Benzodiazepines and Cognitive Functioning in Older Adults. With Emphasis on Long-Term Use and Withdrawal

Benzodiazepines (BZD) and benzodiazepine related drugs (RD) are the most commonly used psychotropics among the aged. The use of other psychotropics taken concomitantly with BZD/ RD or their cognitive effects with BZD/RD have not been studied frequently. The aim of this academic thesis was to describe and analyse relationships between the use of BZD/RD alone or concomitantly with antipsychotics, antidepressants, opioids, antiepileptics, opioids and anticholinergics in the aged and their health. Especially, the relationships between long-term use of BZD/RD and cognitive decline were studied. Additionally, the effect of melatonin on BZD/RD withdrawal and the cognitive effects of BZD/RD withdrawal were studied. This study used multiple data sets: the first study (I) was based on clinical data containing aged patients (≥65 years; N=164) admitted to Pori City Hospital due to acute disease. The second data set (Studies II and III) was based on population-based data from the Lieto Study, a clinico-epidemiological longitudinal study carried out among the aged (≥65 years) in the municipality of Lieto. Follow-up data was formed by combining the cohort data collected in 1990-1991 (N=1283) and in 1998-1999 (N=1596) from those who participated in both cohorts (N=617). The third data set (Studies IV and V) was based on the Satauni Study’s data. This study was performed in the City of Pori in 2009-2010. In the RCT part of the Satauni Study, ninety-two long-term users of BZD/RD were withdrawn from their drugs using melatonin against placebo. The change of their cognitive abilities was measured during and after BZD/ RD withdrawal. BZD/RD use was related to worse cognitive and functional abilities, and their use may predict worse cognitive outcomes compared with BZD/RD non-users. Hypnotic use of BZD/RD could be withdrawn with psychosocial support in motivated participants, but melatonin did not improve the withdrawal results compared to those with placebo. Cognitive abilities in psychomotor tests did not show, or showed only modest, improvements for up to six months after BZD/RD withdrawal. This suggests that the cognitive effects of BZD/RD may be longlasting or permanent.Bentsodiatsepiinit ja niiden tavoin vaikuttavat lääkkeet ovat yleisimpiä iäkkäiden käyttämiä psyykenlääkkeitä. Muiden psyykenlääkkeiden tai niiden yhteiskäytön yhteyksiä bentsodiatsepiinien ja niiden tavoin vaikuttavien lääkkeiden kanssa kognitiivisten kykyjen heikkenemiseen ei ole juurikaan tutkittu. Tämän väitöskirjatutkimuksen tavoitteena oli kuvata ja analysoida bentsodiatsepiinien ja niiden tavoin vaikuttavien lääkkeiden, psykoosilääkkeiden, masennuslääkkeiden, opioidien, epilepsialääkkeiden ja antikolinergien käytön, erityisesti pitkäaikaiskäytön, yhteyksiä terveydentilaan ja kognitiivisen toimintakyvyn heikkenemisen vaaraan iäkkäillä. Erityistä huomiota kiinnitettiin näiden lääkeryhmien samanaikaisen käytön, erityisesti pitkäkestoisen samanaikaisen käytön, yhteyksiin kognitiivisen toimintakyvyn laskun vaaraan. Lisäksi tutkittiin, voidaanko melatoniinilla helpottaa pitkäaikaisesta bentsodiatsepiinien unilääkekäytöstä vieroittumista ja vaikuttaako bentsodiatsepiinien vieroitus kognitiiviseen tai psykomotoriseen toimintakykyyn. Tutkimuksen osa-aineistoina käytettiin useita aineistoja: Ensimmäisenä osa-aineistona (I osatutkimus) käytettiin yli 65-vuotiaita Porin kaupunginsairaalan akuuttiosastojen potilaita, jotka saapuivat äkillisen sairauden vuoksi hoitoon heinäkuussa 2004 (N=164). Toinen osa-aineisto (II ja III osatutkimukset) muodostettiin Liedon kunnassa suoritetun väestöpohjaisen kliinis-epidemiologisen pitkittäistutkimuksen perus- ja seuranta-aineistoista. Liedossa suoritettiin vuosina 1990–1991 kaikkien kunnassa asuneiden 65 vuotta täyttäneiden (N=1283) laaja terveystutkimus, jossa osallistujia oli 1196 (93 %). Seuraava poikkileikkaustutkimus suoritettiin vuosina 1998–1999, jolloin aineiston muodostivat kyseisenä ajankohtana Liedossa asuneet 65 vuotta täyttäneet henkilöt (N=1596), joista 82 % saapui tutkimuksiin (N=1260). Seuranta-aineisto kognition muutoksen suhteen muodostettiin niistä henkilöistä, jotka olivat elossa molempien poikkileikkaustutkimusten aikana ja osallistuivat niihin (N=617). Tutkimuksen kolmantena osa-aineistona (IV ja V osatutkimukset) käytettiin Porissa 2009–2010 suoritettua Satauni-tutkimusta (N=92). Tässä tutkimuksessa vieroitettiin unilääkkeiden (bentsodiatsepiinien ja niiden tavoin vaikuttavien lääkkeiden) pitkäaikaiskäyttäjiltä unilääkitys RCT-asetelmassa pitkävaikutteista melatoniinivalmistetta ja lumetta käyttäen. Bentsodiatsepiinien tai niiden tavoin vaikuttavien lääkkeiden käyttö oli yhteydessä alentuneeseen kognitiiviseen ja toiminnalliseen toimintakykyyn ei-käyttäjiin verrattuna. Seurantatutkimus osoitti, että näiden lääkkeiden käyttö oli yhteydessä myös huonomman kognitiivisen toimintakyvyn ennusteeseen. Unilääkekäytöstä oli mahdollista vieroittaa motivoituneita pitkäaikaiskäyttäjiäSiirretty Doriast

Benzodiazepines and Z-drugs may cause prolonged cognitive issues in young adults - are hypnotics not only a geriatric dilemma?

Peer reviewe

#StrongTogether? Qualitative Sentiment Analysis of Social Media Reactions to Disaster Volunteering during a Forest Fire in Finland

The transformation of disaster volunteering has been highlighted in academic literature. This study examined that transformation via a big data approach. The context for the study was provided by a forest fire in Finland, which sparked a debate on volunteering. The data (806 social media messages) were analyzed using qualitative sentiment analysis to (1) identify the sentiments relating to a variety of volunteers and (2) understand the context of and tensions behind those sentiments. The data suggested that the prevailing view of disaster volunteering is a rather traditional one, while the observations on the transformation remain largely latent. The positive sentiments reflected a view of the co-production of extinguishing forest fires as an activity of formal governmental and nonprofit emergency management organizations and volunteers from expanding and extending organizations. Unaffiliated volunteers were seen as extra pairs of hands that could be invited to help in an organized way and with limited tasks, only if required. Sentiments with a more negative tone raised concerns about having sufficient numbers of affiliated volunteers in the future and the rhetorical level of appreciation of them. The data revealed a dichotomous relationship between “professionals” and “amateurs” and the politicization of the debate between different actor groups.© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).fi=vertaisarvioitu|en=peerReviewed

Relationship between SDB and short-term outcome in Finnish ischemic stroke patients

Objectives Presence of sleep-disordered breathing (SDB) affects negatively recovery from stroke. The aim of this study is to evaluate the relationships between sleep-disordered breathing (SDB) and outcome measures in Finnish stroke unit cohort: mRS, need of rehabilitation and hospitalization time. Material and Methods An observational longitudinal study consisted of 95 patients referred to the Stroke Unit of Satakunta Hospital District over a period of November 2013 to March 2016. Patients were tested for SDB within 72 hr from the hospital admission because of ischemic stroke or TIA. The patients underwent polysomnography with NOX T3 wireless recorder. Results There are 37% (n = 35) non-OSA patients, 20% (n = 19) of patients have mild obstructive sleep apnea (OSA) and 39% (n = 37) have moderate/severe OSA and 4% (n = 4) have CSA. Patients with OSA have higher proportion of disability scores of mRS 3-5 (38%) compared to non-OSA (11%) and mild OSA (5%) patients on registration day (mRS0), and the same trend is seen at hospital discharge 35% versus 9% and 5%. (p = .009). Proportion of patients with OSA who needed rehabilitation is 65% (n = 19) versus non-OSA patients 17.5% (n = 4) and mild OSA patients 17.5% (n = 4;p = .039). We observed longer duration of hospitalization (5-15 days) in 29% of OSA patients compared to mild OSA patients 47% and OSA patients 54%. (p = .045). Conclusion Ischemic stroke patients with OSA have higher disability, higher need of rehabilitation, and longer hospitalization length. Prescreening tools for recognizing these stroke patients in acute phase could be valuable. That could result in earlier initiation of treatment and might prevent worse recovery from stroke.Peer reviewe

Wake-up strokes are linked to obstructive sleep apnea and worse early functional outcome

Background and Aims Presence of sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is a known risk factor for ischemic stroke. Additionally, SDB effects negatively on recovery after stroke. Up to one fourth of strokes are present on awakening. The link between OSA and wake-up stroke (WUS) has been suggested. We aim to determine the association between OSA and WUS in a Finnish stroke unit cohort. Material and Methods An observational prospective longitudinal study consisted of 95 TIA (transient ischemic attack) and mild to moderate stroke patients referred to a Stroke Unit in Finland. Respiratory polygraphy was performed within 72 h of hospital admission. Patients were classified into WUS and non-WUS, and functional outcome measures (mRS, rehabilitation, hospitalization time) were collected. Functional outcomes and prevalence of OSA were compared between non-WUS and WUS. Results OSA (AHI > 15/h) was more frequent among WUS than non-WUS (71% and 36%, respectively, p = 0.009). Functional outcome measured with mRS was worse in patients with WUS than non-WUS on registration day and at hospital discharge (p = 0.001). Need for rehabilitation in WUS was 43% of cases compared to 23% of non-WUS (p = 0.067). Hospitalization time was longer (5-15days) in 55% of WUS and 41% of non-WUS patients (p = 0.261). Conclusion Moderate-to-severe OSA is related to WUS compared to non-WUS. In addition, WUS have worse short-term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.Peer reviewe

Häiriötekijä vai resurssi? : Haastattelututkimus neljännen sektorin roolista säteilyvaaratilanteen kontekstissa

Tässä artikkelissa paneudutaan neljännen sektorin (spontaanien vapaaehtoisten ja emergenttien kansalaisryhmien) rooliin kompleksisessa häiriötilanteessa käyttäen esimerkkinä säteilyvaaratilannetta. Artikkelin tavoitteena on analysoida neljännen sektorin roolia sekä sen jännitteitä suhteessa turvallisuusviranomaisten ja valmiusjärjestöjen toimintaan. Empiirinen aineisto muodostuu kahdeksastatoista säteilyvaaratilanteen kannalta relevanteissa asiantuntija- tai johtotehtävissä toimivan viranomais- ja järjestötahon haastattelusta, jotka on analysoitu teorialähtöisen sisällönanalyysin avulla. Tulosten perusteella neljännen sektorin rooli näyttäytyy muuntautuvan kontekstin muutosten ja kriisin vaiheiden mukaisesti, mutta melko usein edelleen pelkistyvän viranomaisten ja järjestöjen ”apukäsiksi”, joiden toimintaa on tarpeellista selkeästi koordinoida ja johtaa. Neljännen sektorin merkitystä ja mahdollisuuksia kriisin eri vaiheissa ei täysin osata tunnistaa, eikä siten toistaiseksi täysin hyödyntää sen potentiaalia.This article investigates the role of the fourth sector (spontaneous volunteers and emergent citizen groups) in a complex crisis using a radiation hazard as an example. The article aims to analyze the role of the fourth sector as well as its tensions in relation to the activities of security authorities and voluntary civil protection organisations. The empirical data consists of interviews with eighteen authorities or NGO actors working in expert or managerial positions relevant to the radiation hazard, analysed using theory-driven content analysis. Based on the results, the role of the fourth sector appears to be changing in line with the changing context and stages of the radiation hazard, but quite often continues to be reduced to “extra hands” for authorities and NGOs, that need to be clearly coordinated and managed. The discussion on enabling the self-organisation and self-management of the fourth sector seems thus to remain more of an academic interest, while the practical interest is in taking control of the fourth sector.©2022 Focus Localis ry.fi=vertaisarvioitu|en=peerReviewed

Could virtual volunteerism enhance information resilience in a nuclear emergency? The potential role of disaster knowledge workers and virtual emergent groups

Informal volunteerism in its various forms is on the rise in the safety and security arena. This study focuses on a new mode of informal volunteerism, virtual volunteerism. The study uses the complex context of a nuclear emergency to explore (1) the extent to which informal volunteerism, in the form of virtual volunteerism, can develop information resilience and (2) the problems and challenges involved. The study relies on interview data gathered from 18 Finnish public authorities and NGO actors working in expert or managerial positions connected to nuclear emergency response. The study results suggest that informal virtual volunteerism could play a role in the development of information resilience in the society. However, as suggested in previous studies, virtual volunteerism could be a double-edged sword. There is a real risk of mis- and disinformation because of the volatile times in which we live. The identified risk sparked a debate on the inclusion and exclusion of unaffiliated disaster knowledge workers and virtual emergent groups in nuclear emergency preparedness, response, and recovery.© 2023 EDP Sciences. The original publication is available at https://doi.org/10.1051/radiopro/2023003fi=vertaisarvioitu|en=peerReviewed

Lääkehoidon kokonaisarviointi lääkärin työkaluna

Iä­käs ih­minen ensim­mäistä ker­taa vastaa­no­tolla, ai­kaa varat­tuna 20 mi­nuuttia akuutin vai­van hoi­toon. Poti­laalla pal­jon muu­takin asiaa, lääk­keitä nähtä­västi viiti­sen­ toista. Pe­rehtyä ha­luaisi, mut­ta ai­ka ei rii­tä edes kaik­kien diag­noosien selvit­tä­miseen. Rat­kaisu voi ol­la moniam­ma­til­linen lääke­hoidon koko­nai­sar­viointi