Characteristics of outdoor falls among older people: A qualitative study

Background Falls are a major threat to older people’s health and wellbeing. Approximately half of falls occur in outdoor environments but little is known about the circumstances in which they occur. We conducted a qualitative study to explore older people’s experiences of outdoor falls to develop understanding of how they may be prevented. Methods We conducted nine focus groups across the UK (England, Wales, and Scotland). Our sample was from urban and rural settings and different environmental landscapes. Participants were aged 65+ and had at least one outdoor fall in the past year. We analysed the data using framework and content analyses. Results Forty-four adults aged 65 – 92 took part and reported their experience of 88 outdoor falls. Outdoor falls occurred in a variety of contexts, though reports suggested the following scenarios may have been more frequent: when crossing a road, in a familiar area, when bystanders were around, and with an unreported or unknown attribution. Most frequently, falls resulted in either minor or moderate injury, feeling embarrassed at the time of the fall, and anxiety about falling again. Ten falls resulted in fracture, but no strong pattern emerged in regard to the contexts of these falls. Anxiety about falling again appeared more prevalent among those that fell in urban settings and who made more visits into their neighbourhood in a typical week. Conclusions This exploratory study has highlighted several aspects of the outdoor environment that may represent risk factors for outdoor falls and associated fear of falling. Health professionals are recommended to consider outdoor environments as well as the home setting when working to prevent falls and increase mobility among older people

Sensitivity, specificity, inclusivity and exclusivity of the updated Aptima Combo 2 assay, which provides detection coverage of the new diagnostic-escapeChlamydia trachomatisvariants

Background Four new variants ofChlamydia trachomatis(nvCTs), detected in several countries, cause false-negative or equivocal results using the Aptima Combo 2 assay (AC2; Hologic). We evaluated the clinical sensitivity and specificity, as well as the analytical inclusivity and exclusivity of the updated AC2 for the detection of CT andNeisseria gonorrhoeae(NG) on the automated Panther system (Hologic). Methods We examined 1004 clinical AC2 samples and 225 analytical samples spiked with phenotypically and/or genetically diverse NG and CT strains, and other potentially cross-reacting microbial species. The clinical AC2 samples included CT wild type (WT)-positive (n = 488), all four described AC2 diagnostic-escape nvCTs (n = 170), NG-positive (n = 214), and CT/NG-negative (n = 202) specimens. Results All nvCT-positive samples (100%) and 486 (99.6%) of the CT WT-positive samples were positive in the updated AC2. All NG-positive, CT/NG-negative,Trichomonas vaginalis(TV)-positive, bacterial vaginosis-positive, andCandida-positive AC2 specimens gave correct results. The clinical sensitivity and specificity of the updated AC2 for CT detection was 99.7 and 100%, respectively, and for NG detection was 100% for both. Examining spiked samples, the analytical inclusivity and exclusivity were 100%, i.e., in clinically relevant concentrations of spiked microbe. Conclusions The updated AC2, including two CT targets and one NG target, showed a high sensitivity, specificity, inclusivity and exclusivity for the detection of CT WT, nvCTs, and NG. The updated AC2 on the fully automated Panther system offers a simple, rapid, high-throughput, sensitive, and specific diagnosis of CT and NG, which can easily be combined with detection ofMycoplasma genitaliumand TV.Peer reviewe

Sensitivity, specificity, inclusivity and exclusivity of the updated Aptima Combo 2 assay, which provides detection coverage of the new diagnostic-escapeChlamydia trachomatisvariants

Background Four new variants ofChlamydia trachomatis(nvCTs), detected in several countries, cause false-negative or equivocal results using the Aptima Combo 2 assay (AC2; Hologic). We evaluated the clinical sensitivity and specificity, as well as the analytical inclusivity and exclusivity of the updated AC2 for the detection of CT andNeisseria gonorrhoeae(NG) on the automated Panther system (Hologic). Methods We examined 1004 clinical AC2 samples and 225 analytical samples spiked with phenotypically and/or genetically diverse NG and CT strains, and other potentially cross-reacting microbial species. The clinical AC2 samples included CT wild type (WT)-positive (n = 488), all four described AC2 diagnostic-escape nvCTs (n = 170), NG-positive (n = 214), and CT/NG-negative (n = 202) specimens. Results All nvCT-positive samples (100%) and 486 (99.6%) of the CT WT-positive samples were positive in the updated AC2. All NG-positive, CT/NG-negative,Trichomonas vaginalis(TV)-positive, bacterial vaginosis-positive, andCandida-positive AC2 specimens gave correct results. The clinical sensitivity and specificity of the updated AC2 for CT detection was 99.7 and 100%, respectively, and for NG detection was 100% for both. Examining spiked samples, the analytical inclusivity and exclusivity were 100%, i.e., in clinically relevant concentrations of spiked microbe. Conclusions The updated AC2, including two CT targets and one NG target, showed a high sensitivity, specificity, inclusivity and exclusivity for the detection of CT WT, nvCTs, and NG. The updated AC2 on the fully automated Panther system offers a simple, rapid, high-throughput, sensitive, and specific diagnosis of CT and NG, which can easily be combined with detection ofMycoplasma genitaliumand TV.Peer reviewe

Chlamydia trachomatis samples testing falsely negative in the Aptima Combo 2 test in Finland, 2019

Since February 2019, over 160 Chlamydia trachomatis (CT) cases testing negative or equivocal by Aptima Combo 2 (AC2) but positive by Aptima CT test run with Panther instruments occurred in Finland. The AC2 test targets chlamydial 23S rRNA while the CT test targets 16S rRNA. Sequencing of 10 strains revealed a nucleotide substitution in 23S rRNA. The significance of this for the failure of the AC2 test to detect the variant is not yet known.Peer reviewe

The first human report of mobile colistin resistance gene, mcr-1, in Finland

Colistin resistance mediated by mobile mcr-1 gene has raised concern during the last years. After steep increase in mcr-1 reports, other mcr-gene variants (mcr-2 to mcr-5) have been revealed as well. In 2016, a clinical study was conducted on asymptomatic stool carriage of extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae among Finnish adults. All suspected ESBL producing bacterial isolates were first tested by phenotypic ESBL-confirmation methods, and then further analyzed with whole genome sequencing to identify the resistance genes. We found one study subject carrying a colistin resistant E.coli with a transferrable mcr-1 gene. This multi-drug resistant isolate, although initially suspected to be an ESBL producer, did not carry any ESBL genes, but was proven to carry several other resistance genes by using whole genome sequencing. Sequence type was ST93. The mcr-1 gene was connected to IncX4 plasmid which suggests that the colistin resistance gene locates in the respective plasmid. Here, we report the finding of a mcr-1 harboring human E.coli isolate from Finland. Clinical antimicrobial resistance (AMR) rates are low in Finland, and mobile colistin resistance has not been reported previously. This highlights the importance of AMR surveillance also in populations with low levels of resistance

Itämeren kalan ja muun kotimaisen kalan ympäristömyrkyt: PCDD/F-, PCB-, PBDE-, PFCja OT-yhdisteet : EU-kalat ll

EU-KALAT II hankkeessa tuotettiin tietoa Itämeren kalojen ja kotimaisten järvikalojen sekä kasvatettujen kalojen PCDD/F- ja PCB- sekä PBDE-pitoisuuksista eri ikäisissä ja kokoisissa kaloissa sekä lajeittain että alueittain. Hankkeessa tutkittiin myös perfluorattuja yhdisteitä (PFC) ja organotina (OT)-yhdisteitä sekä lihaksesta että maksasta. Tutkimuksesta saatiin uutta tietoa kalojen haitallisten aineiden pitoisuuksista riskinhallintaa varten. Vuoden 2009 tuloksia verrattiin aikaisempiin tuloksiin vuosilta 2002-2003. Itämeren ja muun kotimaisen kalan PCDD/F- ja PCB-pitoisuuksista nousevat esiin samat kalalajit, joiden on aiemminkin todettu keräävän näitä ympäristömyrkkyjä. Silakka, lohi ja meritaimen sekä nahkiainen ja tässä hankkeessa lisäksi kampela Kotkan alueelta ylittävät PCDD/F- ja PCB-yhdisteille asetetut enimmäispitoisuusrajat. Itämeren kaloista, kilohailin, muikun, ahvenen, hauen, kuhan, mateen ja turskan dioksiinien mediaanipitoisuudet eivät yllä edes puoleen sallitusta enimmäispitoisuudesta, joka on 4 pg/g tuorepainoa. Kun verrataan vuoden 2002-2003 pitoisuuksia vuoden 2009 PCDD/F- ja PCB- sekä PBDE-yhdisteiden pitoisuuksiin, ovat lohen ja silakan keskimääräiset pitoisuudet pienentyneet. Avomerialueiden OT-pitoisuudet lihaksessa olivat noin kolmanneksen pienemmät kuin vuonna 2005–2007 pyydetyissä näytteissä. Pahimpia Itämeren ympäristömyrkkyjä ovat edelleen dioksiinit ja dioksiininkaltaiset PCB-yhdisteet. PBDE- ja PFOS- ja OTpitoisuudet ovat pieniä muutamaa poikkeusta lukuun ottamatta. Useista kalalajeista suurimmat haitta-aineiden pitoisuudet todettiin seuraavilta alueilta: Selkämereltä Porin edusta ja Turun ja Kotkan pyyntialueet sekä kaikkein pahimpana Helsingin Vanhankaupunginlahti, jossa sekä OT- että PFOS-pitoisuudet antavat aihetta suositella kulutuksen rajoittamista, ainakin isojen ahventen osalta

Levels of organic tin compounds in Baltic sea and Finnish fresh water fish

Orgaanisten tinayhdisteiden (OT) pitoisuuksia kotimaisessa meri- ja järvikalassa alettiin tutkia kattavasti, kun Helsingin uuden suursataman rakentamisen yhteydessä vuonna 2005 mitattiin kalasta ja sedimentistä suuria OT-pitoisuuksia. Tutkimuksessa keskityttiin niihin sisävesi- ja merikaloihin, joita suomalaiset pääsääntöisesti käyttävät ravinnokseen. Näytteitä kerättiin sekä kuormitetuilta satama- ja teollisuusalueilta että alueilta, joilla ei ole paikallista kuormitusta. Sisävesillä kalojen OT-pitoisuudet jäivät yleensä alle 10 μg/kg tuorepaino (tp), mutta neljällä paikkakunnalla (Varkaus, Lohja, Jyväskylä ja Tampere) pitoisuudet olivat 19–28 μg/kg. Varkauden Huruslahden sedimentistä mitattiin hankkeen yhteydessä 2–6 cm:n syvyydeltä jopa 35000 μg/kg kuivapaino (kp) pitoisuus. Merialueiden kaloissa OT-pitoisuudet olivat noin 10 kertaa suurempia kuin sisävesillä. Merialueilla, joilla ei ole paikallista kuormitusta, OT-pitoisuudet kaloissa olivat alle 20 μg/kg tp. Kuormitetuilla alueilla pitoisuudet ylittivät 40 μg/kg. Pahasti saastuneilta alueilta löydettiin 150–500 μg/kg pitoisuuksia. Suurimmat OT-pitoisuudet todettiin Helsingin Vanhankaupunginlahden ahvenista (28–528 μg/kg), joilla sekä pituus että paino korreloivat OT-pitoisuuden kanssa. Suuria pitoisuuksia todettiin myös Naantalin satamassa, jossa pitoisuudet kuitenkin pienenivät nopeasti avomerelle siirryttäessä. OT-pitoisuudet vaihtelivat samoilta pyyntialueilta kerättyjen kalalajien välillä. Ahvenesta, lahnasta ja kuhasta, jotka viihtyvät saaristossa ja sisälahdissa, mitattiin keskimäärin suurempia pitoisuuksia kuin silakasta, lohesta ja kilohailista, jotka viihtyvät lähinnä avomerellä.Man beslöt undersöka halterna organiska tennföreningar (OT) i inhemsk havs- och insjöfisk på bred front då stora OT-halter i fisk och sediment uppmättes år 2005 i samband med byggandet av den nya storhamnen i Helsingfors. I undersökningen koncentrerade man sig på sådan insjö- och havsfisk, som finländare i regel använder som föda. Prover samlades in såväl i belastade hamn- och industriområden som i områden utan lokal belastning. I insjövatten stannade OT-halterna i fisk i allmänhet under 10 μg/kg färsk vikt (fv), men på fyra orter (Varkaus, Lojo, Jyväskylä och Tammerfors) var halterna 19–28 μg/kg. I sedimentet i Huruslahti i Varkaus uppmättes i samband med projektet på 2–6 cm djup halter på hela 35000 μg/kg (torrvikt). I fisk i havsområden var OT-halterna cirka 10 gånger högre än i insjöfisk. I havsområden utan lokal belastning var OT-halterna i fisk under 20 μg/kg fv. I belastade områden översteg halterna 40 μg/kg. I svårt förorenade områden påträffades halter på 150–500 μg/kg. De högsta OT-halterna påträffades i abborrar i Gammelstadsviken i Helsingfors (28–528 μg/kg), hos vilka såväl längden som vikten korrelerade med OT-halten. Höga halter påträffades också i hamnen i Nådendal, där de ändå snabbt sjönk allt efter som man förflyttade sig längre ut mot öppet hav. OT-halterna varierade mellan fiskar insamlade i samma fångstområden. Hos abborre, braxen och gös som trivs i skärgården och innervikar uppmättes i genomsnitt högre halter än hos strömming, lax och vassbuk som främst trivs i öppet hav.The decision to launch an extensive study on the levels of organic tin compounds (OTC) in Finnish fresh water and sea fish was made when high levels of OTC were found in fish and in the sediment in connection with the construction project of the new harbour in Helsinki in 2005. The study focused on the fresh water and sea fish species that Finns mainly use as food. Samples were collected both in harbour and industrial areas with OTC contamination and in areas with no local contamination. OTC content in fresh water fish usually remained under 10 μg/kg fresh weight (fw), but contents measured in four municipalities (Varkaus, Lohja, Jyväskylä and Tampere) were 19–28 μg/kg. OTC content of as high as 35,000 μg/kg (dry weight) was measured in the sediment in Huruslahti Bay, Varkaus, at the depth of 2–6 cm. Sea fish showed OTC levels about ten times higher than fresh water areas. OTC content in fish was under 20 μg/kg fw in sea areas with no local contamination. Contents in contaminated areas exceeded 40 μg/kg. Contents of 150–500 μg/kg were found in severely contaminated areas. The highest OTC contents (28–528 μg/kg) were found in perch caught in Vanhankaupunginlahti Bay in Helsinki. In this case, both the length and weight of fish correlated with the OTC content. High OTC levels were also found in the Naantali Harbour where the level decreased rapidly when moving towards the open sea. The OTC levels in fish caught in the same area varied between different species. Levels found in perch, bream and pike-perch, the preferred habitats of which are in the archipelago and inland bays, were on average higher than levels found in herring, salmon and sprat, which live in the open sea

No evidence of the role of early chemical exposure in the development of β-cell autoimmunity

Exposure to environmental chemicals can modulate the developing immune system, but its role in the pathogenesis of type 1 diabetes is largely unexplored. Our objective was to study the levels of circulating concentrations of environmental pollutants during the first years of life and their associations with the later risk of diabetes-predictive autoantibodies. From two birth-cohort studies including newborn infants with HLA-conferred susceptibility to type 1 diabetes (FINDIA and DIABIMMUNE), we identified case children with at least one biochemical diabetes-associated autoantibody (n = 30–40) and from one to four autoantibody-negative controls per each case child matched for age, gender, diabetes-related HLA-risk, delivery hospital, and, in FINDIA, also dietary intervention group. Plasma levels of 13 persistent organic pollutants and 14 per- and polyfluorinated substances were analyzed in cord blood and plasma samples taken at the age of 12 and 48 months. Both breastfeeding and the geographical living environment showed association with circulating concentrations of some of the chemicals. Breastfeeding-adjusted conditional logistic regression model showed association between decreased plasma HBC concentration at 12-month-old children and the appearance of diabetes-associated autoantibodies (HR, 0.989; 95% Cl, 0.978–1.000; P = 0.048). No association was found between the plasma chemical levels and the development of clinical type 1 diabetes. Our results do not support the view that exposure to the studied environmental chemicals during fetal life or early childhood is a significant risk factor for later development of β-cell autoimmunity and type 1 diabetes.</p

Itämeren kalan ja muun kotimaisen kalan ympäristömyrkyt: PCDD/F-, PCB-, PBDE-, PFC- ja OT-yhdisteet : EU-kalat II

EU-KALAT II hankkeessa tuotettiin tietoa Itämeren kalojen ja kotimaisten järvikalojen sekä kasvatettujen kalojen PCDD/F- ja PCB- sekä PBDE-pitoisuuksista eri ikäisissä ja kokoisissa kaloissa sekä lajeittain että alueittain. Hankkeessa tutkittiin myös perfluorattuja yhdisteitä (PFC) ja organotina (OT)-yhdisteitä sekä lihaksesta että maksasta. Tutkimuksesta saatiin uutta tietoa kalojen haitallisten aineiden pitoisuuksista riskinhallintaa varten. Vuoden 2009 tuloksia verrattiin aikaisempiin tuloksiin vuosilta 2002-2003. Itämeren ja muun kotimaisen kalan PCDD/F- ja PCB-pitoisuuksista nousevat esiin samat kalalajit, joiden on aiemminkin todettu keräävän näitä ympäristömyrkkyjä. Silakka, lohi ja meritaimen sekä nahkiainen ja tässä hankkeessa lisäksi kampela Kotkan alueelta ylittävät PCDD/F- ja PCB-yhdisteille asetetut enimmäispitoisuusrajat. Itämeren kaloista, kilohailin, muikun, ahvenen, hauen, kuhan, mateen ja turskan dioksiinien mediaanipitoisuudet eivät yllä edes puoleen sallitusta enimmäispitoisuudesta, joka on 4 pg/g tuorepainoa. Kun verrataan vuoden 2002-2003 pitoisuuksia vuoden 2009 PCDD/F- ja PCB- sekä PBDE-yhdisteiden pitoisuuksiin, ovat lohen ja silakan keskimääräiset pitoisuudet pienentyneet. Avomerialueiden OT-pitoisuudet lihaksessa olivat noin kolmanneksen pienemmät kuin vuonna 2005–2007 pyydetyissä näytteissä. Pahimpia Itämeren ympäristömyrkkyjä ovat edelleen dioksiinit ja dioksiininkaltaiset PCB-yhdisteet. PBDE- ja PFOS- ja OTpitoisuudet ovat pieniä muutamaa poikkeusta lukuun ottamatta. Useista kalalajeista suurimmat haitta-aineiden pitoisuudet todettiin seuraavilta alueilta: Selkämereltä Porin edusta ja Turun ja Kotkan pyyntialueet sekä kaikkein pahimpana Helsingin Vanhankaupunginlahti, jossa sekä OT- että PFOS-pitoisuudet antavat aihetta suositella kulutuksen rajoittamista, ainakin isojen ahventen osalta.As an outcome of the EU FISH II project, information was produced about PCDD/F and PCB as well as PBDE levels in Baltic fish, domestic freshwater fish and farmed fish. Variations in the levels were studied by age and size of the fish as well as by species and areas. Analyses of the presence of perfluorinated compounds (PFC) and organotin compounds (OT) in muscles and liver were also carried out within the scope of the project. New data on the content of hazardous substances in fish were obtained for use in risk management. The 2009 results were compared with the results of the previous project conducted in 2002-2003. Analyses of PCDD/F and PCB levels in fish highlight the same species that have also previously been found to be susceptible to accumulation of these environmental toxins. Baltic herring, salmon and sea trout as well as river lamprey and now in this study also European flounder in Kotka area show levels of PCDD/F and PCB compounds exceeding the maximum stipulated limits. In Baltic fish, the median levels of dioxin equivalents in sprat, vendace, perch, pike, pike-perch, burbot and cod are not even half of the permitted maximum level, which is 4 pg/g of fresh weight. The comparison of the levels measured in 2002-2003 with the 2009 levels of PCDD/F and PCB as well as PBDE compounds shows that the mean levels have decreased in salmon and herring. The OT levels measured in the muscles of open sea fish were about one third lower than in the fish samples caught in 2005–2007. Dioxins and dioxin-like PCB compounds are still the worst contaminants in the Baltic Sea. The levels of PBDE, PFOS and OT were low, with a few exceptions. The Bothnian Sea and the fishing areas of Pori, Turku and Kotka took the lead in the contamination ranking, but the worst area was Vanhankaupunginlahti Bay of Helsinki, where both OT and PFOS levels give cause to recommend consumption restrictions, at least as far as large perch are concerned.I projektet EU-FISK II producerades information om PCDD/F- och PCBjämte PBDE-halterna i östersjöfisk och inhemsk insjöfisk och odlad fisk av olika ålder och storlek såväl artvis som regionvis. I projektet undersöktes också såväl muskler som levern med tanke på perfluorkolväten (PFC) som organiska tennföreningar (OT). Undersökningen gav ny information om halterna skadliga ämnen i fisk med tanke på riskhanteringen. Resultaten från år 2009 jämfördes med de tidigare resultaten från åren 2002-2003. I fråga om PCDD/F- och PCB-halterna i östersjöfisk och annan inhemsk fisk framhävs samma fiskarter som också tidigare kontaterats samla på sig av dessa miljötoxiner. Strömming, lax och havsöring jämte nejonöga och i detta projekt också flundra från Kotkaområdet överskred gränsvärdena som fastställts för PCDD/F- och PCB-föreningar. Av östersjöfisken når medianhalterna dioxinekvivalenter i skarpsill, siklöja, abborre, gädda, gös, lake och torsk inte ens upp till halva det tillåtna gränsvärdet, som är 4 pg/g färskvikt. Då man jämför halterna år 2002-2003 med halterna PCDD/F- och PCB- jämte PBDE-föreningar år 2009, har de genomsnittliga halterna i lax och strömming minskat. OT-halterna i muskler i fisk från öppet havar är cirka en tredjedel mindre än i proverna från fisk som fångats år 2005–2007. Dioxinerna och de dioxinliknande PCB-föreningarna utgör fortsättningsvis de värsta kontaminanterna i Östersjön. PBDE-, PFOS- och OT-halterna var med några få undantag små. Som mest kontaminerade framstod fiskeriområdena Bottenhavet, Björneborg, Åbo och Kotka och som det allra värsta området Gammelstadsviken i Helsingfors, där såväl OT- som PFOS-halterna ger orsak att rekommendera en begränsing av konsumtionen åtminstone för stora abborrars del