Burden of Oral Symptoms and Health-Related Quality of Life in Long-Term Care Settings in Helsinki, Finland

Objectives Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL. Design A cross-sectional study in 2017. Setting All long-term care wards in Helsinki, Finland. Participants 2401 older residents (74% females, mean age 83.9). Measurements Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D). Results Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL. Conclusion Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.Peer reviewe

Swallowing difficulty and nutrient intakes among residents in assisted living facilities in Helsinki

Background: Swallowing difficulty (SWD) commonly occurs and is associated with malnutrition in old age. Less is known of how SWD is associated with various nutrient intakes. Objectives: To examine how SWD among residents in assisted living facilities. Materials and methods: In this cross-sectional study, we examined 345 residents in Helsinki in 2007. Detailed energy, protein and nutrient intakes were calculated from 1-day food diaries and compared with the Nordic Nutrition Recommendations (NNRs) as a measure of dietary adequacy. Swallowing was assessed by the closest nurse knowing the resident well. Nutritional status was assessed using the Mini-Nutritional Assessment (MNA). Results: Of the participants, 14% (n = 48) suffered from SWD, often had prior stroke, increased comorbidities and lower body-mass index. A larger proportion of residents with SWD consumed oral nutritional supplements. The MNA showed that over 52% of residents with SWD were malnourished, whereas the respective figure was 17% among residents without SWD. A large proportion of the study population had lower than recommended intakes of energy, protein and micronutrients. However, those with SWD differed significantly from those without only in higher protein and lower zinc and folic acid intakes. Conclusion: Although malnutrition was more common among those with SWD than those without, the daily intakes of energy, protein and micronutrients were similar in these groups, highlighting that the risk of malnutrition and low nutrient intakes commonly occurred in both groups of residents in assisted living facilities. (C) 2017 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.Peer reviewe

Modified Atkins diet induces subacute selective ragged-red-fiber lysis in mitochondrial myopathypatients

Mitochondrial myopathy (MM) with progressive external ophthalmoplegia (PEO) is a common manifestation of mitochondrial disease in adulthood, for which there is no curative therapy. In mice with MM, ketogenic diet significantly delayed progression of the disease. We asked in this pilot study what effects high-fat, low-carbohydrate modified Atkins diet (mAD) had for PEO/MM patients and control subjects and followed up the effects by clinical, morphological, transcriptomic, and metabolomic analyses. All of our five patients, irrespective of genotype, showed a subacute response after 1.5-2weeks of diet, with progressive muscle pain and leakage of muscle enzymes, leading to premature discontinuation of the diet. Analysis of muscle ultrastructure revealed selective fiber damage, especially in the ragged-red-fibers (RRFs), a MM hallmark. Two years of follow-up showed improvement of muscle strength, suggesting activation of muscle regeneration. Our results indicate that (i) nutrition can modify mitochondrial disease progression, (ii) dietary counseling should be part of MM care, (iii) short mAD is a tool to induce targeted RRF lysis, and (iv) mAD, a common weight-loss method, may induce muscle damage in a population subgroup.Peer reviewe

Measuring inequality: tools and an illustration

BACKGROUND: This paper examines an aspect of the problem of measuring inequality in health services. The measures that are commonly applied can be misleading because such measures obscure the difficulty in obtaining a complete ranking of distributions. The nature of the social welfare function underlying these measures is important. The overall object is to demonstrate that varying implications for the welfare of society result from inequality measures. METHOD: Various tools for measuring a distribution are applied to some illustrative data on four distributions about mental health services. Although these data refer to this one aspect of health, the exercise is of broader relevance than mental health. The summary measures of dispersion conventionally used in empirical work are applied to the data here, such as the standard deviation, the coefficient of variation, the relative mean deviation and the Gini coefficient. Other, less commonly used measures also are applied, such as Theil's Index of Entropy, Atkinson's Measure (using two differing assumptions about the inequality aversion parameter). Lorenz curves are also drawn for these distributions. RESULTS: Distributions are shown to have differing rankings (in terms of which is more equal than another), depending on which measure is applied. CONCLUSION: The scope and content of the literature from the past decade about health inequalities and inequities suggest that the economic literature from the past 100 years about inequality and inequity may have been overlooked, generally speaking, in the health inequalities and inequity literature. An understanding of economic theory and economic method, partly introduced in this article, is helpful in analysing health inequality and inequity

Sequential application of hyperspectral indices for delineation of stripe rust infection and nitrogen deficiency in wheat

© 2015, Springer Science+Business Media New York. Nitrogen (N) fertilization is crucial for the growth and development of wheat crops, and yet increased use of N can also result in increased stripe rust severity. Stripe rust infection and N deficiency both cause changes in foliar physiological activity and reduction in plant pigments that result in chlorosis. Furthermore, stripe rust produce pustules on the leaf surface which similar to chlorotic regions have a yellow color. Quantifying the severity of each factor is critical for adopting appropriate management practices. Eleven widely-used vegetation indices, based on mathematic combinations of narrow-band optical reflectance measurements in the visible/near infrared wavelength range were evaluated for their ability to discriminate and quantify stripe rust severity and N deficiency in a rust-susceptible wheat variety (H45) under varying conditions of nitrogen status. The physiological reflectance index (PhRI) and leaf and canopy chlorophyll index (LCCI) provided the strongest correlation with levels of rust infection and N-deficiency, respectively. When PhRI and LCCI were used in a sequence, both N deficiency and rust infection levels were correctly classified in 82.5 and 55 % of the plots at Zadoks growth stage 47 and 75, respectively. In misclassified plots, an overestimation of N deficiency was accompanied by an underestimation of the rust infection level or vice versa. In 18 % of the plots, there was a tendency to underestimate the severity of stripe rust infection even though the N-deficiency level was correctly predicted. The contrasting responses of the PhRI and LCCI to stripe rust infection and N deficiency, respectively, and the relative insensitivity of these indices to the other parameter makes their use in combination suitable for quantifying levels of stripe rust infection and N deficiency in wheat crops under field conditions

Yield formation of spring rye at high latitudes with reference to seeding rate and plant growth regulation

Aspects of crop physiology and agronomy of spring rye were evaluated at Viikki Experimental Farm, University of Helsinki in 1996-1998 to get baseline information on its potential as a novel cereal crop in southern Finland.The German spring rye cultivar Ovid was fertilized with 80 kg N ha-1. Seeding rates were 300,500 and 700 viable seeds m-2. Chlormequat chloride (CCC)was sprayed at the two-node stage of the main shoot and its effects on lodging and yield formation were studied. Various traits were assessed that characterised tiller and main shoot growth and productivity, growth duration and plant stand structure.Spring rye responded differently over years and among CCC treatments. CCC increased grain yield by about 200 kg ha -1 compared with the control.Spring rye has long straw (130-140 cm)and tended to lodge under heavy rainfall.Thus,grain yield was maximum (ca. 5200 kg ha -1 in 1997)when rainfall was minimum.Partly because high seeding rates enhanced lodging,no seeding rate effects on grain yield were recorded.At 300 seeds m-2, yield formation of both main shoot and tillers was enhanced to compensate for the reduced number of main shoots m-2. Ripening was not delayed at low seeding rates.Grain and hectolitre weights were not affected by seeding rate. Thus,spring rye is a potential crop for Finland if low seeding rates are used.;Kolmivuotisessa kokeessa tutkittiin kylvötiheyden jakasvunsääteiden vaikutusta kevätrukiin satoon Etelä-Suomen kasvuoloissa.Kokeet järjestettiin Helsingin yliopiston Viikin koetilalla.Kylvö tiheydet olivat kokeessa 300,500 tai 700 itävää siementä neliö metrillä, ja kasvustot joko käsiteltiin kasvunsääteellä [klor-mekvattikloridi(CCC)] tai ei.. Tutkittu saksalainen kevätruislajike Ovid oli hyvin pitkä kortinen ja altis lakoontumaan.CCC-käsittely lyhensi kortta ja vähensi lakoontumista vuosina, jolloin runsas sade ei aiheuttanut kasvustojen lähes täydellistä lakoontumista. Keskimäärin CCC-käsittely paransi satoa 200 kg ha -1.Paras kevätruissato (5200 kg ha -1 )saatiin normaalia lämpimämpänä ja vähä sateisempana kasvukautena (1997),vaikka tähkälle tulo oli muihin vuosiin verrattuna enimmillään jopa 12 päivää ja jyväntäyttymisaika kuusi päivää lyhyempi. Kylvö tiheys ei vaikuttanut sadon määrään,vaikka eri kylvö tiheyksillä kasvusto olikin hyvin erilainen. Mitä alhaisempi kylvötiheys,sitä voimakkaammin kasvusto versoi ja sitä enemmän versoista saatiin satoa,mutta myös pääverson sato parani olennaisesti alhaista kylvösiemenmäärää käytettäessä.Tutkimustemme perusteella kevätruista ei ole syytä kylvää tiheämpään kuin 300 siementä neliö metrille,koska pitkä kortisena kevätruis on hyvin laonaltis,ja koska versominen kompensoi muita kevätviljoja paremmin harvan kylvön ilman,että kasvusto tuleentuisi epätasaisesti