Changing Immunochemistry Platforms : Thyroid Function Test Comparison and Reference Intervals Based on Clinical Needs

Background: Diagnosis of thyroid dysfunction relies on thyroid stimulating hormone (TSH), free thyroxine (FT4), and free tri-iodothyronine (FT3) tests against valid reference intervals (Rls). We changed the immunoassay platform from Abbott Architect to Siemens Atellica and aimed to establish Atellica Rls based on laboratory information system (LIS) patient data. Methods: Atellica thyroid hormone immunoassays were verified against those of Architect. Real-life patient results were retrieved from LIS. A single result per patient dataset was used to establish the Rls by the indirect method. Results: Atellica and Architect assays correlated well but Atellica showed a positive bias between 13% and 53%, the largest for FT4. Variations of the Atellica assays were Conclusions: We verified thyroid hormone Rls for Atellica by the indirect method for the first time. Our model proved reliable for selecting results of presumably healthy individuals from LIS data. Critical review of the Rls with local endocrinologists is essential.Peer reviewe

Mielenterveysvaikutusten ennakkoarviointi : MIVA käyttöön

Hyvä mielenterveys on keskeistä yksilöiden, yhteisöjen ja yhteiskunnan hyvinvoinnille ja menestykselle. Kunnat ja hyvinvointialueet voivat päätöksillään ja toimillaan tukea monin tavoin asukkaidensa mielenterveyttä. Mielenterveyden edistäminen ja mielenterveyshäiriöiden ehkäisy edellyttävät, että mielenterveyskysymykset huomioidaan paitsi sosiaali- ja terveysalan päätöksissä hyvinvointialueilla, myös esimerkiksi kunnan koulutus-, asunto- ja ympäristöpolitiikkaan, yhteisöllisyyteen ja kestävään kehitykseen liittyvissä päätöksissä. Mielenterveysvaikutusten ennakkoarviointi tuottaa tietoa päätöksen mahdollisista ja todennäköisistä vaikutuksista asukkaiden mielenterveydelle. Tietoon perustuvilla päätöksillä voidaan lisätä asukkaiden hyvinvointia, vaikuttaa kunnan ja hyvinvointialueen toimivuuteen, vakauteen ja kustannuksiin. Suomessa on toistaiseksi arvioitu mielenterveysvaikutuksia kuntapäätösten valmistelussa verrattain vähän, eikä yhtenäistä toimintamallia ole olemassa. Arviointeja on tehty esimerkiksi kuraattoripalveluihin, kehitysvammahuollon asuinpalveluihin, mielenterveyspalveluiden resurssointiin ja kouluihin liittyvien päätösten valmistelussa. Tässä raportissa esitellään konkreettinen toimintamalli, jonka tarkoituksena on yhdenmukaistaa, selkeyttää ja helpottaa kuntien ja hyvinvointialueiden mielenterveysvaikutusten ennakkoarviointia.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa.(tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Physical health examination in outpatients with schizophrenia : the cost effectiveness of laboratory screening tests

Background Guidelines on laboratory screening in schizophrenia recommend annual monitoring of fasting lipids and glucose. The utility and the cost effectiveness of more extensive laboratory screening have not been studied. Methods The Living Conditions and the Physical Health of Outpatients with Schizophrenia Study provided a comprehensive health examination, including a laboratory test panel for 275 participants. We calculated the prevalence of the results outside the reference range for each laboratory test, and estimated the cost effectiveness to find an aberrant test result using the number needed to screen to find one abnormal result (NNSAR) and the direct cost spent to find one abnormal result (DCSAR, NNSAR x direct cost per test) formulas. In addition, we studied whether patients who were obese or used clozapine had more often abnormal results. Results A half of the sample had 25-hydroxyvitamin D below, and almost one-fourth cholesterol, triglycerides or glucose above the reference range. One-fifth had sodium below and gamma glutamyltransferase above the reference range. NNSAR was highest for potassium (137) and lowest for 25-hydroxyvitamin D (2). DCSAR was below 5euro for glucose, all lipids and sodium, and below 10euro for creatinine and gamma glutamyltransferase. Potassium (130euro), pH-adjusted ionized calcium (33 euro) and thyroid stimulating hormone (33euro) had highest DCSARs. Several abnormal results were more common in obese and clozapine using patients. Conclusions An annual laboratory screening panel for an outpatient with schizophrenia should include fasting glucose, lipids, sodium, creatinine, a liver function test and complete blood count, and preferably 25-hydroxyvitamin D.Peer reviewe

Changes in prevalence and correlates of alcohol-use disorders in Finland in an 11-year follow-up

Aims: This study aimed to examine changes in prevalence and correlates of alcohol-use disorders (AUD) between 2000 and 2011. We also explored the impact of using multiple imputation on prevalence estimates, to address survey nonresponse. Methods: The study used a Finnish nationally representative survey of adults aged 30 years and older in 2000 and in 2011. The Munich Composite International Diagnostic Interview (M-CIDI) was used to diagnose AUD in 6005 persons in 2000 (response rate 75%) and 4381 in 2011 (response rate 55%). Multiple imputation using sociodemographic, health, and registry-linked data on mental health hospitalizations was compared with weights to account for nonresponse. Results: Prevalence of 12-month AUD in Finland decreased from 4.6% (95% CI 4.0–5.1) in 2000 to 2.0% in 2011 (95% CI 1.6–2.4). Lifetime AUD prevalence decreased from 10.8% (95% CI 9.9–11.6) to 7.5% (CI 95% 6.8–8.3) from 2000 to 2011. The reduction was observed for people aged 30–64 years. At both time points, AUD prevalence was higher among individuals aged 30–64, men and those unmarried, widowed or divorced. The observed prevalence changes can be partly attributed to reporting and selection bias. The latter was addressed by multiple imputation. Conclusions: Alcohol use disorders appear to have decreased in Finland from 2000 to 2011, especially for the 30–64 years age group. Males, younger adults and those unmarried, widowed or divorced had a higher risk of AUD.</p