Cardiovascular Responses to Psychosocial Stress Reflect Motivation State in Adults Born at Extremely Low Birth Weight

Background. Adults born extremely preterm appear to have more difficulty managing the stresses of early adulthood than their term-born peers. Objective. To examine the effects of being born at extremely low birth weight (ELBW; birth weight < 1000 g) versus at full term on cardiovascular responses to stress. Method. Cardiovascular responses were elicited during administration of a widely used laboratory stressor, the Trier Social Stress Test (TSST). Results. Term-born adults exhibited a larger decrease in total peripheral resistance and larger increase in cardiac output for TSST performance, reflecting greater resilience, than did ELBW adults. Furthermore, in ELBW participants but not controls, cardiovascular responses were correlated with anxiety, suggesting that their responses reflected feelings of stress. Conclusions. Skills-training and practice with relevant stressors may be necessary to increase the personal resources of ELBW participants for managing stress as they transition to adulthood.Peer reviewe

Koronarokoteturvallisuus : Yhteenvetoraportti ajalta 1.1.2021-31.12.2022 : Kooste Terveyden ja hyvinvoinnin laitoksen lakisääteisen tehtävän toteuttamisesta

Koronapandemian aikana Terveyden ja hyvinvoinnin laitoksessa (THL) toteutettiin lukuisia koronapandemian edellyttämiä toimintoja työryhmissä, joihin osallistui THL:n asiantuntijoita myös infektiotauteihin ja rokottamiseen liittyvän työn ulkopuolelta. Yksi THL:n lakisääteisistä tehtävistä on rokotteiden haittavaikutusten selvittäminen. Koronarokotusten alettua Suomessa loppuvuodesta 2020 THL:ssä perustettiin työryhmä, joka sai tehtäväkseen tämän viranomaisvelvollisuuden toteuttamisen koronarokotusten osalta. Tässä yhteenvetoraportissa kuvataan koronarokoteturvallisuustyöryhmän työtä 1.1.2021 31.12.2022 väliseltä ajalta keskittyen kuvailemaan työtapoja sekä saavutettuja tuloksia

Intrapartum zigzag pattern of fetal heart rate is an early sign of fetal hypoxia : A large obstetric retrospective cohort study

Introduction The aim of the present study was to identify possible associations of fetal heart rate (FHR) patterns during the last 2 hours of labor with fetal asphyxia expressed by umbilical artery acidemia at birth and with neonatal complications in a large obstetric cohort. Material and methods Cardiotocographic recordings from 4988 singleton term childbirths over 1 year were evaluated retrospectively and blinded to the pregnancy and neonatal outcomes in a university teaching hospital in Helsinki, Finland. Umbilical artery pH, base excess and pO(2), low Apgar scores at 5 minutes, need for intubation and resuscitation, early neonatal hypoglycemia, and neonatal encephalopathy were used as outcome variables. According to the severity of the neonatal complications at birth, the cohort was divided into three groups: no complications (Group 1), moderate complications (Group 2) and severe complications (Group 3). Results Of the 4988 deliveries, the ZigZag pattern (FHR baseline amplitude changes of >25 bpm with a duration of 2-30 minutes) occurred in 11.7%, late decelerations in 41.0%, bradycardia episodes in 52.9%, reduced variability in 36.7%, tachycardia episodes in 13.9% and uterine tachysystole in 4.6%. No case of saltatory pattern (baseline amplitude changes of >25 bpm with a duration of >30 minutes) was observed. The presence of the ZigZag pattern or late decelerations, or both, was associated with cord blood acidemia (odds ratio [OR] 3.3, 95% confidence interval [CI] 2.3-4.7) and severe neonatal complications (Group 3) (OR 3.3, 95% CI 2.4-4.9). In contrast, no significant associations existed between the other FHR patterns and severe neonatal complications. ZigZag pattern preceded late decelerations in 88.7% of the cases. A normal FHR preceded the ZigZag pattern in 90.4% of the cases, whereas after ZigZag episodes, a normal FHR pattern was observed in only 0.9%. Conclusions ZigZag pattern and late decelerations during the last 2 hours of labor are significantly associated with cord blood acidemia at birth and neonatal complications. The ZigZag pattern precedes late decelerations, and the fact that normal FHR pattern precedes the ZigZag pattern in the majority of the cases suggests that the ZigZag pattern is an early sign of fetal hypoxia, which emphasizes its clinical importance.Peer reviewe

Intrapartal cardiotocographic patterns and hypoxia-related perinatal outcomes in pregnancies complicated by gestational diabetes mellitus

Aims In previous reports, cardiotocographic (CTG) fetal heart rate (FHR) monitoring has shown only limited benefits in decreasing adverse perinatal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM). The aim of the present study was to evaluate whether an association exists between the recently reported ZigZag pattern (FHR baseline amplitude changes of > 25 bpm with a duration of 2-30 min) and asphyxia-related neonatal outcomes in GDM pregnancies. Methods Intrapartal CTGs were recorded in a one-year cohort of 5150 singleton childbirths. The following CTG changes were evaluated: ZigZag pattern, saltatory pattern, late decelerations, episodes of tachycardia and bradycardia, reduced variability, and uterine tachysystole. The cohort was divided into three groups: women with GDM, women with normal oral glucose tolerance test (OGTT), and women with no OGTT performed. Umbilical artery (UA) blood gases, Apgar scores, neonatal respiratory distress, and neonatal encephalopathy were used as outcome variables. Results GDM was diagnosed in 624 (12.1%), OGTT was normal in 4115 (79.9%), and OGTT was not performed in 411 (8.0%) women. Hypoxia-related ZigZag patterns (OR 1.94, 95% CI 1.64-2.34) and late decelerations (OR 1.65, 95% CI 1.27-2.13) of FHR, as well as a greater risk of fetal asphyxia (UA pH < 7.10 and/or UA BE < -12.0 meq/L and/or Apgar scores < 7 at 5-min) (OR 6.64, 95% CI 1.84-12.03) were observed in those with GDM compared with those without GDM. Conclusions GDM is associated with intrapartal ZigZag pattern and late decelerations, cord blood acidemia and low 5-min Apgar scores at birth indicating increased occurrence of fetal hypoxia in GDM pregnancies.Peer reviewe

Bone mineral density in very low birthweight adults-A sibling study

Background Children and adults born very low birthweight (VLBW,Peer reviewe

COVID-19 vaccination as a rare potential etiology for cause of death after medicolegal autopsy. A Finnish nationwide study

Abstract COVID-19 vaccinations began globally at the end of 2020. By the end of 2021, 9.8 million doses were given in Finland. Regarding safety, most vaccine-related adverse reactions have been mild, but severe and lethal ones have also occurred. Autopsies in post vaccination deaths may give insight to the extent of fatal health conditions with potential COVID-19 vaccine etiology and provide new hypotheses of possible causalities between vaccination and severe health conditions. We searched the complete documentation on all medicolegal autopsies in Finland between December 2020 and December 2021 to assess how often the indication for autopsy was a suspected fatal adverse reaction to COVID-19 vaccination, and whether vaccination remained a potential etiology for any health condition determined as a cause of death after the autopsy. We linked register-based data on individual COVID-19 vaccination course and pre-existing health conditions. We found 428 autopsy cases with a mention of COVID-19 vaccination, and prior to autopsy, vaccination was suspected to play a part in 76 deaths. Post autopsy, a forensic pathologist considered vaccination to be potentially related to underlying cause of death in five and contributory cause of death in seven autopsy cases. These included seven thromboembolisms, two diabetic ketoacidoses, one myocarditis, one acute pancreatitis, and one eosinophilic granulomatosis with polyangiitis. In relation to the number of vaccinations within Finland, medicolegal autopsies were rarely performed because of a possible vaccine-related severe adverse reaction. Among the autopsies performed for such reasons, only a few considered a vaccine-related severe adverse reaction as a cause of death, although considerable doubt remains in the accuracy of individual considerations, and autopsy cannot definitively confirm causality between vaccination and death. Regarding vaccination safety, continuing evaluation of suspected vaccine-related deaths is essential, and autopsy should be considered in cases of death where vaccine etiology is possible.Abstract COVID-19 vaccinations began globally at the end of 2020. By the end of 2021, 9.8 million doses were given in Finland. Regarding safety, most vaccine-related adverse reactions have been mild, but severe and lethal ones have also occurred. Autopsies in post vaccination deaths may give insight to the extent of fatal health conditions with potential COVID-19 vaccine etiology and provide new hypotheses of possible causalities between vaccination and severe health conditions. We searched the complete documentation on all medicolegal autopsies in Finland between December 2020 and December 2021 to assess how often the indication for autopsy was a suspected fatal adverse reaction to COVID-19 vaccination, and whether vaccination remained a potential etiology for any health condition determined as a cause of death after the autopsy. We linked register-based data on individual COVID-19 vaccination course and pre-existing health conditions. We found 428 autopsy cases with a mention of COVID-19 vaccination, and prior to autopsy, vaccination was suspected to play a part in 76 deaths. Post autopsy, a forensic pathologist considered vaccination to be potentially related to underlying cause of death in five and contributory cause of death in seven autopsy cases. These included seven thromboembolisms, two diabetic ketoacidoses, one myocarditis, one acute pancreatitis, and one eosinophilic granulomatosis with polyangiitis. In relation to the number of vaccinations within Finland, medicolegal autopsies were rarely performed because of a possible vaccine-related severe adverse reaction. Among the autopsies performed for such reasons, only a few considered a vaccine-related severe adverse reaction as a cause of death, although considerable doubt remains in the accuracy of individual considerations, and autopsy cannot definitively confirm causality between vaccination and death. Regarding vaccination safety, continuing evaluation of suspected vaccine-related deaths is essential, and autopsy should be considered in cases of death where vaccine etiology is possible

Self-Reported Mental Health Problems Among Adults Born Preterm : A Meta-analysis

CONTEXT: Preterm birth increases the risk for mental disorders in adulthood, yet findings on abstract self-reported or subclinical mental health problems are mixed. OBJECTIVE: To study self-reported mental health problems among adults born preterm at very low birth weight (VLBW; DATA SOURCES: Adults Born Preterm International Collaboration. STUDY SELECTION: Studies that compared self-reported mental health problems using the Achenbach Young Adult Self Report or Adult Self Report between adults born preterm at VLBW (n = 747) and at term (n = 1512). DATA EXTRACTION: We obtained individual participant data from 6 study cohorts and compared preterm and control groups by mixed random coefficient linear and Tobit regression. RESULTS: Adults born preterm reported more internalizing (pooled beta =.06; 95% confidence interval.01 to.11) and avoidant personality problems (.11;.05 to.17), and less externalizing (-.10;-. 15 to-. 06), rule breaking (-.10;-. 15 to-. 05), intrusive behavior (-.14;-. 19 to-.09), and antisocial personality problems (-.09;-. 14 to-.04) than controls. Group differences did not systematically vary by sex, intrauterine growth pattern, neurosensory impairments, or study cohort. LIMITATIONS: Exclusively self-reported data are not confirmed by alternative data sources. CONCLUSIONS: Self-reports of adults born preterm at VLBW reveal a heightened risk for internalizing problems and socially avoidant personality traits together with a lowered risk for externalizing problem types. Our findings support the view that preterm birth constitutes an early vulnerability factor with long-term consequences on the individual into adulthood.Peer reviewe

Common Core Assessments in follow-up studies of adults born preterm-Recommendation of the Adults Born Preterm International Collaboration

Background Of all newborns, 1%-2% are born very preterm (VP;Peer reviewe

Preterm birth and the risk of chronic disease multimorbidity in adolescence and early adulthood: : A population-based cohort study

Peer reviewe

Kuolleisuus välittömästi koronarokottamisen jälkeen : Koronarokotusten turvallisuus Suomessa

Terveyden ja hyvinvoinnin laitoksen (THL) asettama koronarokotusten turvallisuustyöryhmä aloitti tammikuussa 2021 seurantatutkimuksen, jossa tutkitaan, onko kokonaiskuolleisuus odotettua korkeampaa välittömästi koronarokottamisen jälkeen. Tutkimuksessa analysoidaan koronarokotettujen kuolemia 63 päivän sisällä rokottamisesta, kuolinsyystä ja haittaepäilyistä riippumatta. Tutkimusmenetelmänä on Suomen väestön kattava havainnoiva rekisteripohjainen tutkimus, jossa väestöä seurataan takautuvasti 1.10.2020 alkaen kuolemaan tai tutkimuksen päättymiseen 19.9.2022 saakka. Kuolleisuutta 0–20, 21–41 ja 42–62 päivää koronarokotuksen jälkeen verrataan kuolleisuuteen rokottamattomana aikana rokotevalmisteittain ja annoksittain käyttämällä Poisson-regressiomallia. Analyysissa vakioidaan ikä, sukupuoli, taustasairaudet, hoitoisuus ja ajankohta. Kuolleisuuserot raportoidaan uhkasuhteina ja näiden 95 % luottamusväleinä (LV). Rokotevalmisteista ja annoksista mukana ovat Comirnaty ja Spikevax ensimmäisen neljän annoksen osalta, sekä lisäksi Vaxzevria ensimmäisen ja toisen annoksen osalta. Kuolleisuus oli ensimmäisten 63 päivän aikana koronarokotuksen jälkeen alhaisempaa kaikkien rokotetuotteiden ja annosten kohdalla verrattuna aikaan ilman koronarokotusta. Kuolleisuus oli kunkin rokoteannoksen jälkeen alhaisinta ensimmäisten 21 päivän aikana verrattuna myöhäisempiin aikaikkunoihin. Suurin uhkasuhde 0–20 päivää minkä tahansa koronarokotuksen jälkeen oli 0,48 (LV; 0,41–0,55) ensimmäisen Spikevax-annoksen jälkeen, eli tuona aikana rokotettujen kuolleisuus oli suurimmillaan noin puolet samankaltaisten rokottamattomien kuolleisuudesta. Suurin uhkasuhde 21–41 tai 42–62 päivää minkä tahansa koronarokotuksen jälkeen oli 0,68 (LV; 0,60–0,76) ensimmäisen Spikevax-annoksen jälkeen, eli tuona aikana rokotettujen kuolleisuus oli noin kolmasosan pienempi rokottamattomiin verrattuna. Alhaisempi kokonaiskuolleisuus 63 päivän sisällä koronarokottamisesta johtuu todennäköisesti suurelta osin muista syistä kuin koronarokotteen suojaavasta vaikutuksesta. Koronakuolemalta suojaava vaikutus ei ala välittömästi ensimmäisen koronarokotuksen jälkeen, ja lisäksi koronakuolemat muodostavat vain pienen osan kokonaiskuolleisuudesta Suomessa. Mahdollinen selitys alhaisemmalle kokonaiskuolleisuudelle rokottamisen jälkeen voi olla se, että välittömässä kuoleman vaarassa olevia henkilöitä ei rokoteta