The Many Faces of Solitary and Multiple Erythema Migrans

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Association of ADIPOR2 gene variants with cardiovascular disease and type 2 diabetes risk in individuals with impaired glucose tolerance: the Finnish Diabetes Prevention Study

<p>Abstract</p> <p>Background</p> <p>Adiponectin is an adipokine with insulin-sensitising and anti-atherogenic effects. Two receptors for adiponectin, ADIPOR1 and ADIPOR2, have been characterized that mediate effects of adiponectin in various tissues. We examined whether genetic variation in <it>ADIPOR2 </it>predicts the development of cardiovascular disease (CVD) and/or Type 2 Diabetes (T2DM) in individuals with impaired glucose tolerance (IGT) participating the Finnish Diabetes Prevention Study (DPS).</p> <p>Methods</p> <p>CVD morbidity and mortality data were collected during a median follow-up of 10.2 years (range 1-13 years) and conversion from IGT to T2DM was assessed during a median follow-up of 7 years (range 1-11 years). Altogether eight SNPs in the <it>ADIPOR2 </it>locus were genotyped in 484 participants of the DPS. Moreover, the same SNPs were genotyped and the mRNA expression levels of <it>ADIPOR2 </it>were determined in peripheral blood mononuclear cells and subcutaneous adipose tissue samples derived from 56 individuals participating in the Genobin study.</p> <p>Results</p> <p>In the DPS population, four SNPs (rs10848554, rs11061937, rs1058322, rs16928751) were associated with CVD risk, and two remained significant (p = 0.014 for rs11061937 and p = 0.020 for rs1058322) when all four were included in the same multi-SNP model. Furthermore, the individuals homozygous for the rare minor alleles of rs11061946 and rs11061973 had increased risk of converting from IGT to T2DM. Allele-specific differences in the mRNA expression levels for the rs1058322 variant were seen in peripheral blood mononuclear cells derived from participants of the Genobin study.</p> <p>Conclusions</p> <p>Our results suggest that SNPs in the <it>ADIPOR2 </it>may modify the risk of CVD in individuals with IGT, possibly through alterations in the mRNA expression levels. In addition an independent genetic signal in <it>ADIPOR2 </it>locus may have an impact on the risk of developing T2DM in individuals with IGT.</p> <p>Trial registration number</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT00981877">NCT00518167</a></p

Impact of Early Growth on Postprandial Responses in Later Life

Peer reviewe

Mitä suomalainen tyypin 2 diabeteksen ehkäisytutkimus DPS on opettanut?

Vertaisarvioitu.Suomalainen diabeteksen ehkäisytutkimus (Diabetes Prevention Study, DPS) loi näyttöön pohjautuvan perustan tyypin 2 diabeteksen ehkäisylle elintapaohjauksella Suomessa ja maailmanlaajuisesti. DPS-tutkimuksen tehostettu elintapaohjaus, jonka tavoitteena olivat suositusten mukainen ruokavalio, fyysinen aktiivisuus ja painon väheneminen, vaikutti suotuisasti diabetekseen liittyviin aineenvaihduntahäiriöihin ja pienensi diabeteksen ilmaantuvuutta 58 % henkilöillä, joiden glukoosinsieto oli lähtötilanteessa heikentynyt. Elintapaohjaus tehosi myös perinnöllisen diabetesalttiuden yhteydessä. Jatkoseurannassa elintapaohjauksen vaikutus diabeteksen ilmaantuvuuteen säilyi ainakin 13 vuoden ajan, vaikka elintapaohjaus lopetettiin keskimäärin neljän vuoden jälkeen. DPS-tutkimuksen aineistoa on tähän mennessä analysoitu ja raportoitu sekä sen tuloksia hyödynnetty monipuolisesti, ja osallistujien seuranta jatkuu rekisteritutkimuksena. Näin saamme tietoa myös diabeteksen lisäsairauksien kehittymisestä.Peer reviewe

Mitä suomalainen tyypin 2 diabeteksen ehkäisytutkimus DPS on opettanut?

Vertaisarvioitu.Suomalainen diabeteksen ehkäisytutkimus (Diabetes Prevention Study, DPS) loi näyttöön pohjautuvan perustan tyypin 2 diabeteksen ehkäisylle elintapaohjauksella Suomessa ja maailmanlaajuisesti. DPS-tutkimuksen tehostettu elintapaohjaus, jonka tavoitteena olivat suositusten mukainen ruokavalio, fyysinen aktiivisuus ja painon väheneminen, vaikutti suotuisasti diabetekseen liittyviin aineenvaihduntahäiriöihin ja pienensi diabeteksen ilmaantuvuutta 58 % henkilöillä, joiden glukoosinsieto oli lähtötilanteessa heikentynyt. Elintapaohjaus tehosi myös perinnöllisen diabetesalttiuden yhteydessä. Jatkoseurannassa elintapaohjauksen vaikutus diabeteksen ilmaantuvuuteen säilyi ainakin 13 vuoden ajan, vaikka elintapaohjaus lopetettiin keskimäärin neljän vuoden jälkeen. DPS-tutkimuksen aineistoa on tähän mennessä analysoitu ja raportoitu sekä sen tuloksia hyödynnetty monipuolisesti, ja osallistujien seuranta jatkuu rekisteritutkimuksena. Näin saamme tietoa myös diabeteksen lisäsairauksien kehittymisestä.Peer reviewe

Patients Receiving Palliative Care and Their Experiences of Encounters With Healthcare Professionals

The study aimed to explore experiences of encounters with health care professionals among patients receiving palliative cancer care in specialist palliative care inpatient units. A qualitative explorative study design was conducted in a specialist palliative care inpatient setting. Data collection was implemented using semi-structured individual interviews (20 palliative care cancer patients) and analysed with inductive content analysis. Palliative care patients experienced both meaningful and disrespectful encounters with healthcare professionals. The meaningful encounters encompassed authentic and supportive experiences, while the disrespectful encounters included indifferent and inadequate experiences. Caring for a patient receiving palliative care requires care beyond tending to a patient’s physical needs. Patients should be encountered holistically and as equal human beings without highlighting their roles as patients. The healthcare professionals and the organisations should also acknowledge the importance of time and effort spent for encounters and conversations with the patients instead of concentrating resources mainly on physical care.publishedVersionPeer reviewe

Neonatal Nutrition Predicts Energy Balance in Young Adults Born Preterm at Very Low Birth Weight

Epidemiological studies and animal models suggest that early postnatal nutrition and growth can influence adult health. However, few human studies have objective recordings of early nutrient intake. We studied whether nutrient intake and growth during the first 9 weeks after preterm birth with very low birth weight (VLBW,Peer reviewe

Clinical characteristics and evaluation of the incidence of cryptococcosis in Finland 2004-2018

Background Cryptococcosis is one of the major causes of mortality among HIV patients worldwide. Though most often associated with late stage HIV infection/AIDS, a significant number of cases occur in other immunocompromised patients such as solid organ transplant recipients and patients with hematological malignancies. Immunocompromised patients are a heterogeneous group and their number increases constantly. Since little is known about the incidence and the clinical features of cryptococcosis in Northern Europe, our aim was to investigate the clinical characteristics of cryptococcosis patients in Finland. Methods We retrospectively reviewed the laboratory confirmed cryptococcosis cases in Finland during 2004-2018. Only those who were treated for cryptococcosis were included in the study. Initial laboratory findings and medical records were also collected. Results A total of 22 patients with cryptococcosis were included in our study. The annual incidence of cryptococcosis was 0.03 cases per 100,000 population. Ten patients were HIV-positive and 12 out of 22 were HIV-negative. Hematological malignancy was the most common underlying condition among HIV-negative patients. Conclusions To our knowledge, this is the first study of the clinical presentation and incidence of cryptococcosis in Finland. We demonstrate that invasive cryptococcal infection occurs not only in HIV/AIDS patients or otherwise immunocompromised patients but also in immunocompetent individuals. Even though cryptococcosis is extremely rare in Finland, its recognition is important since the prognosis depends on rapid diagnostics and early antifungal therapy.Peer reviewe

Healthy Food Intake Index (HFII) - Validity and reproducibility in a gestational-diabetes-risk population

Background: The aim was to develop and validate a food-based diet quality index for measuring adherence to the Nordic Nutrition Recommendations (NNR) in a pregnant population with high risk of gestational diabetes (GDM). Methods: This study is a part of the Finnish Gestational Diabetes Prevention Study (RADIEL), a lifestyle intervention conducted between 2008 and 2014. The 443 pregnant participants (61 % of those invited), were either obese or had a history of GDM. Food frequency questionnaires collected at 1st trimester served for composing the HFII; a sum of 11 food groups (available score range 0-17) with higher scores reflecting higher adherence to the NNR. Results: The average HFII of the participants was 10.2 (SD 2.8, range 2-17). Factor analysis for the HFII component matrix revealed three factors that explained most of the distribution (59 %) of the HFII. As an evidence of the component relevance 9 out of 11 of the HFII components independently contributed to the total score (item-rest correlation coefficients Conclusions: The HFII components reflect the food guidelines of the NNR, intakes of relevant nutrients, and characteristics known to vary with diet quality. It largely ignores energy intake, its components have independent contribution to the HFII, and it exhibits reproducibility. The main shortcomings are absence of red and processed meat component, and the validation in a selected study population. It is suitable for ranking participants according to the adherence to the NNR in pregnant women at high risk of GDM.Peer reviewe

Ten-Year Mortality and Cardiovascular Morbidity in the Finnish Diabetes Prevention Study—Secondary Analysis of the Randomized Trial

The Finnish Diabetes Prevention Study (DPS) was a randomized controlled trial, which showed that it is possible to prevent type 2 diabetes by lifestyle changes. The aim of the present study was to examine whether the lifestyle intervention had an effect on the ten-year mortality and cardiovascular morbidity in the DPS participants originally randomized either into an intervention or control group. Furthermore, we compared these results with a population-based cohort comprising individuals of varying glucose tolerance states.Middle-aged, overweight people with IGT (n = 522) were randomized into intensive intervention (including physical activity, weight reduction and dietary counseling), or control "mini-intervention" group. Median length of the intervention period was 4 years and the mean follow-up was 10.6 years. The population-based reference study cohort included 1881 individuals (1570 with normal glucose tolerance, 183 with IGT, 59 with screen-detected type 2 diabetes, 69 with previously known type 2 diabetes) with the mean follow-up of 13.8 years. Mortality and cardiovascular morbidity data were collected from the national Hospital Discharge Register and Causes of Death Register. Among the DPS participants who consented for register linkage (n = 505), total mortality (2.2 vs. 3.8 per 1000 person years, hazard ratio HR = 0.57, 95% CI 0.21-1.58) and cardiovascular morbidity (22.9 vs. 22.0 per 1000 person years, HR = 1.04, 95% CI 0.72-1.51) did not differ significantly between the intervention and control groups. Compared with the population-based cohort with impaired glucose tolerance, adjusted HRs were 0.21 (95% CI 0.09-0.52) and 0.39 (95% CI 0.20-0.79) for total mortality, and 0.89 (95% CI 0.62-1.27) and 0.87 (0.60-1.27) for cardiovascular morbidity in the intervention and control groups of the DPS, respectively. The risk of death in DPS combined cohort was markedly lower than in FINRISK IGT cohort (adjusted HR 0.30, 95% CI 0.17-0.54), but there was no significant difference in the risk of CVD (adjusted HR 0.88, 95% CI 0.64-1.21).Lifestyle intervention among persons with IGT did not decrease cardiovascular morbidity during the first 10 years of follow-up. However, the statistical power may not be sufficient to detect small differences between the intervention and control groups. Low total mortality among participants of the DPS compared with individuals with IGT in the general population could be ascribed to a lower cardiovascular risk profile at baseline and regular follow-up.ClinicalTrials.gov NCT00518167