Sex Difference in the Case Fatality of Older Myocardial Infarction Patients

Background The female sex is associated with poorer outcomes after myocardial infarction (MI), although current evidence in older patients is limited and mixed. We sought to evaluate sex-based differences in outcome after MI in older patients. Method Consecutive older (>= 70 years) all-comer patients with out-of-hospital MI admitted to 20 hospitals in Finland between 2005 and 2014 were studied using national registries (n = 40 654, mean age 80 years, 50% women). The outcome of interest was death within 1 year after MI. Differences between sexes (age, baseline features, medication, comorbidities, revascularization, and treating hospital) were balanced by inverse probability weighting. Results Adjusted all-cause case fatality was lower in women than in men at 30 days (16.0% vs 19.0%, respectively) and at 1 year (27.7% vs 32.4%, respectively) after MI (hazard ratio: 0.83; confidence interval [CI]: 0.80-0.86; p = 80 years, patients with and without ST elevation MI, revascularized and non-revascularized patients, patients with and without atrial fibrillation, and patients with and without diabetes. The sex difference in case fatality remained similar during the study period. Conclusions Older women were found to have a lower hazard of death after an out-of-hospital MI when compared to older men with similar features and treatments. This finding was consistent in several subgroups.Peer reviewe

Virtsaamisvaivat iäkkäillä naisilla

Virtsaamisvaivat ovat yleisiä iäkkäillä naisilla. Vaivat haittaavat päivittäisiä toimintoja ja heikentävät elämänlaatua. Virtsankarkailu ja erilaiset muut rakko-oireet, kuten tyhjentämisongelmat on syytä erottaa toisistaan hoitoa mietittäessä. Virtsaamisvaivoihin liittyvät muut lantionpohjan toimintahäiriöt tai oireet kuten laskeumat ja ummetus on hyvä huomioida. Huolellinen anamneesi ja kliininen tutkimus ovat tärkeitä, tarvittaessa myös muiden sairauksien ja lääkitysten moniammatillinen arviointi. Ikä sinänsä ei vaikuta hoidon valinan, mutta lääkehoidon suhteen tulee noudattaa varovaisuutta hyvin iäkkäillä, monisairailla ja gerasteenisilla. Ensisijaisina hoitomuotoina ovat elämäntapaohjaus, liikunta- ja toimintakyvyn ylläpitäminen ja parantaminen, jotka auttavat myös lantionpohjan lihasten toiminnan ja virtsarakon hallinnassa. Ponnistusvirtsankarkailun leikkaushoidon tulokset ovat iäkkäillä huonommat kuin nuoremmilla. Hoidolla tavoitellaan parempaa elämänlaatua. </p

Sex Differences in Cardiovascular Outcomes of Older Adults After Myocardial Infarction

Background Evidence on the impact of sex on prognoses after myocardial infarction (MI) among older adults is limited. We evaluated sex differences in long-term cardiovascular outcomes after MI in older adults. Methods and Results All patients with MI >= 70 years admitted to 20 Finnish hospitals during a 10-year period and discharged alive were studied retrospectively using a combination of national registries (n=31 578, 51% men, mean age 79). The primary outcome was combined major adverse cardiovascular event within 10-year follow-up. Sex differences in baseline features were equalized using inverse probability weighting adjustment. Women were older, with different comorbidity profiles and rarer ST-segment-elevation MI and revascularization, compared with men. Adenosine diphosphate inhibitors, anticoagulation, statins, and high-dose statins were more frequently used by men, and renin-angiotensin-aldosterone inhibitors and beta blockers by women. After balancing these differences by inverse probability weighting, the cumulative 10-year incidence of major adverse cardiovascular events was 67.7% in men, 62.0% in women (hazard ratio [HR], 1.17; CI, 1.13-1.21; P= 80 years. Conclusions Older men had higher long-term risk of major adverse cardiovascular events after MI, compared with older women with similar baseline features and evidence-based medications. Our results highlight the importance of accounting for confounding factors when studying sex differences in cardiovascular outcomes.Peer reviewe

Vanhuksen vajaaravitsemuksen arviointi, ehkäisy ja hoito

Vanhuksilla vajaaravitsemus on yleisintä sairaalassa ja ympärivuorokautisessa hoidossa. Vanhusten vajaaravitsemuksen ja sen riskin seulonnan ja arvioinnin validoitu mittari on Mini Nutritional Assessment (MNA). Syiden ja taustatekijöiden arvioinnin tulisi olla kokonaisvaltaista. Vajaaravitsemusta ehkäistään ja hoidetaan ravitsemusneuvonnalla sekä tehostetulla ravitsemushoidolla.</div

Non-Violent Childhoods : Action Plan for the Prevention of Violence against Children 2020–2025

The objective of the action plan on Non-Violent Childhoods 2020–2025 is to prevent violence against children aged 0–17 in different growth and operating environments. The action plan deals with the rights of the child, inclusion, factors that protect against violence as well as risk factors and their consequences. The aim is to improve the position of the child victim in the current service, care and crime systems, also taking into account those children who are at risk of ending up using or have already used violence. The action plan contains 93 actions and consist of fourteen chapters dealing with the prevention of emotional and physical violence and sexual violence from three different perspectives: prevention, minimising harmful impact and providing treatment, with the main focus on prevention. The plan seeks to take into account issues related to children in particularly vulnerable situations with regard to violence, as well as some topical specific issues. The plan emphasises the importance of multidisciplinary cooperation. A broad group of experts from various organisations, ministries and NGOs wrote the action plan. A steering group nominated by the Finnish Institute for Health and Welfare is responsible for monitoring and directing the objectives and actions. In 2022, a mid-term review will be carried out concerning the implementation of the action plan's objectives and actions

Sex Difference in the Case Fatality of Older Myocardial Infarction Patients

Background: The female sex is associated with poorer outcomes after myocardial infarction (MI), although current evidence in older patients is limited and mixed. We sought to evaluate sex-based differences in outcome after MI in older patients.Methods: Consecutive older (≥ 70 years) all-comer patients with out-of-hospital MI admitted to 20 hospitals in Finland between 2005-2014 were studied using national registries (n=40,654, mean age 80 years, 50% women). The outcome of interest was death within one year after MI. Differences between sexes (age, baseline features, medication, comorbidities, revascularization, and treating hospital) were balanced by inverse probability weighting.Results: Adjusted all-cause case fatality was lower in women than in men at 30 days (16.0% vs. 19.0%, respectively) and at 1 year (27.7% vs. 32.4%, respectively) after MI (hazard ratio: 0.83; confidence interval [CI]: 0.80-0.86; pConclusions: Older women were found to have a lower hazard of death after an out-of-hospital MI when compared to older men with similar features and treatments. This finding was consistent in several subgroups.</p

Kohti happamien sulfaattimaiden hallintaa - Ehdotus happamien sulfaattimaiden aiheuttamien haittojen vähentämisen suuntaviivoiksi

Tässä maa- ja metsätalousministeriön toimeksiannosta laaditussa raportissa tarkastellaan happamien sulfaattimaiden haittojen vähentämiseen liittyviä selvitystarpeita ja haittojen vähentämisen suuntaviivoja. Selvityksen tavoitteena on edistää kestäviä maankäytön ja kuivatuksen ratkaisuja sekä löytää käytäntöjä, joilla happamien sulfaattimaiden aiheuttama happamuus- ja metallikuormitus saadaan mahdollisimman pieneksi