean ABI was 0.95 and mean RHI 2.11. Endothelial dysfunction, defined as RHI < 1.67, was detected in 15/66 (23%) of the subjects. There were no statistically significant differences in RHI values between subjects with different cardiovascular risk factors. The only exception was that subjects with impaired fasting glucose (IFG) had slightly lower RHI values (mean RHI 1.91) than subjects without IFG (mean RHI 2.24) (P = 0.02). Conclusions: In a cardiovascular risk population with borderline ABI nearly every fourth subject had endothelial dysfunction, indicating an elevated risk of cardiovascular events. This might point out a subgroup of individuals in need of more aggressive treatment for their risk factors. © 2011 Syvänen, publisher and licensee Dove Medical Press Ltd.

Ekblad M.,University of Turku | Gissler M.,Finnish National Institute for Health and Welfare | Gissler M.,Nordic School of Public Health | Lehtonen L.,University of Turku | And 2 more authors.
Archives of General Psychiatry | Year: 2010

Context: Prenatal smoking exposure modulates brain development, which may deviate mental development of the offspring. Objective: To study the effects of prenatal smoking exposure on psychiatric morbidity and mortality among Finnish young adults by means of population-based longitudinal register data. Design: Information on maternal smoking as reported by the mothers (0, <10, or >10 cigarettes a day) and other background factors (maternal age and parity and child's sex, gestational age, birth weight, and 5-minute Apgar score) was derived from the Finnish Medical Birth Register. Information on children's psychiatric diagnoses related to outpatient visits (1998-2007), children's inpatient care (1987-2007), and mothers' psychiatric inpatient care (1969-1989) was derived from the Finnish Hospital Discharge Register. Information on deaths and their causes for the children (1987-2007) was received from the Cause-of-Death Register. Setting: Population-based study of all singletons born in Finland from 1987 to 1989 with information on prenatal smoking exposure. Patients: The source population included all singleton births in Finland from January 1, 1987, through December 31, 1989 (n=175 869), excluding children with major congenital anomalies (3.1%) and children who died during the first week of life (0.3%). Main Outcome Measures: Psychiatric morbidity and mortality. Results: The prevalence of maternal smoking was 15.3%. The risk of psychiatric morbidity was significantly higher in the exposed children than in the unexposed children. Among the offspring of mothers who smoked fewer than 10 cigarettes a day, 21.0% had any psychiatric diagnoses (adjusted odds ratio [OR], 1.53 [95% confidence interval (CI), 1.47-1.60]) compared with 24.7% among those of mothers who smoked more than 10 cigarettes a day (1.85 [1.74-1.96]) and 13.7% in the unexposed children (the reference group). The risk was significantly increased for most of the psychiatric diagnoses. The strongest effects were in psychiatric disorders due to psychoactive substance use and in behavioral and emotional disorders. The risk of mortality was significantly higher in children exposed to more than 10 cigarettes a day (OR, 1.69 [95% CI, 1.31-2.19]) compared with unexposed children. Conclusion: Prenatal smoking exposure is associated with an increased risk of psychiatric morbidity, whereas prenatal exposure to more than 10 cigarettes a day increases the risk of mortality in childhood, adolescence, and young adulthood. ©2010 American Medical Association. All rights reserved.

Ahmaniemi T.,Nokia Inc. | Marila J.,Satakunta Hospital District | Lantz V.,Nokia Inc.
IEEE Transactions on Haptics | Year: 2010

This paper describes a method for creating virtual textures without force feedback by using a simple motion sensor and a single vibrotactile actuator. It is based on wavetable synthesis driven by the user's hand movements. The output of the synthesis is rendered with the tactile actuator attached in a hand-held box together with the motion sensor. The method provides a solution for creating tangible properties for virtual objects which can be explored by pointing at them with the sensor-actuator device. The study introduces 12 virtual textures which were based on three different envelope ridge lengths, two spatial densities, and were either regularly or irregularly organized. To evaluate the role of each design parameter in the perception of the texture, a series of experiments was conducted. The perceived similarity was assessed in a pairwise comparison test and the outcome was analyzed by using multidimensional scaling. The analysis revealed that envelope ridge length and spatial density were distinguishable design parameters while regularity was not. The textures were also rated according to five attribute scales previously determined in the pilot experiment. The results show that ridge length and spatial density influence perceived roughness and flatness similarly as with real textures. © 2010 IEEE.

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