Transpancreatic biliary sphincterotomy for biliary access is safe also on a long-term scale

Background Transpancreatic biliary sphincterotomy (TPBS) is an advanced cannulation method for accessing common bile duct (CBD) in endoscopic retrograde cholangiopancreatography (ERCP). If CBD cannulation is difficult, an endoscopist can open the septum between the pancreatic and biliary duct with a sphincterotome to gain access. Long-term results of this procedure are unclear. We wanted to evaluate the short- and long-term complications of TPBS on patients with native papilla and benign indication for ERCP. Patients and Methods ERCPs performed in Helsinki University Hospital between 2007 and 2013 were reviewed. The study group comprised 143 consecutive patients with TPBS and 140 controls (CG). Data were collected from patient records and a phone survey was performed as a follow-up >= 4 years after the index ERCP. Results Post-ERCP pancreatitis (PEP) developed in seven patients (4.9%) in TPBS and one patient (0.7%) in CG (p = 0.067). The rates of other acute complications were similar between the groups. ERCP ended with no access to CBD in four cases (2.8%) in TPBS. The median length of follow-up was 6 years in TPBS and 7 years in CG. During this period, three patients (2.1%) in TPBS and six patients (4.3%) in CG suffered from acute pancreatitis (AP) (p = 0.238). One (0.7%) patient in CG and none in TPBS developed chronic pancreatitis (CP). Abdominal pain was suffered by ten patients (6.9%) in TPBS and twelve patients (8.6%) in CG daily, whereas by six patients (4.2%) in TPBS and twelve patients (8.6%) in CG weekly. Conclusion TPBS is a useful procedure, with acceptable complication rates. No significant difference occurred between the groups when evaluating the short-term or long-term complications with a follow-up period of four to 10 years. Additionally, no significant differences occurred in upper abdominal pain, episodes of AP, or development of CP.Peer reviewe

Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1-3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.Peer reviewe

Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank

BACKGROUND: Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use. METHODS: In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines – non-drinking (never or former drinkers); moderate consumption (1–14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study. FINDINGS: During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9–30·8) years, women 29·8 (29·2–30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4–29·0) years, women 29·6 (29·4–29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9–26·0) years, women 24·0 (21·4–26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3–26·8), women 27·5 (26·4–28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less. INTERPRETATION: Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller. FUNDING: Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund

Association of alcohol use with years lived without major chronic diseases : A multicohort study from the IPD-Work consortium and UK Biobank

Background Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use. Methods In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines - non-drinking (never or former drinkers); moderate consumption (1-14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study. Findings During 1.73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29.3 (95%CI 27.9-30.8) years, women 29.8 (29.2 - 30.4) years)] and moderate drinkers with no binge drinking habit [men 28.7 (28.4-29.0) years, women 29.6 (29.4-29.7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23.4 (20.9-26.0) years, women 24.0 (21.4-26.5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26.0 (25.3-26.8), women 27.5 (26.4 - 28.5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1.5 years or less. Interpretation Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Safety of alemtuzumab in a nationwide cohort of Finnish multiple sclerosis patients

Background Alemtuzumab is an effective disease-modifying therapy (DMT) for highly active multiple sclerosis (MS). However, safety concerns limit its use in clinical practice. Objectives To evaluate the safety of alemtuzumab in a nationwide cohort of Finnish MS patients. Methods In this retrospective case series study, we analyzed the data of all but two MS patients who had received alemtuzumab in Finland until 2019. Data were systematically collected from patient files. Results Altogether 121 patients were identified, most of whom had received previous DMTs (82.6%). Median follow-up time after treatment initiation was 30.3 months and exceeded 24 months in 78 patients. Infusion-associated reactions (IARs) were observed in 84.3%, 57.3%, and 57.1% of patients during alemtuzumab courses 1-3, respectively. Serious adverse events (SAEs) were observed in 32.2% of patients, serious IARs in 12.4% of patients, and SAEs other than IARs in 23.1% of patients. Autoimmune adverse events were observed in 30.6% of patients. One patient died of hemophagocytic lymphohistiocytosis, and one patient died of pneumonia. A previously unreported case of thrombotic thrombocytopenic purpura was documented. Conclusions SAEs were more frequent in the present cohort than in previous studies. Even though alemtuzumab is a highly effective therapy for MS, vigorous monitoring with a long enough follow-up time is advised.</p

Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank

BackgroundHeavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use.MethodsIn primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines – non-drinking (never or former drinkers); moderate consumption (1–14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study.FindingsDuring 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9–30·8) years, women 29·8 (29·2–30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4–29·0) years, women 29·6 (29·4–29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9–26·0) years, women 24·0 (21·4–26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3–26·8), women 27·5 (26·4–28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less.InterpretationIndividuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller.</p

Opiskelijalähtöistä vapaaehtoistoimintaa : SPR Campus-osaston toiminnan kehittäminen

Opinnäytetyössä kartoitettiin kansalaistoimintaa ja kansalaisaktiivisuutta nuorten aikuisten ja opiskelijoiden näkökulmasta ja tuotettiin tietoa ja ideoita SPR Campus-osaston toimintaa varten. Selvityksestä voi olla Campus-osaston lisäksi hyötyä myös niille, jotka suunnittelevat ja organisoivat vapaaehtoistoimintaa, tai toimivat työssä nuorten aikuisten parissa. Campus-osasto perustettiin Jyväskylässä vuonna 2010. Se on opiskelijoiden perustama ja hallinnoima Punaisen Ristin osasto, joka on tehnyt Punaisen Ristin toimintaa tunnetuksi paikallisissa oppilaitoksissa. Toiminnan kulussa ilmeni huolta sen jatkumisesta ja uusien toimijoiden löytymisestä. Syntyi toive vakiintuneen toimintamuodon varaan rakentuvasta toiminnasta, jota varten opinnäytetyössä tietoa tuotettiin. Tarve ja lähtökohdat huomioiden opinnäytetyön tavoitteena oli kartoittaa tietoa opiskelijalähtöisestä toiminnasta ja soveltaa sitä suunnittelun tueksi. Työn tietoperustassa painottui kansalaisaktiivisuus, arvot, motivaatio, rakenteet sekä yhteiskunnalliset muutokset vapaaehtoistoiminnan taustavaikuttajina. Läpi työn punaisena lankana kulki tietous Punaisesta Rististä, sillä tarkoituksena oli luoda Punaisen Ristin varaan rakentuvaa opiskelijoiden toimintaa. Monipuolisen tiedonkeruun kautta tuotettiin Campuksen toimintaa ja opiskelijalähtöistä toimintaa palvelevaa tietoa ja paneuduttiin siihen, millaisia tarpeita ja edellytyksiä vapaaehtoisuudelle nuorten ja opiskelijoiden keskuudessa on olemassa. Työn loppuosassa on kuvattu tiedon käytäntöön soveltamista. Työn edetessä Campuksen toiminta vakiintui opiskelijoiden suunnittelemiksi vertaistapaamisiksi, joita myös työn loppuosassa kuvataan.The thesis surveyed civic work and activity from the viewpoint of young adults and students, and in addition, it provided information and ideas for the operations of the Finnish Red Cross branch called ´Campus´. In addition to Campus, the survey can also benefit those who plan and organize voluntary work or work with young adults. Campus was established in Jyväskylä in 2010. It is a Red Cross branch established and managed by students and it has shared information about the operations of the Red Cross in the local educational institutions. Concern has been voiced with regard to the continuation of the Campus operations and finding new volunteers. Thus, hopes were expressed about building the operations on a more established basis, and for this purpose information was produced in the thesis. Taking into account the needs and starting points, the aim of the thesis was to collect information about student-based activities and to apply it for the support of the plan. The knowledge base of this work focused on civic activity, values, motivation, structures and the changes of society as the background motivators of voluntary work. The main theme permeating through the work was the awareness of the Red Cross because the purpose was to create student activities for the Red Cross. Through versatile data collection information was produced in order to support the operations of Campus and students. The focus was on the needs and prerequisites of voluntary work among young people and students. The final part of the work describes the application of the information into practice. With the progress of the work, the Campus operations established themselves as peer meetings planned by the students, which is also described in the final part of the work

FIDELITY AND FEASIBILITY OF PREVENTIVE FAMILY-BASED INTERVENTIONS IN ADULT MENTAL HEALTH SERVICES: CLINICIANS' EXPERIENCES

Mental health disorders are among leading public health challenges in health care services. Beliefs, attitudes, and practices regarding clinicians' care for their patients in adult psychiatric services have been changing over the past century with new views particularly focused on helping the children of mentally ill parents by clinicians. The present study deals with successful implementation of child mental health measures in psychiatric services for adults. The aim of the present study is to establish if the clinicians, having no or very little basic training in prevention or in clinical work with children, can be trained and are able to carry out child-centered and family-based preventive methods with fidelity, and if the methods are feasible to be practised in adult psychiatric services. Results: the clinicians benefited from the log books in utilizing two preventive interventions. The interventions were feasible for implementation and were delivered with fidelity. The clinicians reported that the working relationship with parents correlated with the children's motivation and openness during Family Intervention, and the motivation and openness in the Child's Session were related to the parental openness in the intervention sessions. The clinicians' assessments of both interventions were very positive. In conclusion, both intervention methods are feasible and can be implemented in the psychiatric services for adults with fidelity to the principles and the structure of the interventions. Family-based and child-centered public health interventions can be implemented in adult mental health services. Asiasanat:prevention, promotion, family-based, child-centred, feasibility and fidelity of the intervention, and implementing preventio