Suomalaisessa leivonnassa tapahtuvista tiamiinihäviöistä

The investigation comprised a number of different types of wheat and rye bread. They could be considered to represent the most common types of bread in Finland. A part of the flours were still of the standard conditioned by the war-time regulations, a part can be regarded as normal. Customary baking technique was employed. The vitamin content of the crumb and of the crust of the loaf were determined separately in each case. The bread types examined were as follows: Soft types of wheat bread 1. The so-called French bread (weight of the loaf 400 g., volume 1530 ml., height 65 mm., length 335 mm., breadth 90 mm.) made from half-white wheat flour of war-time qaulity (ash content 0.85 %, dry basis). 2. The so-called yeast bread, leavened with yeast, round loaf (weight 446 g., volume 920 ml., height 65 mm., diameter 145 mm.) made from dark high-extraction flour (mill stream BM3, ash content 4.00 %). 3. Yeast bread, round loaf (weight 389 g., volume 730 ml., height 67 mm., diameter 135 mm.) from the same flour as the previous one (2) but vitaminized with thiamine hydrochloride. 4. Whole-meal yeast bread, round loaf (height 60 mm., diameter 158 mm.). 5. Sweet bread (weight of the loaf 460 g., height 55 mm., length 330 mm., breadth 100 mm.) made from fine white flour (mill stream 82, ash content 0.70 %). In addition to flour, the dough contained 3.5 % eggs, 13 % butter, 10 % sugar, 1 %*salt, 3 % yeast ,35 % milk, and 5 % water colculated on the weight of flour. Soft types of rye bread 6. Whole-meal sour bread, leavened with acid ferment, round loaf (height 60 mm., diameter 143 mm.). 7. Whole-meal sour bread, leavened with acid ferment, round loaf with a hole in the centre (weight 378 g., volume 580 ml., height 24 mm., diameter 195 mm.) 8. Whole-meal bread, leavened with yeast, round loaf) weight 370 g., volume 530 ml., height mm., diameter 143 mm.). 9. Strongly fermented bread (height of the loaf 70 mm., diam. 193 mm.) made from a mixture of rye whole-meal and high-extraction wheat flour (97; 3). 10. Sour bread (weight of the loaf 470 g., volume 645 ml., height 55 mm., diam. 146 mm.) made from a mixture of rye whole-meal and high-extraction wheat flour (85 : 15). Hard thin bread (crisp bread) 11. Whole-meal wheat bread, leavened with yeast (thickness of the loaf 9 mm., diam. 230 mm water content 8.4 %) (same dough as in n:o 4). 12. Sout bread from a mixture of rye whole-meal and highextraction wheat flour (same as no. 9) (thickness of the loaf 6 mm., diam. 230 mm., water content 9.1 %). 13. Whole-meal rye bread, leavened with yeast, commercial quality (Elanto's bakery, size of the loaf 7,5x240x265 mm., water content 9.7 %). 14. Whole-meal rye bread, leavened with yeast, commercial quality (Elanto's bakery, size of the loaf 6.5x240x280 mm., water content 8.4 %). Customary baking procedure, adapted to each bread type, was followed. The additional ingredients were: common salt 1—2% and yeast 3 % of the weight of the flour. In making the sour bread (loaves nos. 6,7, 9, 10, 12) and acid ferment was used, instead of yeast, in 1.3—1.7 % of the weight of flour to raise the dough. The pH of the sour bread was 3.32—3.95. Baking was carried out in this laboratory, except that two of the hard thin loaves were made in a big Finnish bakery (Elanto). There the baking was performed in a wire-net travelling oven, the temperature being, with no 3, at the start 270°C and at the end 230°C, and with no 6, 280°C and 230°C respectively. The baking temperature of the wheat loaves was 225—240°C, that of the rye loaves 240—260°C Vitamin B1 was determined in the soft loaves, from which the crust could be removed, in the entire loaf, and besides, in the crumb and in the bottom and top crust separately. For this purpose the crust was very carefully removed from the loaf. It weighed 20—30 % of the total weight of the loaf. Determination of vitamin B1 was made according to the method of Feilenberg and Bernhard (9, 10). For the enzymatic hydrolysis diastase and papain were used and in some experiments cysteine for reduction of the disulphide form of thiamine. However, cysteine was not found to affect the results. Before oxidation to thiochrome the solution to be examined was purified by shaking it twice with 2.5 volumes of isobutanol (12). This because we had previously noted that the extracts of rye-meal and ryebread have a strong fluorescense of their own (19). The same is true of the extracts obtained from the crust of wheat bread. The method of Andrews and Nordgren (1) was also tested for determination of thiamine. The results obtained were in fairly good agreement with these obtained by the first mentioned method. The loss of vitamin B1 occuring in baking was 10—25 % of the initial amount (Table 2). In the group of soft wheat bread the loss was smaller (11 %) in the whole-meal loaves than in the others (16 —20 %). The difference between wheat and rye bread was not great. The loss was 15—25 % in the soft rye bread, or slightly higher than in the wheat bread. This may be due, for instance, to differences in the baking temperature or in the acidity. The loss was regularly greater in the crust of bread than in the crumb, in certain cases 3, even 4 times greater. In the bottom crust the loss was always greater than in the top crust. In particular, the attention was drawn to the fact that in the hard thin crisp bread which in fact consists of crust only, the losses of vitamin B1 were of the same order as in the corresponding soft-bread loaves. Thus, for instance, the loss was 11 % in a yeast bread loaf (no. 4) made from wheat whole-meal and 14 % in the hard thin loaf (no. 11) from the same material. In the loaf (no. 9) made from mixed rye meal the loss was 21 %, while in the corresponding crisp bread (loaf no. 12) it was 15 %- For the sake of comparison some data have been collected from the literature concerning the losses of thiamine in baking (Table 1)

Nurses’ Roles, Responsibilities and Actions in the Hospital Discharge Process of Older Adults with Health and Social Care Needs in Three Nordic Cities : A Vignette Study

The hospital discharge process of older adults in need of both medical and social care post hospitalisation requires the involvement of nurses at multiple levels across the different phases. This study aims to examine and compare what roles, responsibilities and actions nurses take in the hospital discharge process of older adults with complex care needs in three Nordic cities: Copenhagen (Denmark), Stockholm (Sweden) and Tampere (Finland). A vignette-based interview study consisting of three cases was conducted face-to-face with nurses in Copenhagen (n = 11), Stockholm (n = 16) and Tampere (n = 8). The vignettes represented older patients with medical conditions, cognitive loss and various home situations. The interviews were conducted in the local language, recorded, transcribed and analysed thematically. The findings show that nurses exchanged information with both healthcare (all cities) and social care services (Copenhagen, Tampere). Nurses in all cities, particularly Stockholm, reported to inform, and also convince patients to make use of home care. Nurses in Stockholm and Tampere reported that some patients refuse care due to co-payment. Nurses in these two cities were more likely to involve close relatives, possibly due to such costs. Not accepting care, due to costs, poses inequity in later life. Additionally, organisational changes towards a shift in location of care, i.e., from hospital to home, and from professional to informal caregivers, might be reflected in the work of the nurses through their initiatives to convince older patients to accept home care and to involve close relatives.Peer reviewe

Cardiac troponin and natriuretic peptide analytical interferences from hemolysis and biotin: educational aids from the IFCC Committee on Cardiac Biomarkers (IFCC C-CB).

Two interferences recently brought to the forefront as patient safety issues include hemolysis (hemoglobin) and biotin (vitamin B7). The International Federation for Clinical Chemistry Committee on Cardiac Biomarkers (IFCC-CB) obtained input from a majority of cTn and NP assay manufacturers to collate information related to high-sensitivity (hs)-cTnI, hs-cTnT, contemporary, and POC cTn assays, and NP assays interferences due to hemolysis and biotin. The information contained in these tables was designed as educational tools to aid laboratory professionals and clinicians in troubleshooting cardiac biomarker analytical results that are discordant with the clinical situation

Novel Biomarker Candidates for Febrile Neutropenia in Hematological Patients Using Nontargeted Metabolomics

Background. Novel potential small molecular biomarkers for sepsis were analyzed with nontargeted metabolite profiling to find biomarkers for febrile neutropenia after intensive chemotherapy for hematological malignancies. Methods. Altogether, 85 patients were included into this prospective study at the start of febrile neutropenia after intensive chemotherapy for acute myeloid leukemia or after autologous stem cell transplantation. The plasma samples for the nontargeted metabolite profiling analysis by liquid chromatography-mass spectrometry were taken when fever rose over 38° and on the next morning. Results. Altogether, 90 differential molecular features were shown to explain the differences between patients with complicated (bacteremia, severe sepsis, or fatal outcome) and noncomplicated courses of febrile neutropenia. The most differential compounds were an androgen hormone, citrulline, and phosphatidylethanolamine PE(18:0/20:4). The clinical relevance of the findings was evaluated by comparing them with conventional biomarkers like C-reactive protein and procalcitonin. Conclusion. These results hold promise to find out novel biomarkers for febrile neutropenia, including citrulline. Furthermore, androgen metabolism merits further studies.</p

Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study

BACKGROUND: The associations of social isolation and loneliness with premature mortality are well known, but the risk factors linking them remain unclear. We sought to identify risk factors that might explain the increased mortality in socially isolated and lonely individuals. METHODS: We used prospective follow-up data from the UK Biobank cohort study to assess self-reported isolation (a three-item scale) and loneliness (two questions). The main outcomes were all-cause and cause-specific mortality. We calculated the percentage of excess risk mediated by risk factors to assess the extent to which the associations of social isolation and loneliness with mortality were attributable to differences between isolated and lonely individuals and others in biological (body-mass index, systolic and diastolic blood pressure, and handgrip strength), behavioural (smoking, alcohol consumption, and physical activity), socioeconomic (education, neighbourhood deprivation, and household income), and psychological (depressive symptoms and cognitive capacity) risk factors. FINDINGS: 466 901 men and women (mean age at baseline 56·5 years [SD 8·1]) were included in the analyses, with a mean follow-up of 6·5 years (SD 0·8). The hazard ratio for all-cause mortality for social isolation compared with no social isolation was 1·73 (95% CI 1·65–1·82) after adjustment for age, sex, ethnic origin, and chronic disease (ie, minimally adjusted), and was 1·26 (95% CI 1·20–1·33) after further adjustment for socioeconomic factors, health-related behaviours, depressive symptoms, biological factors, cognitive performance, and self-rated health (ie, fully adjusted). The minimally adjusted hazard ratio for mortality risk related to loneliness was 1·38 (95% CI 1·30–1·47), which reduced to 0·99 (95% CI 0·93–1·06) after full adjustment for baseline risks. INTERPRETATION: Isolated and lonely people are at increased risk of death. Health policies addressing risk factors such as adverse socioeconomic conditions, unhealthy lifestyle, and lower mental wellbeing might reduce excess mortality among the isolated and the lonely. FUNDING: Academy of Finland, NordForsk, and the UK Medical Research Counci

Psychosocial functioning and intelligence both partly explain socioeconomic inequalities in premature death. A population-based male cohort study

The possible contributions of psychosocial functioning and intelligence differences to socioeconomic status (SES)-related inequalities in premature death were investigated. None of the previous studies focusing on inequalities in mortality has included measures of both psychosocial functioning and intelligence.The study was based on a cohort of 49 321 men born 1949-1951 from the general community in Sweden. Data on psychosocial functioning and intelligence from military conscription at ∼18 years of age were linked with register data on education, occupational class, and income at 35-39 years of age. Psychosocial functioning was rated by psychologists as a summary measure of differences in level of activity, power of initiative, independence, and emotional stability. Intelligence was measured through a multidimensional test. Causes of death between 40 and 57 years of age were followed in registers.The estimated inequalities in all-cause mortality by education and occupational class were attenuated with 32% (95% confidence interval: 20-45%) and 41% (29-52%) after adjustments for individual psychological differences; both psychosocial functioning and intelligence contributed to account for the inequalities. The inequalities in cardiovascular and injury mortality were attenuated by as much as 51% (24-76%) and 52% (35-68%) after the same adjustments, and the inequalities in alcohol-related mortality were attenuated by up to 33% (8-59%). Less of the inequalities were accounted for when those were measured by level of income, with which intelligence had a weaker correlation. The small SES-related inequalities in cancer mortality were not attenuated by adjustment for intelligence.Differences in psychosocial functioning and intelligence might both contribute to the explanation of observed SES-related inequalities in premature death, but the magnitude of their contributions likely varies with measure of socioeconomic status and cause of death. Both psychosocial functioning and intelligence should be considered in future studies

Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock

Altres ajuts: VPH was supported by the Aarne Koskelo Foundation (no grant number): http://www. aarnekoskelonsaatio.fi/, and the Finnish Cardiac Foundation (no grant number): https://www. fincardio.fi/. Laboratory kits were provided by Roche Diagnostics. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. Theprimary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5-4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1-3.8], IABPSHOCK II score adjusted odds ratio 2.5 [95%CI 1.2-5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2-7.1]). In serial measurements,albumin levels decreased at a similar rate between 0h and 72h in both survivors andnonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p 0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock

Opportunities for transitional care and care continuity following hospital discharge of older people in three Nordic cities : A comparative study

Aim: To outline and discuss care transitions and care continuity following hospital discharge of older people with complex care needs in three Nordic cities: Copenhagen, Tampere and Stockholm. Methods: Data on potential pathways following hospital discharge of older people were obtained from existing literature and expert consultations. The pathways for each system were outlined and presented in three figures. The hospital discharge process of the systems was then compared. Results: In all three care systems, the main care path from hospital is to home. Short-term intermediate healthcare can be provided in all three systems, possibly creating additional care transitions; however, once home, extensive home healthcare may prevent further care transitions. Opportunities for continuity of care include needs assessments (all cities) and meetings with the patient about care upon return home (Copenhagen, Stockholm). Yet this is challenged by lack of transfer of information (Tampere) and patients’ having to apply for some services themselves (Tampere, Stockholm). Conclusions: Comparisons of the discharge processes studied suggest that despite individual care planning and short- and long-term care options, transitional care and care continuity are challenged by limited access as some services need to be applied for by the older person themselves.publishedVersionPeer reviewe

Participatory learning and action cycles with women s groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability.

WHO recommends participatory learning and action cycles with women's groups as a cost-effective strategy to reduce neonatal deaths. Coverage is a determinant of intervention effectiveness, but little is known about why cost-effectiveness estimates vary significantly. This article reanalyses primary cost data from six trials in India, Nepal, Bangladesh and Malawi to describe resource use, explore reasons for differences in costs and cost-effectiveness ratios, and model the cost of scale-up. Primary cost data were collated, and costing methods harmonized. Effectiveness was extracted from a meta-analysis and converted to neonatal life-years saved. Cost-effectiveness ratios were calculated from the provider perspective compared with current practice. Associations between unit costs and cost-effectiveness ratios with coverage, scale and intensity were explored. Scale-up costs and outcomes were modelled using local unit costs and the meta-analysis effect estimate for neonatal mortality. Results were expressed in 2016 international dollars. The average cost was $203 (range:$61-$537) per live birth. Start-up costs were large, and spending on staff was the main cost component. The cost per neonatal life-year saved ranged from$135 to $1627. The intervention was highly cost-effective when using income-based thresholds. Variation in cost-effectiveness across trials was strongly correlated with costs. Removing discounting of costs and life-years substantially reduced all cost-effectiveness ratios. The cost of rolling out the intervention to rural populations ranges from 1.2% to 6.3% of government health expenditure in the four countries. Our analyses demonstrate the challenges faced by economic evaluations of community-based interventions evaluated using a cluster randomized controlled trial design. Our results confirm that women's groups are a cost-effective and potentially affordable strategy for improving birth outcomes among rural populations