Objectively measured preoperative physical activity and sedentary behaviour among Finnish patients scheduled for elective cardiac procedures : baseline results from randomized controlled trial

Background: We investigated preoperative physical activity (PA) and sedentary behaviour (SB) in patients scheduled for elective cardiac procedures and compared them with population-based sample of Finnish adults. Methods: Cardiac patients (n=139) undergoing cardiac operations carried a triaxial accelerometer for seven days during the month before the procedure. Patients were categorised into four groups according to the procedure: percutaneous coronary intervention or coronary angiography (PCI-CA), coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and mitral valve surgery (MVS). The raw accelerometer data was analyzed with dedicated algorithms to determine metabolic equivalents (METs, 3.5 mL/kg/min of oxygen consumption) of PA. The intensity of PA was divided into two categories: light (LPA, 1.5-2.9 METs) and moderate-to-vigorous (MVPA, >= 3.0 METs), while SB represented intensity < 1.5 MET without movements. SB and PA were described as daily means and accumulation from different bout lengths. Daily standing, steps and mean and peak MET-values were calculated. The results were compared between the patient groups and against the reference group from a population-based study FinFit2017. Results: Cardiac patients had fewer daily steps than the FinFit population (p= 0.01), and less SB accumulating from 10 min bouts (p< 0.001) than the FinFit population. Conclusions: We found large differences in PA and SB between the patient groups and the FitFit population, CABG group having the worst activity profile. Also, the variation within the patient groups was wide, which should be considered to individualise the rehabilitation programs postoperatively.Peer reviewe

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch : the Nordic-Baltic Bifurcation Study IV

Background It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods The study was a randomised, superiority trial. Enrolment required a SB >= 2.75 mm, >= 50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results A total of 450 patients were assigned to simple stenting (n = 221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI -0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p = 0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p = 0.10) after simple versus complex treatment. Conclusion In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years.Peer reviewe

The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF) : study rationale, design, and patient characteristics

Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish AF patients from 1st January 2004 to 31st December 2018. The aim of this paper is to describe the study rationale, the process of integrating data from the applied resources and to define the study cohort. Using national unique personal identification number, individual patient data is linked from nationwide health care registries (primary, secondary, and tertiary care), drug purchases, education, and socio-economic status as well as places of domicile, incomes, and taxes. Six regional laboratory databases (similar to 282,000, 77% of the patients) are also included. The study cohort comprises of a total of 411,000 patients. Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The prevalence of AF in Finland-4.1% of whole population-is for the first time now established. The FinACAF study allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This article provides the rationale and design of the study together with a summary of the characteristics of the cohort.Peer reviewe

Sisäilma ja terveys: kehitys, nykytilanne, seuranta ja vertailu eri maiden sekä julkisen ja yksityisen sektorin välillä

Tässä selvityksessä kartoitettiin Suomen sisäilman laadun nykytilaa ja sisäilmaongelmien määrää yksityisellä ja julkisella sektorilla sekä verrattiin tuloksia Ruotsin sisäilmatilanteeseen. Kuntien omistamissa ja käyttämissä rakennuksissa merkittäviä sisäilmaongelmia esiintyy 5–18 % rakennusten kokonaisneliömäärästä. Suomen ja Ruotsin kunnissa esiintyi lähes yhtä paljon merkittäviä sisäilmaongelmia, mutta yleisimmät syyt sisäilmaongelmien taustalla poikkesivat maiden välillä. Kiinteistökannan ikärakenne ja riittämättömät investoinnit nähtiin merkittävimpänä taustasyinä sisäilmaongelmille molemmissa maissa. Sisäilma-asioiden huomioiminen strategisella tasolla merkitsi usein toimivia sisäilmaongelmien käsittelyprosesseja ja parempaa sisäilmatilanteen hallintaa. Kyselytutkimuksien mukaan merkittävä osa suomalaisista on kokenut saaneensa oireita sisäilmasta joskus elämänsä aikana. Valtaosa ihmisistä raportoi oireiden olevan vaikeusasteeltaan lieviä tai kohtalaisia. Sisäilmaan liitetty oireilu on huomattavasti yleisempää työpaikoilla kuin kotona. Työpaikoilla kunta-alan työntekijät ja heistä hoito- ja opetustyötä tekevät työntekijät kokevat yleisemmin sisäilmaan liitettyjä oireita ja olosuhdehaittoja. Kuntien, valtion, yliopistokiinteistöjen ja sairaanhoitopiirin toimintatavat kiinteistöjen kunnon ja sisäilmaongelmien selvittämisessä ohjaavat eri tahoja yhteistyöhön ja prosessimaiseen etenemiseen. Rakennuksen omistussuhde vaikutti toimintamalleissa lähinnä vastuisiin ja rooleihin. Tarvitaan uusia keinoja vahvistaa eri toimijoiden yhteistyötä ja rooleja sisäilmaongelmien ratkaisemisessa. Kunnilla on edelleen tarve keskitetylle ohjeistukselle terveydellisen riskin arviointiin sekä lisäksi kaivataan käytäntöjä ja tukea, miten hallita julkisen paineen vaikutusta kunnallisessa päätöksen teossa. Riskiviestinnän osaamisen ja viestinnän toimintatapojen kehittämisen tarve on ilmeinen.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Sisäilma ja terveys : kehitys, nykytilanne, seuranta ja vertailu eri maiden sekä julkisen ja yksityisen sektorin välillä

Tässä selvityksessä kartoitettiin Suomen sisäilman laadun nykytilaa ja sisäilmaongelmien määrää yksityisellä ja julkisella sektorilla sekä verrattiin tuloksia Ruotsin sisäilmatilanteeseen. Kuntien omistamissa ja käyttämissä rakennuksissa merkittäviä sisäilmaongelmia esiintyy 5–18 % rakennusten kokonaisneliömäärästä. Suomen ja Ruotsin kunnissa esiintyi lähes yhtä paljon merkittäviä sisäilmaongelmia, mutta yleisimmät syyt sisäilmaongelmien taustalla poikkesivat maiden välillä. Kiinteistökannan ikärakenne ja riittämättömät investoinnit nähtiin merkittävimpänä taustasyinä sisäilmaongelmille molemmissa maissa. Sisäilma-asioiden huomioiminen strategisella tasolla merkitsi usein toimivia sisäilmaongelmien käsittelyprosesseja ja parempaa sisäilmatilanteen hallintaa. Kyselytutkimuksien mukaan merkittävä osa suomalaisista on kokenut saaneensa oireita sisäilmasta joskus elämänsä aikana. Valtaosa ihmisistä raportoi oireiden olevan vaikeusasteeltaan lieviä tai kohtalaisia. Sisäilmaan liitetty oireilu on huomattavasti yleisempää työpaikoilla kuin kotona. Työpaikoilla kunta-alan työntekijät ja heistä hoito- ja opetustyötä tekevät työntekijät kokevat yleisemmin sisäilmaan liitettyjä oireita ja olosuhdehaittoja. Kuntien, valtion, yliopistokiinteistöjen ja sairaanhoitopiirin toimintatavat kiinteistöjen kunnon ja sisäilmaongelmien selvittämisessä ohjaavat eri tahoja yhteistyöhön ja prosessimaiseen etenemiseen. Rakennuksen omistussuhde vaikutti toimintamalleissa lähinnä vastuisiin ja rooleihin. Tarvitaan uusia keinoja vahvistaa eri toimijoiden yhteistyötä ja rooleja sisäilmaongelmien ratkaisemisessa. Kunnilla on edelleen tarve keskitetylle ohjeistukselle terveydellisen riskin arviointiin sekä lisäksi kaivataan käytäntöjä ja tukea, miten hallita julkisen paineen vaikutusta kunnallisessa päätöksen teossa. Riskiviestinnän osaamisen ja viestinnän toimintatapojen kehittämisen tarve on ilmeinen.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF): study rationale, design, and patient characteristics

Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish AF patients from 1st January 2004 to 31st December 2018. The aim of this paper is to describe the study rationale, the process of integrating data from the applied resources and to define the study cohort. Using national unique personal identification number, individual patient data is linked from nationwide health care registries (primary, secondary, and tertiary care), drug purchases, education, and socio-economic status as well as places of domicile, incomes, and taxes. Six regional laboratory databases (similar to 282,000, 77% of the patients) are also included. The study cohort comprises of a total of 411,000 patients. Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The prevalence of AF in Finland-4.1% of whole population-is for the first time now established. The FinACAF study allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This article provides the rationale and design of the study together with a summary of the characteristics of the cohort.</p

Using the nonlinear control of anaesthesia-induced hypersensitivity of EEG at burst suppression level to test the effects of radiofrequency radiation on brain function

Background In this study, investigating the effects of mobile phone radiation on test animals, eleven pigs were anaesthetised to the level where burst-suppression pattern appears in the electroencephalogram (EEG). At this level of anaesthesia both human subjects and animals show high sensitivity to external stimuli which produce EEG bursts during suppression. The burst-suppression phenomenon represents a nonlinear control system, where low-amplitude EEG abruptly switches to very high amplitude bursts. This switching can be triggered by very minor stimuli and the phenomenon has been described as hypersensitivity. To test if also radio frequency (RF) stimulation can trigger this nonlinear control, the animals were exposed to pulse modulated signal of a GSM mobile phone at 890 MHz. In the first phase of the experiment electromagnetic field (EMF) stimulation was randomly switched on and off and the relation between EEG bursts and EMF stimulation onsets and endpoints were studied. In the second phase a continuous RF stimulation at 31 W/kg was applied for 10 minutes. The ECG, the EEG, and the subcutaneous temperature were recorded. Results No correlation between the exposure and the EEG burst occurrences was observed in phase I measurements. No significant changes were observed in the EEG activity of the pigs during phase II measurements although several EEG signal analysis methods were applied. The temperature measured subcutaneously from the pigs' head increased by 1.6°C and the heart rate by 14.2 bpm on the average during the 10 min exposure periods. Conclusion The hypothesis that RF radiation would produce sensory stimulation of somatosensory, auditory or visual system or directly affect the brain so as to produce EEG bursts during suppression was not confirmed.BioMed Central Open acces

Randomised comparison of provisional side branch stenting versus a two-stent strategy for treatment of true coronary bifurcation lesions involving a large side branch:the Nordic-Baltic Bifurcation Study IV

Background - It is still uncertain whether coronary bifurcations with lesions involving a large side branch (SB) should be treated by stenting the main vessel and provisional stenting of the SB (simple) or by routine two-stent techniques (complex). We aimed to compare clinical outcome after treatment of lesions in large bifurcations by simple or complex stent implantation. Methods - The study was a randomised, superiority trial. Enrolment required a SB≥2.75 mm, ≥50% diameter stenosis in both vessels, and allowed SB lesion length up to 15 mm. The primary endpoint was a composite of cardiac death, non-procedural myocardial infarction and target lesion revascularisation at 6 months. Two-year clinical follow-up was included in this primary reporting due to lower than expected event rates. Results - A total of 450 patients were assigned to simple stenting (n=221) or complex stenting (n=229) in 14 Nordic and Baltic centres. Two-year follow-up was available in 218 (98.6%) and 228 (99.5%) patients, respectively. The primary endpoint of major adverse cardiac events (MACE) at 6 months was 5.5% vs 2.2% (risk differences 3.2%, 95% CI −0.2 to 6.8, p=0.07) and at 2 years 12.9% vs 8.4% (HR 0.63, 95% CI 0.35 to 1.13, p=0.12) after simple versus complex treatment. In the subgroup treated by newer generation drug-eluting stents, MACE was 12.0% vs 5.6% (HR 0.45, 95% CI 0.17 to 1.17, p=0.10) after simple versus complex treatment. Conclusion - In the treatment of bifurcation lesions involving a large SB with ostial stenosis, routine two-stent techniques did not improve outcome significantly compared with treatment by the simpler main vessel stenting technique after 2 years