Lääketiedon hyödyntäminen : Selvitysraportti

Lääkehoidon ja -huollon tietopohja on laadukas ja runsas, mutta pirstaleinen. Tietopohja koostuu useista tietoaineistoista, joita ovat raakatietolähteet, rekisterit, tietokannat, mastertietolähteet, tilastot, yhteenvedot ja indikaattorit. Tietopohjaa ylläpitävät ja kehittävät useat toimijat. Keskeisiä tiedon tuottajia ovat Kansaneläkelaitos, Terveyden ja hyvinvoinnin laitos THL sekä Lääkealan turvallisuus- ja kehittämiskeskus Fimea. Tietoa tuottavat myös useat muut kaupalliset ja julkiset toimijat. Tiedon keskeisiä hyödyntäjiä ovat STM, THL, Palveluvalikoimaneuvosto Palko, Lääkkeiden hintalautakunta Hila, Valvira, Fimea, aluehallintovirastot, sosiaali- ja terveydenhuollon yksiköt kaikissa kokoluokissa sekä tulevien hyvinvointialueiden strateginen ja operatiivinen johto. Tiedon tuottajat hyödyntävät tietoa esim. oman organisaationsa, viranomaisyhteistyön sekä viranomaistehtäviensä kehittämiseen. Selvityksen aikana tunnistettiin useita käynnissä olevia tai käynnistyviä lääketietopohjan kehittämishankkeita. Keskeisiä hankkeita ovat esimerkiksi kansallisen lääkityslistan kehitystyö sekä selvitystyö lääketietovarannosta. Lisäksi tunnistettiin eri kehityskohteita. Keskeisimmiksi kehitysteemoiksi tunnistettiin alueellisen ja kansallisen tason tahtotilan muodostaminen, vaikuttavuus- ja kustannusvaikuttavuustieto, lääkehoidon seurantatieto ja tietojärjestelmäkehittäminen

Influence of early life risk factors and lifestyle on systemic vascular resistance in later adulthood: the cardiovascular risk in young Finns study

Purpose There are limited data available concerning the effects of lifetime risk factors and lifestyle on systemic hemodynamics, especially on systemic vascular resistance. The purpose of the study was to evaluate how lifetime cardiovascular risk factors (body mass index (BMI), high-density lipoprotein, low-density lipoprotein, triglycerides, systolic blood pressure, blood glucose) and lifestyle factors (vegetable consumption, fruit consumption, smoking and physical activity) predict systemic vascular resistance index (SVRI) and cardiac index (CI) assessed in adulthood. Materials and Methods Our study cohort comprised 1635 subjects of the Cardiovascular Risk in Young Finns Study followed up for 27 years since baseline (1980; aged 3-18 years, females 54.3%) who had risk factor and lifestyle data available since childhood. Systemic hemodynamics were measured in 2007 (aged 30-45 years) by whole-body impedance cardiography. Results In the multivariable regression analysis, independent predictors of the adulthood SVRI were childhood BMI, blood glucose, vegetable consumption, smoking, and physical activity (p p p p p p Conclusion Childhood BMI, blood glucose, vegetable consumption, smoking and physical activity independently predict systemic vascular resistance in adulthood. A favourable change in the number of risk factors or BMI from childhood to adulthood was associated with lower vascular resistance in adulthood.</p

Association of lifetime blood pressure with adulthood exercise blood pressure response: the cardiovascular risk in young Finns study

PurposeElevated blood pressure (BP) in childhood has been associated with increased adulthood BP. However, BP and its change from childhood to adulthood and the risk of exaggerated adulthood exercise BP response are largely unknown. Therefore, we studied the association of childhood and adulthood BP with adulthood exercise BP response.Materials and methodsThis investigation consisted of 406 individuals participating in the ongoing Cardiovascular Risk in Young Finns Study (baseline in 1980, at age of 6-18 years; follow-up in adulthood in 27-29 years since baseline). In childhood BP was classified as elevated according to the tables from the International Child Blood Pressure References Establishment Consortium, while in adulthood BP was considered elevated if systolic BP was >= 120 mmHg or diastolic BP was >= 80 mmHg or if use of antihypertensive medications was self-reported. A maximal cardiopulmonary exercise test with BP measurements was performed by participants in 2008-2009, and exercise BP was considered exaggerated (EEBP) if peak systolic blood pressure exceeded 210 mmHg in men and 190 mmHg in women.ResultsParticipants with consistently high BP from childhood to adulthood and individuals with normal childhood but high adulthood BP had an increased risk of EEBP response in adulthood (relative risk [95% confidence interval], 3.32 [2.05-5.40] and 3.03 [1.77-5.17], respectively) in comparison with individuals with normal BP both in childhood and adulthood. Interestingly, individuals with elevated BP in childhood but not in adulthood also had an increased risk of EEBP [relative risk [95% confidence interval], 2.17 [1.35-3.50]).ConclusionsThese findings reinforce the importance of achieving and sustaining normal blood pressure from childhood through adulthood.</p

Systemic vascular resistance predicts the development of hypertension: the cardiovascular risk in young Finns study

Purpose: To study whether systemic hemodynamics, especially systemic vascular resistance, predicts the development of hypertension and improves the risk prediction of incident hypertension beyond common risk factors in the risk models in young adults. Materials and methods: Typical risk factors for hypertension in the risk prediction models (systolic and diastolic blood pressure, parental history of hypertension, age, sex, body-mass index, smoking), laboratory values (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, glucose, insulin, C-reactive protein), heart rate (HR), stroke index (SI), and systemic vascular resistance index (SVRI) calculated by whole-body impedance cardiography were evaluated in 2007 and blood pressure in 2011 in 1293 Finnish adults (aged 30-45 years; females 56%;n = 1058 normotensive in 2007). Results: Of hemodynamic variables, SVRI and HR evaluated in 2007 were independently associated with systolic blood pressure (p Conclusions: These findings suggest that systemic vascular resistance index predicts the incidence of hypertension in young adults and that the evaluation of systemic hemodynamics could provide an additional tool for hypertension risk prediction.</div

Determinants of exercise peak arterial blood pressure, circulatory power, and exercise cardiac power in a population based sample of Finnish male and female aged 30 to 47 years: the Cardiovascular Risk in Young Finns Study

Background Novel parameters derived from peak maximal oxygen uptake (VO2) and exercise arterial blood pressure, such as peak circulatory power (CP) and exercise cardiac power (ECP), can be used in the risk assessment of cardiovascular disease and stroke. However, the determinants of these factors are poorly characterized in the general population. Methods We assessed peak arterial blood pressure, CP and ECP with standardized cardiopulmonary exercise test (CPET) on 281 female and 257 male participants of the Cardiovascular Risk in Young Finns Study. The subjects were aged 30–47 years. Peak VO2 as well as systolic and diastolic arterial blood pressures were measured to calculate peak mean arterial pressure, CP and ECP. These parameters were assessed for correlation with sex, age, height, weight, waist-to-hip ratio, smoking, physical activity index (PAI), fasting insulin and glucose levels as well as the use of antihypertensive treatment. Results Sex, age and weight explained 36% of the variation in peak systolic blood pressure, and these factors in combination with height and the use of antihypertensive treatment explained 13% of the variation in peak diastolic blood pressure. Sex, height, weight, waist-to-hip ratio, PAI and smoking explained 49% − 52% of the variation in peak CP. Sex, age, height, weight, waist-to-hip ratio, PAI, smoking and insulin levels explained 21% − 49% of variation in ECP. Conclusions Subject demographics and lifestyle-related factors should be taken into account when exercise blood pressure response, CP and ECP are used to evaluate patients’ cardiac function in CPET.BioMed Central open acces

Liikuntaohjelmasta työkuntoisuutta ja elämäniloa.

Syventävä työ ei kirjastoss

Elinaikaiset riskitekijät, elintavat ja aikuisiän valtimoterveys

Elinaikaiset riskitekijät, elintavat ja aikuisiän valtimoterveys Tarkastettava väitöskirjatyö tutki lapsuudessa ja aikuisiällä määritettyjen valtimotaudin riskitekijöiden, kuten verenpaineen, verensokerin, veren kolesterolin, tupakoinnin, liikunnan ja ruokavalion, yhteyttä aikuisiän pulssiaallon etenemisnopeuteen. Pulssiaallon etenemisnopeutta voidaan pitää valtimoiden ikääntymisen mittarina. Se ennustaa itsenäisesti sydän- ja verisuonisairauksien päätetapahtumia, kuten aivohalvausta, sydäninfarktia ja sydänperäistä kuolemaa. Tutkimuksen tulokset osoittivat, että sekä lapsuuden että aikuisiän systolinen verenpaine ennustaa itsenäisesti aikuisiän pulssiaallon etenemisnopeutta. Lapsena paljon hedelmiä ja vihanneksia syöneillä oli aikuisiällä matalampi pulssiaallon etenemisnopeus kuin niitä vähän syöneillä. Vaikutus oli vielä merkittävämpi, jos hedelmien ja vihannesten käyttö oli runsasta lapsuudesta aikuisikään. Suotuisat riskiprofiilin muutokset, sekä lapsuudesta aikuisikään että nuoresta aikuisiästä keski-ikään, olivat yhteydessä matalampaan pulssiaallon etenemisnopeuteen ja siten alhaisempaan valtimoiden jäykkyyteen aikuisiällä. Tämä muutos säilyi merkitsevänä, kun huomioitiin lähtötilanteen riskiprofiili. Tämän tutkimuksen tulokset kannustavat vähentämään valtimotaudin riskitekijöitä ja mikäli mahdollista, jopa estämään niiden kehittymistä. Pulssiaallon etenemisnopeuden mittaamisesta voisi olla hyötyä kliinisessä työssä sydän- ja verisuonisairauksien hoidossa ja riskiarviossa.Background: Our understanding of the pathophysiology of atherosclerosis has expanded considerably during last two decades. A multifactorial pathophysiological process describes the progression at molecular and cellular levels, eventually manifesting itself as clinical disease. All these processes already begin in childhood, but clinical manifestations—e.g. coronary heart disease, myocardial infarction, or stroke—usually occur decades later in middle-age or in old age. Several reports have consistently shown the favorable effects of lifestyle changes. To improve primordial prevention, i.e. to prevent the development of risk factors, the American Heart Association released in 2010 the concept of Ideal Cardiovascular Health: the simultaneous presence of 4 ideal health behaviors (non-smoking, normal body mass index, being physically active, and a healthy diet) and 3 ideal health factors (normal total cholesterol, blood pressure, and fasting glucose). The health-promoting benefits of each of the components have been well established. This concept has been shown to predict lower cardiovascular disease risk and mortality of all causes. However, the prevalence of Ideal Cardiovascular Health has been extremely low in adolescence and in adulthood. Simultaneously with the atherosclerotic process, aging causes stiffening of elastic arteries, and especially of the aorta. When the aorta ages and stiffens, the pulsations created by the left ventricle cannot be cushioned and are transmitted into the capillaries especially in the brain and kidneys, causing microvascular damage. Arterial aging also increases pressure throughout the systole, which leads to left ventricle hypertrophy and an acceleration of the atherosclerotic process. Arterial aging is an independent process which could advance without atherosclerosis. It is not possible to study only the process of atherosclerosis without arterial stiffening, because it is difficult to separate age-related changes from disease-related changes. Arterial stiffness could be assessed by measuring pulse wave velocity, which is accepted as an independent predictor of cardiovascular events and as a biomarker of vascular aging. Aims: The present study elucidates the associations of traditional and lifestyle risk factors measured in childhood and adulthood with pulse wave velocity assessed in adulthood. Risk factors were used as continuous variables and as defined in the concept of Ideal Cardiovascular Health. Additionally, the present study investigated the association between the change in Ideal Cardiovascular Health status (both from childhood to adulthood and from young adulthood to middle age) and pulse wave velocity in adulthood. Moreover, blood pressure in childhood was defined as normal or elevated according to the three different definitions to investigate whether elevated pediatric blood pressure could predict high pulse wave velocity in adulthood and whether there is a difference in predictive ability between the different definitions. Subjects and Methods: The population studied in this thesis is from the Cardiovascular Risk in Young Finns Study. The first cross-sectional study was conducted in 1980, and 3,596 subjects aged 3−18 years attended. Follow-up studies with standard physical examinations and blood samplings were conducted in 1983, 1986, 2001, and 2007. Pulse wave velocity measurements by impedance cardiography were carried out in 2007, with 1,872 (52.1% of original cohort) participants (aged 30−45 years) attending. Results: Systolic blood pressure and glucose in childhood, and systolic blood pressure, insulin, and triglycerides in adulthood were independent predictors of adult pulse wave velocity. Vegetable consumption both in childhood and in adulthood was inversely and independently associated with adult pulse wave velocity, and the association remained significant when adjusted for lifestyle or traditional risk factors. Elevated pediatric blood pressure predicted high adult pulse wave velocity, and the predictions were equivalent for the simplified and complex definitions. The change in the ideal cardiovascular health index was inversely related to pulse wave velocity in adulthood. This relationship was significant for the younger (change from childhood to adulthood) and the older (change from young adulthood to middle-age) participants and remained significant after adjusting for the ideal cardiovascular health index at baseline. Conclusions: Traditional and lifestyle risk factors in childhood and adulthood predict pulse wave velocity in adulthood. Favorable changes in risk factor status, both from childhood to adulthood and from young adulthood to middle-age, are associated with lower pulse wave velocity in adulthood. Elevated blood pressure is a major risk factor and the simplified blood pressure tables could be used to identify children at an increased risk of high arterial stiffness in adulthood. These results support the efforts to reduce risk factors both in childhood and adulthood in the primary prevention of atherosclerosis

Climate change and electricity consumption--Witnessing increasing or decreasing use and costs?

Climate change affects the need for heating and cooling. This paper examines the impact of gradually warming climate on the need for heating and cooling with an econometric multivariate regression model for five countries in Europe along the south-north line. The predicted changes in electricity demand are then used to analyze how climate change impacts the cost of electricity use, including carbon costs. Our main findings are, that in Central and North Europe, the decrease in heating due to climate warming, dominates and thus costs will decrease for both users of electricity and in carbon markets. In Southern Europe climate warming, and the consequential increase in cooling and electricity demand, overcomes the decreased need for heating. Therefore costs also increase. The main contributors are the role of electricity in heating and cooling, and the climatic zone.Climate change Electricity demand Costs of climate change