In bronchiectasis, poor physical capacity correlates with poor quality of life

Purpose Patients with bronchiectasis (BE) who suffer frequent exacerbations are likely to experience negative effects on quality of life (QoL) and require more healthcare utilization. We aimed to discover, in a cohort of Finnish BE patients, those risk factors that influence QoL. Methods Non-cystic fibrosis BE patients of a Helsinki University Hospital cohort were examined with high-resolution computed tomography (HRCT) of the chest. They completed a disease-specific quality of life-bronchiectasis (QoL-B) questionnaire in Finnish translation. We considered scores in the lowest quarter (25%) of that QoL-B scale to indicate poor QoL. The bronchiectasis severity index (BSI), FACED score, and modified Medical Research Council (mMRC) dyspnoea scale were used. Results Overall, of 95 adult BE patients, mean age was 69 (SD +/- 13) and 79% were women. From the cohort, 82% presented with chronic sputum production and exacerbations, at a median rate of 1.7 (SD +/- 1.6). The number of exacerbations (OR 1.7), frequent exacerbations (>= 3 per year) (OR 4.9), high BSI score (OR 1.3), and extensive disease (>= 3 lobes) (OR 3.7) were all predictive of poor QoL. Frequent exacerbations were associated with bronchial bacterial colonisation, low forced expiratory volume in 1 s (FEV1), and radiological disease severity. Based on the BSI, 34.1% of our cohort had severe disease, with 11.6% classified as severe according to their FACED score. The mMRC dyspnoea score (r = -0.57) and BSI (r = -0.60) correlated, in the QoL-B questionnaire, negatively with physical domain. Conclusion The strongest determinants of poor QoL in the cohort of Finnish BE patients were frequent exacerbations, radiological disease severity, and high BSI score. Neither comorbidities nor BE aetiology appeared to affect QoL. Reduced physical capacity correlated with dyspnoea and severe disease. Study registration University of Helsinki, Faculty of Medicine, 148/16.08.2017.Peer reviewe

Puuttuvuus GeneRISK-tutkimuksen perustietokyselyssä

Imputoinnilla tarkoitetaan sellaisia tilastollisia menetelmiä, joiden tarkoitus on täydentää puuttuvuutta sisältävää aineistoa. Puuttuvuus on iso ongelma tutkimuksissa, ja usein puuttuvat havainnot ja jopa kokonaiset havaintorivit jätetään huomiotta analyysejä tehdessä. Tämä voi kuitenkin merkittävästi vääristää analyysien tuloksia. Tässä tutkielmassa esitellään erilaisia puuttuvuuden tyyppejä, käydään läpi puuttuvuuden mahdollisia syitä ja perehdytään erilaisiin imputointimenetelmiin. Imputointimenetelmien käyttöä havainnollistetaan esimerkeillä, jotka liittyvät GeneRISK-tutkimuksen perustietokyselyyn. GeneRISK-tutkimuksella pyritään selvittämään erityisesti sydän- ja verisuonitautien taustalla piileviä perinnöllisiä riskitekijöitä, sekä sitä, kuinka riskitiedon saaminen vaikuttaa yksilöiden myöhempään terveyskäyttäytymiseen. Puuttuvuuden tyyppi vaikuttaa imputointimenetelmän valintaan, ja tutkielmassa esitelläänkin niin täysin satunnainen, satunnainen, kuin ei-satunnainenkin puuttuvuus. Lisäksi sivutaan suunniteltua puuttuvuutta ja aineiston rakentamisvaiheessa syntyvää puuttuvuutta. Jos vastauksia puuttuu yksittäisiltä vastaajilta osasta kysymyksiä, on kyse erävastauskadosta, ja jos aineistosta puuttuu kokonaisia havaintorivejä, puhutaan yksikkövastauskadosta. Tutkielmassa keskitytään erävastauskatoon. Tutkielmassa käytetään GeneRISK-tutkimuksen Kymenlaakson sairaanhoito- ja sosiaalipalvelujen kuntayhtymä Carean perustietokyselyaineistosta 18.1.2016 jäädytettyä otosta, ja sieltä valikoituja 1278 havaintoriviä. Tutkielmaan valikoitiin kiinnostuksen kohteena oleviksi muuttujiksi ruokailuun ja liikuntatottumuksiin liittyviä muuttujia, sekä taustamuuttujia. Aineistosta poistettiin kaikki sellaiset rivit, jotka sisälsivät puuttuvuutta näissä muuttujissa, ja tämän jälkeen täydelliseen aineistoon simuloitiin eri tyyppisiä puuttuvuuksia. Puuttuvuutta pyrittiin korjaamaan niin yksinkertaisilla imputointimenetelmillä kuin kahdella erilaisella moni-imputointimenetelmälläkin. Yksinkertaisiin imputointimenetelmiin lukeutuu mm. mediaani-imputointi. Ehdollisten mallien moni-imputoinnin ja yhdistettyjen mallien moniimputoinnin on osoitettu kirjallisuudessa toimivan paremmin kuin yksinkertaisten imputointimallien, mutta tätä ei tässä tutkielmassa pystytty osoittamaan. Yhtenä syynä tähän saattaa olla kiinnostuksen kohteeksi valikoituneiden muuttujien väliset riippumattomuudet, sekä vastaajien keskinäinen samankaltaisuus. Edelleen hyvin yleinen tapa käsitellä puuttuvuutta on jättää se kokonaan huomiotta. Tutkielmassa kuitenkin huomataan, kuinka radikaaliin aineiston hupenemiseen se voi johtaa. Tutkielmassa osoitetaankin erityisesti se, kuinka tärkeää puuttuvuutta on tarkastella monelta eri kantilta aina puuttuvuuden syistä aineiston jatkokäyttötarkoituksiin asti

Asthma as aetiology of bronchiectasis in Finland

Background: By definition bronchiectasis (BE) means destructed structure of normal bronchus as a consequence of frequent bacterial infections and inflammation. In many senses, BE is a neglected orphan disease. A recent pan-European registry study, EMBARC, has been set up in order to better understand its pathophysiology, better phenotype patients, and to individualize their management. Aim: To examine the aetiology and co-morbidity of BE in the capital area in Finland. Methods: Two hundred five patients with BE diagnosis and follow up visits between 2016 and 2017 in Helsinki University Hospital were invited to participate in the study. Baseline demographics, lung functions, imaging, microbiological, and therapeutic data, together with co-morbidities were entered into EMBARC database. Clinical characteristics, aetiologic factors, co-morbidities, and risk factors for extensive BE were explored. Results: To the study included 95 adult patients and seventy nine percent of the BE patients were women. The mean age was 69 years (SD +/- 13). Asthma was a comorbid condition in 68% of the patients but in 26% it was estimated to be the cause of BE. Asthma was aetiological factor for BE if it had been diagnosed earlier than BE. As 41% BE were idiopathic, in 11% the disorder was postinfectious and others were associated to rheumatic disease, Alpha-1-antitrypsin deficiency, IgG deficiency and Kartagener syndrome. The most common co-morbidities in addition to asthma were cardiovascular disease (30%), gastroesophageal reflux disease (26%), overweight (22%), diabetes (16%), inactive neoplasia (15%), and immunodeficiency (12%). Extensive BE was found in 68% of BE patients in whom four or more lobes were affected. Risk factors for extensive BE were asthma (OR 2.7), asthma as aetiology for BE (OR 4.3), and rhinosinusitis (OR 3.1). Conclusions: Asthma was associated to BE in 68% and it was estimated as aetiology in every fourth patient. However, retrospectively, it is difficult to exclude asthma as a background cause in patients with asthma-like symptoms and respiratory infections. We propose asthma as an aetiology factor for BE if it is diagnosed earlier than BE. Asthma and rhinosinusitis were predictive for extensive BE.Peer reviewe

Sow removal in Finnish commercial herds : epidemiological approaches

In sow farms, animals are actively removed and replaced to maintain target efficiency levels, herd health status and a static herd size. Sow removal has a critical effect on pig farm functionality and profitability. Excessive removal decreases lifetime production and especially during periods of small profit margins, becomes burdensome. It is also recognized as a welfare issue. The overall aim of this thesis was to investigate the current reality of piglet production in the rapidly changing Finnish production conditions with special emphasis on removal. The thesis is based on three individual studies which utilize diverse data from real commercial piglet producing farms. The types of data collected for each are different and the methods used reflect the differences. We showed systematic and temporal differences in removal between individuals, parities, farms and replacement circumstances in Finland. The results also demonstrated the economic value of improved animal health and removal. We benchmarked national culling and mortality rates retrieved from mandatory registrations. Especially, the average on-farm mortality may be considered relatively high although the rates accorded with published literature. However, the large differences between farms and several farms succeeding in obtaining low levels of removal imply that it is conceivable to strive for and reach certain special targets. Unfortunately, we demonstrated that optimal lifetime of a sow is not a fixed number and as such, no generally applicable policy for replacing sows can be determined. Neither can excessive removal be improved by single improvements only, because of limited resource reserves and other shortages within the individual farm. However, a few factors were found to be linked with an increased risk for removal and higher removal levels in these studies: e.g. the smallest litter sizes and the number of stillborn piglets at the sow level, and features indicative of semi-intensive or intensive farming compared with a combination of environmental animal welfare indicators (mortality) and a non-intensified farming style (culling) at the farm level. Traditional production approach of maximizing the net monetary income or quantitative measures in piglet production is likely to be changed in response to consumer’s increasing concerns around animal well-being, environmental sustainability and one health. We introduced an empirical base that could be used to motivate debate on future development of piglet production systems and delivered useful evidence relevant for stakeholders to engage in and promote research into identification, monitoring and management of sow removal and health. It may be more motivating for Finnish piglet producers, herd advisers and the industry to have specified removal levels to work towards. Our study can also be considered valid for emphasizing awareness of multidisciplinary approaches in integrating accurate epidemiological livestock data into larger frameworks as well as identifying current bottlenecks in available data and modelling methodology.Maatalous on tärkeä elinkeino, ruoantuotannon perusta ja välttämättömyys huoltovarmuuden turvaamiseksi sekä iso osa kulttuuria ja maisemaa. Suomalaisen sikatalouden kokonaiskuva on talouden tunnuslukujen valossa ollut vuosikausia kuitenkin hyvin heikko. Markkinat ovat porsastuottajille ankarat. Eläimiltäkin vaaditaan paljon: emakko synnyttää yhä enemmän porsaita, sen on imetettävä tehokkaasti, tultava viiveettä vieroituksen jälkeen kiimaan sekä pysyttävä terveenä ja tuottavana mahdollisimman pitkään. Tavoitetehokkuuden ja kannattavuuden ylläpitämiseksi sekä riskien hallitsemiseksi eläinainesta on myös uudistettava jatkuvasti. Yrittäjä voi omilla toimillaan emakoiden poistopolitiikkaa hallitsemalla vaikuttaa merkittävästi porsastuotantotilan toimivuuteen ja kustannustehokkuuteen. Varhaiset poistot estävät biologisen tuotoshuipun saavuttamisen, pienentävät elinikäistuotosta, vääristävät karjan ikärakennetta ja etenkin taloudellisesti haastavina aikoina ovat erityisen kuormittavia. Korkeat poistoprosentit voivat myös viitata hyvinvointiongelmiin. Väitöstutkimuksen yleisenä tavoitteena oli kartoittaa ja kuvata suomalaisen porsastuotannon nykytilaa ja erityisesti emakoiden poistoja maatalouden rakennemuutoksessa. Ensimmäisessä ja toisessa osatutkimuksessa selvitettiin monipuolisin kenttäaineistoin yksilö- ja tilatason riskitekijöitä poistoille. Samalla saatiin tieto tämänhetkisestä poistoprosentista ja miten se jakautuu teurastusten ja kuolleisuuden välillä. Kolmannessa osatyössä mallinnettiin taloudellisesti optimaalisinta poistotapaa ja erityisesti merkittävimpien tuotossairauksien vaikutusta siihen. Emakoiden poistoriskiin vaikuttivat yksilön ominaisuudet, tuotantokierron vaihe ja porsimakerta. Varhaiset poistot olivat edelleen yleisiä ja vain noin 60% emakoista selvisi kolmanteen porsimiseen saakka. Tilojen välillä havaittiin eroja teuraspoistoprosenteissa ja emakkokuolleisuudessa riippuen noudatetusta tuotantostrategiasta. Osoitimme lisäksi, että parempi eläinten terveys ja tuotantokestävyys parantavat taloudellista tulosta. Eläinyksilöt, maatilan fyysiset rakenteet, tuotannon laajuus ja malli muodostavat puitteet sikalan perustoiminnalle, jota edelleen ohjaavat taloudelliset seikat ja päätöksenteon perusteet. Tässä tutkimuksessa todettu hajonta tilojen välillä kertoo osaltaan siitä, että poistoja on mahdollista hallita. Toisaalta lähtökohtaisista eroista johtuen yleispätevä ohjeistus optimaalisista teurastuksista ei ole määriteltävissä. Selkeät kansalliset vertailuarvot voivat kuitenkin helpottaa asettamaan tilakohtaisia tavoitteita. Kehitetty optimointimalli havainnollistaa erilaisten eläinten terveyttä ja tuotantokestävyyttä parantavien muutosten taloudellista potentiaalia ja voi osaltaan motivoida tuottajia käytännön päätöksenteon tukena. Osoitimme lisäksi, että myös Suomessa porsastuotos on lisääntynyt viime vuosina nopeasti. Tutkimuksessa mukana olleet emakot porsivat keskimäärin jo lähes 15 porsasta kerrallaan. Pahnuekoon lisäksi yksittäisen tilan lopulliseen tehokkuuteen ja kilpailukykyyn vaikuttavat kuitenkin monet yksityiskohdat. Viime vuosina kuluttajien kiinnostus maataloustuotteiden laatuun, eettisyyteen ja turvallisuuteen on lisääntynyt. Yhteiskunta on asettanut tiukempia vaatimuksia niin tuotannon kuin ympäristönkin suhteen. Tulevaisuuden ratkaisuja kokonaiskannattavuuden heikkenemisen kompensointiin ja suomalaisen raaka-aineen saatavuuden turvaamiseen on edelleen etsittävä huomioimalla monipuolisesti eläimet yksilöinä,tilojen olosuhteet, resurssit ja tuotantostrategia sekä taloustieteelliset tekijät ja ympäristönäkökohdat monitieteellisessä viitekehyksessä

Maternal perceptions of breastfeeding support in a birth hospital before and after designation to the Baby-Friendly Hospital Initiative : A quasi-experimental study

Objective: The purpose of this study was to examine maternal perceptions of postnatal breastfeeding support in the hospital before and after designation to the Baby-Friendly Hospital Initiative (BFHI). Further maternal and infant characteristics associated with the maternal perception of breastfeeding support were investigated. Our hypothesis was that mothers would perceive breastfeeding support more adherent to the standards of the BFHI after the hospital was designated to the BFHI compared with before.Design: The study had a quasi-experimental non-equivalent two-group design.Setting: The study was conducted in one postnatal ward and one neonatal intensive care unit in a public birth hospital in Finland. Participants: Postpartum mothers giving birth in the hospital before (pre-test group, n = 162) and after (post-test group, n = 163) designation to the BFHI participated. Intervention: The aim of the BFHI is to support and promote breastfeeding by implementing the Ten Steps to Successful Breastfeeding into routine care. Implementation in the study hospital required staff training and revision of current hospital practices, which took place during 2017-2018. The postnatal ward and neonatal intensive care unit were designated to the Baby-Friendly Hospital in February 2019. Measurements: Maternal perceptions of postnatal breastfeeding support were measured with a 20-item questionnaire developed for this study. Items were based on maternal self-report of the breastfeeding support in the hospital. A sum variable was created to measure the maternal perception of the support (scale 1-7), and higher scores indicated perception of breastfeeding support that is more adherent to the standards of the BFHI. Descriptive statics, nonparametric statistical tests, and multiple linear regression analysis were used to analyse data.Findings: Mothers in the post-test group (median 6.1, IQR 5.4-6.4) perceived breastfeeding support more adherent to the standards the BFHI compared with mothers in the pre-test group (median 5.0, IQR 4.25.8) (p 35 years) (median 4.4 vs 5.8, p = 7). After the BFHI designation, mothers who experienced preterm birth (GA < 37 weeks) perceived breastfeeding support less adherent to the BFHI standards compared with mothers who experienced a full-term birth. Key conclusions: Designation to the BFHI had a positive impact on breastfeeding support from the maternal perspective. Designation improved particularly multiparas' perceptions of receiving breastfeeding support that is in adherence with the standards of the BFHI. However, more emphasis should be placed, and further research should be conducted to ensure that mothers giving birth to a preterm infant receive breastfeeding support that is adherent to the BFHI standards. Implications for practice: Birth hospitals are recommended to implement the BFHI as it improves breastfeeding support in the hospital and provides mothers with a good basis and continuation for breastfeeding, even after hospital discharge. Maternal perceptions about the impact of BFHI designation are important to consider because mother - infant dyads are at the centre of that support, and their viewpoint may help to assess whether the designation to the BFHI in the unit is successful. Results of this study indicate that designation to BFHI improves breastfeeding support from the maternal perspective.(c) 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )Peer reviewe

Are there differences in the treatment information received to support guided self-management between asthma and allergy patients?: A community pharmacy survey in Finland

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Modeling the Costs of Postpartum Dysgalactia Syndrome and Locomotory Disorders on Sow Productivity and Replacement

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Impairments of executive functionin young children referred to child psychiatric outpatient clinic

Few studies have reported on the quantity and quality of executive function (EF) deficits in young children referred to child psychiatric outpatient clinic with multiple psychiatric symptoms. We evaluated the EF deficits with the Attention and Executive Function Rating Inventory-Preschool (ATTEX-P) filled out by day care teachers for 4- to 7-year-old clinical group (n = 171) and reference group (n = 709). Family background information was collected from all families by parent questionnaire. Diagnoses of the referred children were collected from medical records. Clinical group exhibited higher mean ranks across the ATTEX-P Total score and all nine subscales than reference group (p <.001). Most of the children in the clinical group (58.5%) showed a significant amount of EF deficits (ATTEX-P Total score over clinical cut-off) including distractibility (55.6%) and impulsivity (53.8%) regardless of their diagnoses. In a multiple logistic regression model (controlling for age, gender and parental education), children in the clinical group had increased risk (odds ratio (OR)) = 10.6, 95% confidence interval (CI) = [6.88, 16.2], p <.001) for scoring over the clinical cut-off point on the ATTEX-P Total score. Assessment of EFs should be a routine part of the treatment plan in young children referred to child psychiatric outpatient clinic as it may guide the treatment choices.Peer reviewe

Validation of the Finnish Severe Respiratory Insufficiency Questionnaire

Abstract Introduction Chronic respiratory insufficiency impacts patients? lives and reduces quality of life. The Severe Respiratory Insufficiency (SRI) questionnaire examines health-related quality of life and is designed specifically for patients receiving home mechanical ventilation (HMV) for chronic respiratory failure (CRF). Objectives The aim of this study was to validate the Finnish version of the SRI and study its reproducibility in patients with CRF. Methods Our 74 patients receiving HMV or long-term oxygen treatment for CRF or both completed the SRI and St George?s Respiratory questionnaires (SGRQ) three times (at baseline, and then one week and one month later). Reliability and validity of the questionnaires was analyzed with Cronbach?s alpha and intraclass correlation coefficient. Patients were prospectively followed-up for five years, with data collected on their use of hospital services and mortality. Results Cronbach?s alpha in the SRI ranged from 0.67 to 0.88 and was >0.7 on all subscales except the ?attendant symptoms and sleep?. On four subscales, Cronbach?s alpha was >0.8, and on the summary scale, 0.95. The SRI showed high correlation with SGRQ. Both tests showed good reproducibility. During the five-year follow-up, 27 (36%) patients died. Conclusions The Finnish SRI proved valid, reliable, and reproducible. Its psychometric properties were good and similar to those of the original questionnaire and of other validation studies.Peer reviewe

Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders

Background: Our study addressed the gap in research on the effectiveness of cognitive behavioral therapy (CBT) in treating children with mixed psychiatric disorders. We examined the immediate and long-term effects of group CBT (GCBT), delivered in naturalistic clinical settings, on reducing internalizing and externalizing symptoms in children with mixed psychiatric disorders. Further, we compared the effectiveness of cost-effective, manualized GCBT to treatment as usual (TAU) consisting of individually tailored psychiatric outpatient services delivered by mental health care specialists. Methods: Children aged 6–12 years (n = 103) diagnosed with psychiatric disorders, more than 70% with psychiatric comorbidity, were assigned either directly to GCBT (GCBT group; n = 52) or TAU for approximately 3 months, after which they received GCBT (TAU + GCBT group; n = 51). Internalizing and externalizing symptoms were assessed using parent- and teacher-report questionnaires (Child Behavior Checklist and Teacher Report Form) at referral to treatment, pre-treatment, post-treatment, and six-month follow-up. Results: Parent- and teacher-rated internalizing symptoms and parent-rated externalizing symptoms were reduced immediately after GCBT. Long-term GCBT gains were prominent for parent-rated externalizing symptoms. No differences were observed between the effectiveness of GCBT and TAU. Conclusions: Our results suggest that GCBT and TAU services are equally effective in treating internalizing and externalizing symptoms in children with mixed psychiatric disorders, providing support for the broader use of cost-effective manualized GCBT. Manualized GCBT, which requires relatively short training, can also be delivered at primary healthcare levels. Our results are of relevance to cost-effectiveness and global mental health staff shortages