Effects of a 12-month home-based exercise program on functioning after hip fracture - Secondary analyses of an RCT

Background Long-term functional limitations are common after hip fractures. Exercise may alleviate these negative consequences but there is no consensus on an optimal training program. The objective was to study the effects of a 12-month home-based supervised, progressive exercise program on functioning, physical performance, and physical activity. Methods Secondary analysis of a randomized controlled trial targeting patients with surgical repair of a hip fracture, aged >= 60 years, Mini-Mental State Examination (MMSE) score of >= 12. The participants were randomized into Exercise (n = 61) or Usual care (n = 60). Assessments at baseline, 3, 6, and 12 months included Lawton's Instrumental Activities of Daily Living (IADL), Short Physical Performance Battery (SPPB), handgrip strength, and self-reported frequency of sessions of leisure-time physical activity. Analyzed using mixed-effects models. Results Participants' (n = 121) mean age was 81 years (SD 7), and 75% were women. The mean IADL score at baseline was 17.1 (SD 4.5) in the exercise group, and 17.4 (5.1) in the usual care group. The mean SPPB scores were 3.9 (1.6) and 4.2 (1.8), and handgrip strength was 17.7 (8.9) kg and 20.8 (8.0) kg, respectively. The age- and sex-adjusted mean changes in IADL over 12 months were 3.7 (95% CI 2.8-4.7) in the exercise and 2.0 (1.0-3.0) in the usual care group (between-group difference, p = 0.016); changes in SPPB 4.3 (3.6-4.9) and 2.1 (1.5-2.7) (p < 0.001); and changes in handgrip strength 1.2 kg (0.3-2.0) and 1.0 kg (-1.9 to -0.2) (p < 0.001), respectively. We found no between-group differences in changes in the frequency of leisure-time activity sessions. Conclusion A 12-month home-based supervised, progressive exercise program improved functioning and physical performance more than usual care among patients with hip fractures. However, the training did not increase leisure-time physical activity.Peer reviewe

Cost-effectiveness analysis of guidelines for antihypertensive care in Finland

<p>Abstract</p> <p>Background</p> <p>Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario).</p> <p>Methods</p> <p>A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole.</p> <p>Results</p> <p>The impact of the use of the ACCG scenario in subgroups (aged 40–80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective.</p> <p>Conclusion</p> <p>The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.</p

African Linguistics in Central and Eastern Europe, and in the Nordic Countries

Non peer reviewe

Yläkoululaiset ja tupakkatuotteet

Tiivistelmä Lähtökohdat: Nuuskaaminen on aiempaa yleisempää nuorten keskuudessa. Tutkimuksessa selvitettiin 7.-luokkalaisten nuuskaus- ja tupakointitottumuksia maaseudulla ja kaupungissa, eroja tyttöjen ja poikien välillä, tupakkatuotteiden hankkimisen helppoutta, tiedonsaantia tupakkatuotteista sekä nuorten ajatuksia niiden terveyshaitoista. Menetelmät: Kyselytutkimus toteutettiin Muhoksen maaseutukunnassa (n = 143) ja Oulun kaupungin yhdessä yläkoulussa (n = 129) 2018–2019. Taustatietoina kerättiin ikä ja sukupuoli. Aineistoa kuvattiin tilastollisesti frekvenssein ja jakaumin, ja eroja ryhmien välillä verrattiin khiin neliö -testillä. Tupakan ja nuuskan hankkimisen helppoutta analysoitiin parametrittomalla Mann–Whitneyn testillä. Avoimet kysymykset analysoitiin laadullisen tutkimuksen keinoin. Tulokset: Nuorten tupakkatuotteiden käyttö oli harvinaista, mutta tupakka- ja nuuskakokeilut tavallisia, etenkin maaseudulla. Tupakkatuotteiden hankkiminen koettiin maaseudulla helpommaksi. Nuoret olivat melko hyvin tietoisia tuotteiden terveyshaitoista, mutta riippuvuuden mainitsi vain 6 %. Eniten he saivat tietoa sosiaalisesta mediasta, internetistä, televisiosta/radiosta sekä kavereilta. Johtopäätökset: Tupakkatuotteiden kokeilu on tavallista ja tämän tutkimuksen mukaan jopa yleisempää maalla kuin kaupungissa, joten kohdejoukot/-yksilöt ja terveysohjauksen ajankohta tulisi arvioida huolellisesti. Nuorten tietoisuutta tupakkatuotteiden aiheuttamasta riippuvuudesta on syytä lisätä