The Use of Nervous System Drugs and the Risk of Fractures in Old Adults

Hermostoon vaikuttavien lääkkeiden käyttö on yleistä iäkkäässä väestössä. Erityisen yleistä käyttö on pitkäaikaisessa laitoshoidossa asuvilla iäkkäillä. Hermostoon vaikuttavien lääkkeiden haittavaikutuksia on tutkittu paljon, ja useat hermostoon vaikuttavat lääkeaineryhmät on tunnistettu murtumien riskitekijöiksi. Aikaisemmin ei ole kuitenkaan tutkittu usean hermostoon vaikuttavan lääkkeen yhteiskäytön yhteyksiä murtuman riskiin 65 vuotta täyttäneillä. Väitöskirjatutkimuksessa havaittiin, että usean hermostoon vaikuttavan lääkeaineen yhtäaikainen käyttö oli hyvin yleistä Porin kaupunginsairaalan viidellä pitkäaikaisen laitoshoidon osastolla (n = 154) vuosien 2004 ja 2005 vaihteessa. Kolmasosa tutkituista käytti säännöllisesti kolmea tai useampaa hermostoon vaikuttavaa lääkettä samanaikaisesti. Kun huomioitiin myös tarvittaessa otettavat lääkkeet, vastaava luku oli 53 %. Tutkimuksessa havaittiin myös viitteitä lääkkeiden epäasianmukaisesta käytöstä, kun potilaiden käyttämiä lääkkeitä verrattiin heidän kognitiiviseen ja fyysiseen suorituskyynsä sekä asetettuihin diagnooseihin. Liedon kunnassa 1990-luvulla toteutettuun väestöpohjaiseen Liedon Iäkkäät -seurantatutkimukseen osallistui 1177 lietolaista 65 vuotta täyttänyttä. Lääkitystietoja sekä seuranta-aikana tapahtuneita murtumia analysoimalla havaittiin, että kahden tai useamman bentsodiatsepiinin sekä kahden tai useamman psykoosilääkkeen käyttö oli yhteydessä murtuman riskiin 65 vuotta täyttäneillä miehillä. Opioidin ja psykoosilääkkeen yhteiskäyttö sekä opioidin ja bentsodiatsepiinin yhteiskäyttö oli yhteydessä iäkkäiden miesten murtuman riskiin. Naisilla vastaavia tilastollisesti merkitseviä yhteyksiä ei havaittu. Väitöskirjatutkimuksen uusin osa-aineisto perustui Porissa vuosina 2009–2010 toteutetun Satauni-tutkimuksen aineistoon. Tutkimuksessa osoitettiin 89 potilaan aineistossa, että hallittu, yhden kuukauden aikana lääkärin ja hoitajan tuella toteutettu bentsodiatsepiinivieroitus paransi merkitsevästi 55 vuotta täyttäneiden naisten käden puristusvoimaa kuuden kuukauden seuranta-aikana. Vastaavaa yhteyttä ei havaittu miehillä. Bentsodiatsepiinivieroituksella ei ollut yhteyttä osallistujien tasapainotestin tulosten paranemiseen kuuden kuukauden seurantaaikana. Murtumilla on vakavia seurauksia sekä yksilötasolla että yhteiskunnallisesti iäkkäässä väestössä. Murtumien ehkäisy on hyvin tärkeää. Siinä tulee kiinnittää huomiota potilaan käyttämään lääkitykseen ja arvioida erityisesti usean hermostoon vaikuttavan lääkkeen yhteiskäytön tarpeellisuutta.The use of nervous system drugs is common among adults aged 65 years and older. The use of these drugs is most frequent among adults living in long-term care institutions. Literature on adverse effects of nervous system drugs is rich, and indicates that these medications are associated with the risk of fractures. However, studies concerning concomitant use of nervous system drugs and fractures are rare. This study concluded that the concomitant use of nervous system drugs was very common among patients living in five long-term care wards of Pori City Hospital (n=154). Every third patient used at least three nervous system drugs concomitantly, and the corresponding percentage was 53 when medications taken when needed were also taken into account. Indications of inappropriate drug use were found when patients' medications, cognitive and physical abilities, and diagnoses were compared to evaluate the appropriateness of prescribing practices. The material for fracture studies was obtained from the longitudinal and population-based Lieto Study comprising 1,177 participants 65 years of age and older. The data on medication use and fractures was used to analyze the associations between nervous system drugs and fractures. The concomitant use of two or more benzodiazepines or two or more antipsychotics was associated with an increased risk of fractures in men. Furthermore, the use of an opioid with a benzodiazepine or an antipsychotic increased the risk of fractures in men. These associations were not detected in women. The sample for the benzodiazepine withdrawal study consisted of 89 participants 55 years of age and older participating in the Satauni Study. The study lasted six months. The participants received psychological support while the benzodiazepine dose was gradually lowered over a one month time period. The participants were frequently tested for handgrip strength and balance. The study resulted in the finding that the handgrip strength of women who had withdrawn improved significantly in comparison to non-withdrawers. The associations were weaker for men. During the six–month follow-up period, no significant change in balance test results associated with benzodiazepine withdrawal was detected. Fractures often lead to serious consequences in late life; therefore, fracture prevention should be a top priority in senior health care policies. The role of concomitant use of nervous system drugs should be addressed in fracture prevention programs.Siirretty Doriast

Running in highly cushioned shoes increases leg stiffness and amplifies impact loading

Running shoe cushioning has become a standard method for managing impact loading and consequent injuries due to running. However, despite decades of shoe technology developments and the fact that shoes have become increasingly cushioned, aimed to ease the impact on runners' legs, running injuries have not decreased. To better understand the shoe cushioning paradox, we examined impact loading and the spring-like mechanics of running in a conventional control running shoe and a highly cushioned maximalist shoe at two training speeds, 10 and 14.5 km/h. We found that highly cushioned maximalist shoes alter spring-like running mechanics and amplify rather than attenuate impact loading. This surprising outcome was more pronounced at fast running speed (14.5 km/h), where ground reaction force impact peak and loading rate were 10.7% and 12.3% greater, respectively, in the maximalist shoe compared to the conventional shoe, whereas only a slightly higher impact peak (6.4%) was found at the 10 km/h speed with the maxima list shoe. We attribute the greater impact loading with the maximalist shoes to stiffer leg during landing compared to that of running with the conventional shoes. These discoveries may explain why shoes with more cushioning do not protect against impact-related running injuries.Peer reviewe

Diagnostic accuracy of contrast-enhanced CT for neck abscesses : A systematic review and meta-analysis of positive predictive value

Objectives To review the diagnostic accuracy of contrast-enhanced computed tomography (CT) in differentiating abscesses from cellulitis in patients with neck infections, using surgical findings as the reference standard. Materials and methods Previous studies in the last 32 years were searched from PubMed and Embase. Because of partial verification bias (only positive abscess findings are usually verified surgically), sensitivity and specificity estimates are unreliable, and we focused on positive predictive value (PPV). For all studies, PPV was calculated as the proportion of true positives out of all positives on imaging. To estimate pooled PPV, we used both the median with an interquartile range and a model-based estimate. For narrative purposes, we reviewed the utility of common morphological CT criteria for abscesses, such as central hypodensity, the size of the collection, bulging, rim enhancement, and presence of air, as well as sensitivity and specificity values reported by the original reports. Results 23 studies were found reporting 1453 patients, 14 studies in children (771 patients), two in adults (137 patients), and seven including all ages (545 patients). PPV ranged from 0.67 to 0.97 in individual studies, had a median of 0.84 (0.79–0.87), and a model-based pooled estimate of 0.83 (95% confidence interval 0.80–0.85). Most morphological CT criteria had considerable overlap between abscesses and cellulitis. Conclusions The pooled estimate of PPV is 0.83 for diagnosing neck abscesses with CT. False positives may be due to limited soft tissue contrast resolution. Overall, none of the morphological criteria seem to be highly accurate for differentiation between abscess and cellulitis.© 2022 Hagelberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.fi=vertaisarvioitu|en=peerReviewed

Työurien pituuden kehitys 2000-luvulla

Raportissa esitellään työuran pituuden mittaamista eri menetelmin ja aineistoilla. Erilaiset mittaustavat antavat toisistaan poikkeavia tuloksia työurien keskimääräisestä pituudesta. Tasoeroista riippumatta eri tavoilla saadaan sama päätulos työurien pidentymisestä 2000-luvulla. Kirjan painos on loppu

Comparing the Use of Custom-built and Commercial Off-the-shelf Data Gathering Devices in IoT Systems

IoT refers to a wide range of devices that have Internet access, and collect and transmit information. Data have to be gathered from the most diverse environments. Custom data gathering devices are often necessary in situa- tions where the data being collected are unique or need to be collected in a certain way. This is because commercial off-the-shelf (COTS) products may not have the necessary capabilities or features to meet the specific requirements of the data collection. This study focuses on COTS and self- built data gathering devices by comparing two data gathering prototype systems: The first designed and implemented from scratch and the second built with COTS components. Both systems are compared in terms of various features such as cost-effectiveness, time saving, and the usefulness of the output. The end goal of the study is to provide a proposal for when it is appropriate to use COTS components and when it is necessary to design and build devices yourself.acceptedVersionPeer reviewe