Genetically Determined Hypometabolism in Alzheimer’s Disease and Midlife Risk Factors for Cognitive Impairment

The role of genetic factors in the pathogenesis of Alzheimer’s disease (AD) is not completely understood. In order to improve this understanding, the cerebral glucose metabolism of seven monozygotic and nine dizygotic twin pairs discordant for AD was compared to that of 13 unrelated controls using positron emission tomography (PET). Traditional region of interest analysis revealed no differences between the non-demented dizygotic co-twins and controls. In contrast, in voxel-level and automated region of interest analyses, the non-demented monozygotic co-twins displayed a lower metabolic rate in temporal and parietal cortices as well as in subcortical grey matter structures when compared to controls. Again, no reductions were seen in the non-demented dizygotic co-twins. The reductions seen in the non-demented monozygotic co-twins may indicate a higher genetically mediated risk of AD or genetically mediated hypometabolism possibly rendering them more vulnerable to AD pathogenesis. With no disease modifying treatment available for AD, prevention of dementia is of the utmost importance. A total of 2 165 at least 65 years old twins of the Finnish Twin Cohort with questionnaire data from 1981 participated in a validated telephone interview assessing cognitive function between 1999 and 2007. Those subjects reporting heavy alcohol drinking in 1981 had an elevated cognitive impairment risk over 20 years later compared to light drinkers. In addition, binge drinking was associated with an increased risk even when total alcohol consumption was controlled for, suggesting that binge drinking is an independent risk factor for cognitive impairment. When compared to light drinkers, also non-drinkers had an increased risk of cognitive impairment. Midlife hypertension, obesity and low leisure time physical activity but not hypercholesterolemia were significant risk factors for cognitive impairment. The accumulation of risk factors increased cognitive impairment risk in an additive manner. A previously postulated dementia risk score based on midlife demographic and cardiovascular factors was validated. The risk score was found to well predict cognitive impairment risk, and cognitive impairment risk increased significantly as the score became higher. However, the risk score is not accurate enough for use in the clinic without further testing.Siirretty Doriast

Yksityisten sairaanhoitopalveluiden käyttö, kustannukset ja Kela-korvaukset vuosina 2013–2016 : Kuinka paljon Kela-korvausten alentamiset ovat vaikuttaneet palveluiden käyttöön?

Tässä tutkimuksessa yksityisellä sairaanhoidolla tarkoitetaan yksityissektorin lääkärissäkäyntejä, hammashoitoa sekä tutkimusta ja hoitoa, joista maksetaan sairausvakuutuslain perusteella sairaanhoitokorvauksia (Kela-korvauksia). Työpaperissa tarkastellaan yksityisten sairaanhoitopalvelujen käytön määriä, kustannuksia, korvauksia sekä asiakkaiden maksamia omavastuita rekisteriaineistolla vuosina 2013–2016. Erityisesti selvitetään sitä, miten vuoden 2016 alusta toteutetut huomattavat korvaustason alentamiset heijastuivat yksityisten sairaanhoitopalvelujen käyttöön ja korvauksiin sekä millaisia muutokset olivat eri väestöryhmissä. Tutkimuksessa hyödynnettiin rekisteritietoja Suomessa asuvan väestön iästä, sukupuolesta, voimassa olleista lääkehoitojen korvausoikeuksista, asuinpaikasta, vuosituloista sekä Kelan korvaaman yksityisen sairaanhoidon käytöstä. Tarkasteluun valittiin käynnit, jotka oli tehty tammi–kesäkuussa vuosina 2013–2016 ja joista oli maksettu korvaus kyseisen vuoden tammi–syyskuun aikana. Kun vertailtiin vuosien 2015 ja 2016 ensimmäisillä puolivuotisjaksoilla toteutuneita käyntejä, lääkärissäkäynneistä korvausta saaneiden määrä suhteessa väestöön pieneni 2,7 prosenttia ja tutkimuksesta ja hoidosta korvausta saaneiden osuus pieneni 2,2 prosenttia. Hammashoidosta korvausta saaneiden määrä suhteessa väestöön pieneni jonkin verran enemmän, 5,7 prosenttia. Yksityissektorin palveluiden käyttö oli vähentynyt naisilla hieman enemmän kuin miehillä. 0–9-vuotiaiden ja 10–24-vuotiaiden ikäryhmissä lääkäripalveluiden ja tutkimuksen ja hoidon käyttö yleistyi toisin kuin muissa ikäryhmissä. Lääkkeiden erityiskorvauksiin oikeutetuilla lääkäripalveluista sekä tutkimuksesta ja hoidosta korvausta saaneiden osuus pieneni keskimääräistä enemmän. Hammashoidosta korvausta saaneiden osuus sen sijaan pieneni enemmän niillä, joilla ei ollut erityiskorvausoikeuksia. Lääkärinpalkkioista, hammashoidosta sekä tutkimuksesta ja hoidosta korvausta saaneiden osuudet pienenivät eniten HYKSin ja TAYSin erityisvastuualueilla asuneilla. Lähes kaikkien tarkasteltujen yksityissektorin palveluiden käyttö väheni suhteellisesti sitä enemmän, mitä pienituloisemmasta ryhmästä oli kyse. Pienituloisimmillakaan palveluiden käytön väheneminen ei kuitenkaan ollut kovin suurta. Muutosten seurauksena tuloryhmien väliset erot yksityissektorin palvelujen käytössä kuitenkin suurenivat entisestään. Yksityisen sairaanhoidon Kela-korvaukset on päätetty lakkauttaa vuonna 2021. Suunnitteilla oleva sote-järjestelmä, jossa asiakas saa vapaasti valita perustason palvelut julkiselta, yksityiseltä tai kolmannelta sektorilta, tulee muuttamaan palvelutuotannon kenttää. Kela-korvausten merkittävä pienentäminen ei näytä nykyjärjestelmässä suuresti vähentäneen yksityissektorin palveluiden käyttöä. Itse maksettaville tai yksityisen sairauskuluvakuutuksen korvaamille yksityissektorin palveluille on todennäköisesti kysyntää myös sote-uudistuksen jälkeen

Kajian Perkembangan Permukiman Wilayah Peri Urban Di Sebagian Wilayah Kabupaten Sukoharjo Tahun 2001-2007

Sebagian wilayah kabupaten sukoharjo merupakan wilayah peri urban. Wilayah ini menarik untukditeliti terkait perkembangan permukimannya. Tujuan penelitian ini adalah: 1) Mengetahuikarakteristik permukiman tahun 2001 dan 2007. 2) Mengetahui perkembangan dan arah perkembangantahun 2001-2007. 3) Mengetahui interaksi potensial antar wilayah penelitian dengan model gravitasi.Penelitian dilakukan di kecamatan Kartosuro, Grogol, Baki, dan Sukoharjo. Teknik penentuan daerahpenelitian dilakukan dengan purposive sampling. Teknis analisis yang digunakan adalah analisisdeskriptif dan komparatif dengan pendekatan kuantitatif dan kualitatif. Data yang digunakan adalahsekunder yang diperoleh melalui teknik observasi, studi pustaka, dan studi instansional. Hasilpenelitian ini adalah 1.kepadatan permukiman di daerah penelitian adalah sedang dengan polapemukiman yang linear (Kecamatan Grogol, Kartosuro, Sukoharjo) dan tidak terbentuk secara jelas(kecamatan Baki) 2.Perkembangan permukiman tahun 2001-2007 cukup signifikan kecuali diKecamatan Sukoharjo. Perubahan permukiman tidak signifikan (1%). Arah perkembangan terlihatjelas di daerah Grogol dan sekitarnya. 3.Interaksi Grogol-Baki paling potensial diantara daerahpenelitian

What is behind the seeming cessation of the increase in sleep medicine consumption in Finland during the last years?

In Finland, between 2003 and 2010 and parallel to the increase in the prevalence of insomnia-related symptoms among the general population, there has been a cessation of growth and even a decrease in the consumption of traditional hypnotics. The reasons behind this seemingly paradoxical situation are not known. We analyzed trends over the period 2000-2010 in the estimated consumption of traditional hypnotics and some new drugs that are destined for use in insomnia treatment. We used the annual wholesale statistical database compiled by the Finnish Medicine Agency, FIMEA, and data from the Finnish Drug Prescription Register. We found evidence to support two parallel trends in Finnish outpatient care. First, there seems to be a trend in which physicians increasingly comply with official guidelines for insomnia treatment, which partly accounts for the decrease in the consumption of traditional hypnotics. Second, at the same time, the first trend seems to be resulting in an increasing trend to treat insomnia patients with some new drugs that were not originally developed for insomnia treatment by prescribing these non-hypnotic drugs in small, sub-clinical doses. The current trend in practice may have contradictory effects on the treatment of insomnia. The long-term consequences of using low doses of drugs other than hypnotics to treat insomnia are not known and the situation should, therefore, be followed-up in subsequent studies. However, pharmacological treatment should never be a substitute for non-pharmacological treatments of insomnia

Long-term changes in the incidence of childhood epilepsy. A population study from Finland

BackgroundThe incidence of childhood epilepsy has changed during the past decades, but it is unclear whether it increased or decreased.MethodsChanges in drug-treated childhood epilepsy between 1968 and 2012 were evaluated using the Finnish nationwide register of all children, aged ≤ 15 years, on antiepileptic drugs (AEDs) prescribed for the treatment of epilepsy. The first registered entitlement to full-refundable AEDs was used as a proxy for newly diagnosed epilepsy. Incidence densities were calculated as ratios of annual new cases per 100,000 person-years in each calendar year during 1968 to 2012.ResultsThe annual incidence density of newly treated childhood epilepsy increased from 35 in the 1960s to 87 per 100,000 person-years in the 1990s and decreased thereafter to 61 per 100,000 person-years. Since 1996, the incidence density decreased 1–2% per year in children aged ConclusionThe incidence of drug-treated childhood epilepsy from the late 1960s to the early 1990s distinctly increased. The reasons for the increase are not fully understood but may include increasing ascertainment through improved diagnosis and a wider acceptance of AED treatment. Since the 1990s, a slight decline can be seen, probably reflecting the recent improvement in child health and safety.</p

Length of sickness absence and sustained return-to-work in mental disorders and musculoskeletal diseases: a cohort study of public sector employees

OBJECTIVES: The aim of this study was to investigate the association between the length of sickness absence and sustained return to work (SRTW) and the predictors of SRTW in depression, anxiety disorders, intervertebral disc disorders, and back pain in a population-based cohort of employees in the Finnish public sector. METHODS: We linked data from employers' registers and four national population registers. Cox proportional hazards regression analysis with a cluster option was applied. SRTW was defined as the end of the sickness benefit period not followed by a recurrent sickness benefit period in 30 days. RESULTS: For depression, the median time to SRTW was 46 and 38 days among men and women, respectively. For anxiety disorders, the figures were 24 and 22 days, for intervertebral disc disorders, 42 and 41 days, and, for back pain, 21 and 22 days among men and women respectively. Higher age and the persistence of the health problem predicted longer time to SRTW throughout the diagnostic categories. Comorbid conditions predicted longer time to SRTW in depression and back pain among women. CONCLUSIONS: This large cohort study adds scientific evidence on the length of sickness absence and SRTW in four important diagnostic categories among public sector employees in Finland. Further research taking into account, eg, features of the work environment is suggested. Recommendations on the length of sickness absence at this point should be based on expert opinion and supplemented with research findings

Neurointensive care results and risk factors for unfavorable outcome in aneurysmatic SAH : a comparison of two age groups

Background The mean age of actively treated subarachnoid hemorrhage (SAH) patients is increasing. We aimed to compare outcomes and prognostic factors between older and younger SAH patients. Methods A retrospective single-center analysis of aneurysmal SAH patients admitted to a neuro-ICU during 2014-2019. We defined older patients as >= 70 years and younger patients asPeer reviewe

Characteristics and Outcomes of Thrombolysis-Treated Stroke Patients With and Without Saccular Intracranial Aneurysms

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