Vanhuksen vajaaravitsemuksen arviointi, ehkäisy ja hoito

Vanhuksilla vajaaravitsemus on yleisintä sairaalassa ja ympärivuorokautisessa hoidossa. Vanhusten vajaaravitsemuksen ja sen riskin seulonnan ja arvioinnin validoitu mittari on Mini Nutritional Assessment (MNA). Syiden ja taustatekijöiden arvioinnin tulisi olla kokonaisvaltaista. Vajaaravitsemusta ehkäistään ja hoidetaan ravitsemusneuvonnalla sekä tehostetulla ravitsemushoidolla.</div

Collaborative processes in species identification using an internet-based taxonomic resource

Visual databases are increasingly important resources through which individuals and groups can undertake species identification. This paper reports research on the collaborative processes undertaken by pre-service teacher students when working in small groups to identify birds using an Internet-based taxonomic resource. The student groups are conceptualised as 'knowledge-building communities' working in a 'joint problem space' comprising the collective knowledge of the participants interacting with the taxonomic database. Collaborative group work and associated dialogue were recorded with digital video. The recordings were analysed for the categories of dialogue and the categories of knowledge used by the students as they interacted with the taxonomic database and how they drew on their previous experiences of identifying birds. The outcomes are discussed in the context of the interplay of individual and social processes and the interplay between abstraction and lived experience in the joint problem space.Peer reviewe

Disease-Modifying Antirheumatic Drugs and Risk of Parkinson Disease Nested Case-Control Study of People With Rheumatoid Arthritis

Background and Objectives Epidemiologic studies have suggested a link between rheumatoid arthritis and Parkinson disease (PD). Disease-modifying antirheumatic drugs (DMARDs) might explain this association. The aim of this work was to evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis. Methods This nested nationwide case-control study was conducted within the Finnish Parkinson's Disease (FINPARK) cohort, which includes 22,189 Finnish persons with clinically verified PD diagnosed in 1996 to 2015. The cases had recorded diagnosis of PD in the Special Reimbursement Register and had no exclusion diagnoses with symptoms that may be confused with PD within 2 years of PD diagnosis. This study included cases with PD diagnosed during 1999 to 2015 and rheumatoid arthritis diagnosed >3 years before PD. Rheumatoid arthritis was identified from the Finnish Care Register for Health Care and Special Reimbursement Register. Cases were matched with up to 7 controls by age, sex, duration of rheumatoid arthritis, and region. DMARDs were categorized into 5 classes, and data on purchased prescriptions were identified from the Prescription Register since 1995. Associations were studied with conditional logistic regression adjusted for confounders. Results Altogether, 315 cases with PD and 1,571 matched controls were included. The majority (>60%) were women, and the median duration of rheumatoid arthritis on matching date was 11.6 years for controls and 12.6 years for cases. Use of DMARDs was not associated with risk of PD with a 3-year lag period applied between exposure and outcome except chloroquine/hydroxychloroquine, which associated with decreased risk (adjusted odds ratio [OR] 0.74, 95% confidence interval [CI] 0.56-0.97). Other DMARDs, including sulfasalazine, methotrexate, gold preparations, and immunosuppressants, were not associated with PD. Discussion Our results suggest that the lower risk of PD in people with rheumatoid arthritis is not explained by DMARD use because these drugs in general did not modify the risk of PD among persons with rheumatoid arthritis. Association between chloroquine/hydroxychloroquine and lower risk of PD and the possible underlying mechanisms should be further investigated. Classification of Evidence This study provides Class II evidence that in individuals with rheumatoid arthritis using DMARDs, only chloroquine/ hydroxychloroquine was associated with a potentially decreased risk of developing PD (adjusted OR 0.74, 95% CI 0.56-0.97).Peer reviewe

The association of long-term opioid use with health care and home care service use among aged home care clients

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Use of anti-dementia drugs in home care and residential care and associations with neuropsychiatric symptoms : a cross-sectional study

Background: The number of people with dementia is increasing alongside the aging population, and most of these patients manifest with neuropsychiatric symptoms (NPS). The objective of this study was to investigate anti-dementia drug use and its associations with NPS. Methods: Questionnaires on demographic information, current drug use, activities of daily living and NPS were sent to all municipal home care producers and to all institutions providing long-term residential care in the South Savo Hospital District, Finland. Results: The study population comprised 2821 persons. Their mean age was 81 years and 68 % were female. Dementia had been diagnosed in 31 % (n = 410) in home care and in 56 % (n = 774) in residential care. Anti-dementia drugs were used by 69 % of patients with dementia. Hyperactivity symptoms were common in residential care patients (n = 456, 33 %), while problems with mood and apathy dominated in home care patients (n = 486, 54 %). In multivariate regression analysis, the mood symptoms and apathy subgroup was associated with use of an acetylcholinesterase inhibitor (AChEI) (OR 1.44; 95 % Cl 1.03-2.02), memantine (OR 1.77, 95 % Cl 1.15-2.72) or their combinations (OR 1.56, 95 % Cl 1.03-2.34). Hyperactivity symptoms were associated with combination therapy of this type (OR 2.03, 95 % Cl 1.36-2.34). Conclusions: The use of anti-dementia drugs was common in both care settings. The use of any anti-dementia drug or combination was associated with the mood and apathy subgroup. The hyperactivity subgroup was associated with combination use of memantine and AChEI.Peer reviewe

Risk of head and traumatic brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease : a nationwide matched cohort study

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Increased Risk of Parkinson's Disease in Patients With Schizophrenia Spectrum Disorders

Background PD comorbid with schizophrenia has been considered rare because these diseases associate with opposite alterations in the brain dopamine system. The objective of this study was to investigate the risk of PD after a diagnosis of a schizophrenia spectrum disorder. Methods Regionally, this was a retrospective record-based case-control study. The cohort included 3045 PD patients treated 2004-2019 in southwestern Finland. Nationally this was a nested case-control study using registers to examine Finnish patients who received a clinically confirmed PD diagnosis 1996-2015 (n = 22,189). PD patients with previously diagnosed schizophrenia spectrum disorder (separate analysis for schizophrenia) were included. Comparable non-PD control groups were derived from both data sets. All PD diagnoses were based on individual clinical examinations by certified neurologists. Results In PD patients, the prevalence of earlier schizophrenia spectrum disorder was 0.76% in regional data and 1.50% in nationwide data. In age-matched controls, the prevalence in the regional and national data was 0.16% and 1.31%, respectively. The odds ratio for PD after schizophrenia spectrum disorder diagnosis was 4.63 (95% CI, 1.76-12.19; P <0.01) in the regional data and 1.17 (95% CI, 1.04-1.31; P <0.01) in the national data. Conclusions Schizophrenia spectrum disorder increases the risk of PD later in life. This association was observed in both individual patient data and nationwide register data. Therefore, despite the opposite dopaminergic disease mechanisms, schizophrenia spectrum disorder increases rather than decreases the risk of PD. The increased PD risk could be related to risk-altering effects of dopamine receptor antagonists or to the increased vulnerability of the dopamine system induced by illness phase-dependent dopamine dysregulation in schizophrenia/schizophrenia spectrum disorder. (c) 2021 International Parkinson and Movement Disorder SocietyPeer reviewe

Parkinsonin taudin lääkkeiden erityiskorvausoikeuden saajien määrän muutos vuosina 1996–2015

Lähtökohdat Tutkimme Parkinsonin taudin lääkkeiden erityiskorvausoikeuden saajien määrän muutosta vuosien 1996–2015 aikana. Selvitimme myös, kuinka suurella osalla heistä oli taudin erotus- ja poissulkudiagnoosien mukaisia sairauksia, ja muuttuiko tämä osuus seurannan aikana.Menetelmät Tutkimus oli osa rekisteripohjaista FINPARK-tutkimusta, ja siihen kuuluivat 35 vuotta täyttäneet, vuosina 1996–2015 Parkinsonin taudin lääkkeiden erityiskorvausoikeuden saaneet henkilöt (n = 29 847). Tiedot erotus- ja poissulkudiagnooseista kerättiin hoitoilmoitusrekisteristä kahden vuoden ajalta ennen ja jälkeen korvausoikeuden saannin.Tulokset Korvausoikeuden saaneiden määrä kasvoi tutkimusaikana 0,012 prosenttiyksikköä suhteessa koko Suomen 35 vuotta täyttäneeseen väestöön. Korvausoikeuden saajista 20–30 %:lla oli Parkinsonin taudin lisäksi poissulkudiagnooseja, joista yleisimpiä olivat ekstrapyramidaali- ja liikehäiriöt sekä etenevät neurodegeneratiiviset muistisairaudet.Päätelmät Parkinsonin tautia sairastavien henkilöiden väestöön suhteutettu määrä kasvoi seuranta-aikana. Noin joka neljännellä lääkkeiden erityiskorvausoikeuden saaneista oli kirjaus poissulkudiagnoosista kahden vuoden ajalta ennen tai jälkeen korvausoikeuden saannin. Tämä kertoo kliinisen diagnostiikan epävarmuudesta Parkinsonin taudin varhaisvaiheessa.</p