Compositional association of 24-h movement behavior with incident major adverse cardiac events and all-cause mortality

Cardiovascular disease (CVD) causes a high disease burden. Physical activity (PA) reduces CVD morbidity and mortality. We aimed to determine the relationship between the composition of moderate-to-vigorous PA (MVPA), light PA (LPA), sedentary behavior (SB), and sleep during midlife to the incidence of major adverse cardiac events (MACE) and all-cause mortality at a 7-year follow-up. The study population consisted of Northern Finland Birth Cohort 1966 members who participated in the 46-year follow-up in 2012 and were free of MACE (N = 4147). Time spent in MVPA, LPA, and SB was determined from accelerometer data. Sleep time was self-reported. Hospital visits and deaths were obtained from national registers. Participants were followed until December 31, 2019, or first MACE occurrence (acute myocardial infarction, unstable angina pectoris, stroke, hospitalization due to heart failure, or death due to CVD), death from another cause, or censoring. Cox proportional hazards model was used to estimate hazard ratios of MACE incidence and all-cause mortality. Isotemporal time reallocations were used to demonstrate the dose–response association between time spent in behaviors and outcome. The 24-h time composition was significantly associated with incident MACE and all-cause mortality. More time in MVPA relative to other behaviors was associated with a lower risk of events. Isotemporal time reallocations indicated that the greatest risk reduction occurred when MVPA replaced sleep. Higher MVPA associates with a reduced risk of incident MACE and all-cause mortality after accounting for the 24-h movement composition and confounders. Regular engagement in MVPA should be encouraged in midlife

B-type natriuretic peptide ability to predict mortality after transcatheter aortic valve replacement

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Accelerometer-measured physical activity is associated with knee breadth in middle-aged Finns - a population-based study

Background: Articular surface size is traditionally considered to be a relatively stable trait throughout adulthood. Increased joint size reduces bone and cartilage tissue strains. Although physical activity (PA) has a clear association with diaphyseal morphology, the association between PA and articular surface size is yet to be confirmed. This cross-sectional study aimed to clarify the role of moderate-to-vigorous PA (MVPA) in knee morphology in terms of tibiofemoral joint size. Methods: A sample of 1508 individuals from the population-based Northern Finland Birth Cohort 1966 was used. At the age of 46, wrist-worn accelerometers were used to monitor MVPA (≥3.5 METs) during a period of two weeks, and knee radiographs were used to obtain three knee breadth measurements (femoral biepicondylar breadth, mediolateral breadth of femoral condyles, mediolateral breadth of the tibial plateau). The association between MVPA and knee breadth was analyzed using general linear models with adjustments for body mass index, smoking, education years, and accelerometer weartime. Results: Of the sample, 54.8% were women. Most individuals were non-smokers (54.6%) and had 9-12 years of education (69.6%). Mean body mass index was 26.2 (standard deviation 4.3) kg/m2. MVPA was uniformly associated with all three knee breadth measurements among both women and men. For each 60 minutes/day of MVPA, the knee breadth dimensions were 1.8-2.0% (or 1.26-1.42 mm) larger among women (p < 0.001) and 1.4-1.6% (or 1.21-1.28 mm) larger among men (p < 0.001). Conclusions: Higher MVPA is associated with larger tibiofemoral joint size. Our findings indicate that MVPA could potentially increase knee dimensions through similar biomechanical mechanisms it affects diaphyseal morphology, thus offering a potential target in reducing tissue strains and preventing knee problems. Further studies are needed to confirm and investigate the association between articulation area and musculoskeletal health.Peer reviewe

Kotona asumista tukevat teknologiat ikäihmisille: KATI-viitearkkitehtuuri

Ikääntyneiden henkilöiden kotona asumista, toimintakyvyn ylläpitoa ja heille kotiin tuotavia palveluja voidaan tukea ja mahdollistaa teknologian avulla eri tavoin. Kotona asumisen teknologiat ikäihmisille (KATI) -viitearkkitehtuuri on tarkoitettu hyvinvointialueille ja muille toimijoille, jotka kehittävät toimintamalleja ja palveluja iäkkäiden henkilöiden kotona asumisen ja hyvinvoinnin tueksi sekä parantamaan palvelujen saatavuutta ja yhdenvertaisuutta. Tavoitteena on, että palveluissa teknologia ja toimintamallit integroidaan saumattomaksi palvelukokonaisuudeksi tuottamaan käyttäjilleen hyötyä ja hyvinvointia. Viitearkkitehtuuri taustoittaa teknologian hyödyntämisen mahdollisuuksia, kuvaa kansallisia strategioita ja linjauksia sekä luonnostelee vision, miten teknologia voi olla luonteva osa iäkkään henkilön itsenäistä kotona asumista ja palvelujen tarjoamista kotiin. Teknologian käyttöönotossa huomioitava lainsäädäntökehys kuvataan odotettuine muutostarpeineen. Samoin kuvataan keskeiset kotona asumisen teknologiaratkaisuja kehittävät ja hyödyntävät toimijat, päätietoryhmät ja tietovarannot sekä tietojärjestelmäkokonaisuus. Lopuksi ehdotetaan jatkotoimenpiteitä viitearkkitehtuurin hyödyntämiseksi ja teknologian käyttöönottamiseksi ikääntyvän väestön tukena. Viitearkkitehtuuri ja kansallinen KATI-toimintamalli täydentävät toisiaan

Kuntoutusjärjestelmän kokonaisuudistus – tieto muutostyön tukena

Kuntoutus ei ole Suomessa yhtenäinen järjestelmä, vaan se koostuu useista osajärjestelmistä. Tämän selvityshankkeen tavoitteena on tuottaa monipuolista tietoa kuntoutusjärjestelmän nykytilasta sekä kehitysmahdollisuuksista kuntoutusjärjestelmän uudistusta suunnitteleville ja uudistuksesta päättäville tahoille. Selvitys koostuu neljästä osakokonaisuudesta. Osakokonaisuuksissa on tarkasteltu nykytilan haasteita ja keskeisiä mekanismeja, jotka vaikuttavat kuntoutuksen tuloksiin sekä tunnistettu järjestelmätason muutoksia, jotka mahdollistavat uudenlaisia toimintatapoja ja parempia tuloksia. Osakokonaisuuksien tulosten perusteella on muodostettu yhteiset johtopäätökset kuntoutusjärjestelmän kehittämiseks

Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

Objectives To compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV). Methods We evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry. Results The FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p <0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268) Conclusions In patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings. [GRAPHICS] .Peer reviewe

Huumeongelmaisen hoito : Käypä hoito -suositus. Päivitystiivistelmä

Käypä hoito -suositus. Päivitystiivistelm

Polygenic Risk Scores and Physical Activity

Purpose Polygenic risk scores (PRS) summarize genome-wide genotype data into a single variable that produces an individual-level risk score for genetic liability. PRS has been used for prediction of chronic diseases and some risk factors. As PRS has been studied less for physical activity (PA), we constructed PRS for PA and studied how much variation in PA can be explained by this PRS in independent population samples. Methods We calculated PRS for self-reported and objectively measured PA using UK Biobank genome-wide association study summary statistics, and analyzed how much of the variation in self-reported (MET-hours per day) and measured (steps and moderate-to-vigorous PA minutes per day) PA could be accounted for by the PRS in the Finnish Twin Cohorts (FTC;N= 759-11,528) and the Northern Finland Birth Cohort 1966 (NFBC1966;N= 3263-4061). Objective measurement of PA was done with wrist-worn accelerometer in UK Biobank and NFBC1966 studies, and with hip-worn accelerometer in the FTC. Results The PRS accounted from 0.07% to 1.44% of the variation (R-2) in the self-reported and objectively measured PA volumes (Pvalue range = 0.023 toPeer reviewe