Acute respiratory illness and respiratory viruses: Associations to older citizens’ state of health

The role of many respiratory virus infections among older individuals remains unclear. Respiratory virus detection provides prognostic information about asthma development in children suffering from severe lower airway illnesses, but respective reports in older adults are scarce. Increased susceptibility to respiratory tract infections among older people is thought to be interlinked with poor vitamin D status, nourishment, and general immunological state. Our aim was to investigate the virus presence in the nasopharynx in those over 65 by modern methods and evaluate associations between virus findings and the severity of respiratory illness and chronic illnesses. In addition, we studied whether viral pathogens and conventional inflammatory markers correlate to the presence, signs and symptoms, or prognosis of pneumonia among these patients. Furthermore, we investigated whether serum 25(OH)D, albumin, and LL-37 levels could have prognostic value in older patients with acute respiratory infection. Virus detection was more common among older patients with respiratory symptoms than those without. Over 100 mg/L CRP values with respiratory symptoms were associated with death during hospital stays. Respiratory virus detections did not correlate with clinical course of pneumonia episodes among those studied. Presence of a respiratory virus was associated with fewer revisits among episodes with respiratory symptoms. Serum 25(OH)D deficiency and hypoalbuminemia were present in more than 50% of the study patients. Low serum albumin level was associated with more severe disease; longer hospital stay; death at ward; and 1-, 2- and 5-year mortality. On the contrary, no associations were seen between serum 25(OH)D or LL-37 levels with disease severity, short-term clinical outcome or long-term survival. The results indicate that the presence of respiratory viruses in the upper airways is only modestly associated with respiratory symptoms among older patients. Moreover, respiratory virus detection does not seem to be linked to pneumonia or more severe clinical course of disease. Thus, pneumonia should be treated as a bacterial disease regardless of the virus finding and our data do not support routine virus diagnostics for older patients with pneumonia. Serum albumin level may provide valuable information about the patients’ general health and the recovery potential in treating older patients with respiratory symptoms.Akuutti hengitystieinfektio ja hengitystievirukset – mahdolliset yhteydet ikääntyvän yleiseen terveydentilaan Useiden hengitystievirusinfektioiden merkitys ikääntyneillä on osin epäselvä. Vaikeaa alahengitystieinfektiota sairastavilla lapsilla hengitystieviruksen tunnistaminen antaa ennusteellista arvoa, mutta vastaavaa tutkimusta on vanhusväestöstä vähän. Vanhenevan inhmisen lisääntyvän alttiuden hengitystieinfektioille on ajateltu liittyvän mm. D-vitamiinin saantiin, ravitsemukseen ja yleiseen immunologiseen tilaan. Tavoitteenamme oli selvittää moderneilla menetelmillä, mitä viruksia ikääntyneillä, yli 65-vuotialla, nenänielusta löytyy ja arvioida yhteyttä näiden löydösten ja hengitystiesairauden vaikeuden ja kroonisten hengitystiesairauksien välillä. Tutkimme, korreloivatko viruslöydökset ja perinteiset tulehdusparametrit keuhkokuumelöydöksiin, keuhkokuumeen oireisiin tai ennusteeseen ikääntyneillä. Lisäksi selvitimme, voisiko seerumin 25(OH)D-, albumiini-, ja LL-37-pitoisuuksilla olla ennusteellista arvoa akuuttia hengitystieinfektiota sairastavilla vanhuksilla. Vanhukselta, jolla oli hengitystieoireita, löydettiin useammin hengitystievirus kuin oireettomalta verrokilta. Yli 100 mg/l CRP-arvot hengitystieoireisella vanhuksella kytkeytyi kuolemaan osastohoidon aikana. Hengitystieviruslöydökset eivät kytkeytyneet keuhkokuumeen taudinkulkuun vanhuksilla. Hengitystieviruksen löytäminen ennusti harvempaa uusintakäyntimäärää hengitystieoireisilla. Seerumin 25(OH)D-puutosta ja hypoalbuminemiaa tavattiin molempia yli puolella tutkimuspotilaista. Alhainen seerumin albumiinipitoisuus kytkeytyi vaikeampaan taudinkuvaan, pidempiin hoitojaksoihin, osastohoidonaikaiseen kuolemaan sekä yhden, kahden ja viiden vuoden mortaliteettiin. Sitä vastoin, seerumin 25(OH)D- ja LL-37-pitoisuudet eivät kytkeytyneet taudin vaikeuteen, lyhyen ajan ennusteeseen tai pitkän ajan mortaliteettiin. Tulokset osoittavat, että hengitystieviruslöydökset ylähengitysteissä ovat vain heikosti yhteydessä vanhojen potilaiden hengitystieoireisiin. Viruslöydökset eivät näytä ennustavan keuhkokuumeetta tai vaikeampaa taudinkuvaa. Vanhusten keuhkokuume pitäisikin hoitaa bakteeritautina viruslöydöksistä riippumatta eikä tutkimuksemme tue rutiininomaisten virusdiagnostiikkaa. Seerumin albumiinipitoisuus saattaa tarjota arvokasta tietoa hengitystieoireisen vanhuspotilaan yleisestä terveydentilasta ja toipumispotentiaalista

Viron Inkerin tanssit – Kadrelia, kasatškahia ja Viron veräjää

The article discusses three dance texts from Estonian Ingria that are included in the collections of the Estonian Folklore Archive and have been published in different ways in different periods. The focus of the article is on Ullo Toomi’s work as collector, arranger and choreographer from the 1930s until the 1950s. During his field excursions Ullo Toomi did not observe informal dance events, but the ones that were performed by an experienced group with its own repertoire. Since there are only few studies and publications about the Ingrian dances, Ullo Toomi’s work has a vast importance in all its levels, from the fieldwork to publications. Toomi’s dance publication styles varied according to the time of the publication: before the Second World War he tried to follow, as exactly as possible, the original fieldwork material, but later on, in the 1950s, the original material functioned only as a basis for new national stage dances that Toomi was constructing. The method in this article is to compare and reconstruct dance texts so that we could understand them better, and to place dances into their contexts. By comparing the different variants, it is possible to learn about Toomi’s style as a dance arranger.The article discusses three dance texts from Estonian Ingria that are included in the collections of the Estonian Folklore Archive and have been published in different ways in different periods. The focus of the article is on Ullo Toomi’s work as collector, arranger and choreographer from the 1930s until the 1950s. During his field excursions Ullo Toomi did not observe informal dance events, but the ones that were performed by an experienced group with its own repertoire. Since there are only few studies and publications about the Ingrian dances, Ullo Toomi’s work has a vast importance in all its levels, from the fieldwork to publications. Toomi’s dance publication styles varied according to the time of the publication: before the Second World War he tried to follow, as exactly as possible, the original fieldwork material, but later on, in the 1950s, the original material functioned only as a basis for new national stage dances that Toomi was constructing. The method in this article is to compare and reconstruct dance texts so that we could understand them better, and to place dances into their contexts. By comparing the different variants, it is possible to learn about Toomi’s style as a dance arranger

Paljon enemmänkin kuin tanssia yleisölle

Kirjallisuusarvostel

Respiratory tract virus infections in the elderly with pneumonia

Background: In children suffering from severe lower airway illnesses, respiratory virus detection has given good prognostic information, but such reports in the elderly are scarce. Therefore, our aim was to study whether the detection of nasopharyngeal viral pathogens and conventional inflammatory markers in the frail elderly correlate to the presence, signs and symptoms or prognosis of radiographically-verified pneumonia. Methods: Consecutive episodes of hospital care of patients 65years and older with respiratory symptoms (N = 382) were prospectively studied as a cohort. Standard clinical questionnaire was filled by the study physician. Laboratory analyses included PCR diagnostics of nasopharyngeal swab samples for 14 respiratory viruses, C-reactive protein (CRP) and white blood cell count (WBC). Chest radiographs were systematically analysed by a study radiologist. The length of hospital stay, hospital revisit and death at ward were used as clinical endpoints. Results: Median age of the patients was 83years (range 76-90). Pneumonia was diagnosed in 112/382 (29%) of the studied episodes. One or more respiratory viruses were detected in 141/382 (37%) episodes and in 34/112 (30%) episodes also diagnosed with pneumonia. Pneumonia was associated with a WBC over 15 x 10(9)/L (P = .006) and a CRP value over 80 mg/l (P <.05). A virus was detected in 30% of pneumonia episodes and in 40% of non-pneumonia episodes, but this difference was not significant (P = 0.09). The presence of a respiratory virus was associated with fewer revisits to the hospital (P <.05), whereas a CRP value over 100 mg/l was associated with death during hospital stay (P <.05). Respiratory virus detections did not correlate to WBC or CRP values, signs and symptoms or prognosis of radiographically-verified pneumonia episodes. Conclusion: Among the elderly with respiratory symptoms, respiratory virus detection was not associated with an increased risk of pneumonia or with a more severe clinical course of the illness. CRP and WBC remain important indicators of pneumonia, and according to our findings, pneumonia should be treated as a bacterial disease regardless of the virus findings. Our data does not support routine virus diagnostics for the elderly patients with pneumonia outside the epidemic seasons.Peer reviewe

The long-term prognostic value of serum 25(OH)D, albumin, and LL-37 levels in acute respiratory diseases among older adults

Background Older adults are more susceptible to respiratory tract infection than healthy working age adults. The increased susceptibility of older adults is thought to be interlinked with vitamin D status, nourishment, and immunological state in general. Data are scarce whether these parameters could serve as prognostic markers. Aim To study whether serum 25(OH)D, albumin, and LL-37 level could give prognostic value of long-term survival in the older adults with multimorbidity and acute respiratory infection. Methods Consecutive episodes of hospital care of patients 65 years and older with respiratory symptoms were prospectively studied as a cohort. Standard clinical questionnaire was filled by the study physician. Laboratory markers included serum levels of 25(OH)D, albumin and LL-37, C-reactive protein (CRP), white blood cell count (WBC) and polymerase chain reaction diagnostics for 14 respiratory viruses. Pneumonia was confirmed by chest radiographs. Respiratory illness severity, death at ward, length of hospital stays, and 5-year survival were used as outcomes. Results In total, 289 older adult patients with mean age of 83 years were included in the study. Serum 25(OH)D deficiency (< 50 nmol/liter) was present in 59% and hypoalbuminemia (< 3.5 g/dL) in 55% of the study patients. Low serum albumin level was associated to one, two- and five-year mortality after hospital stay (all P < .05). In addition, it was associated with pneumonia, dyspnea, over 13-night long stay at ward and death at ward (all P < .05). No associations were seen between serum 25(OH)D and LL-37 levels and disease severity, short-term clinical outcome, or long-term survival. Associations between serum 25(OH)D, albumin, and LL-37 levels and respiratory virus presence were not seen. Conclusions Serum albumin level on admission seems to give valuable information about the patients' general health and recovery potential in treating older adults with respiratory symptoms. Serum 25(OH)D and LL-37 had no associations with disease severity or long- and short-term prognosis among older adults hospitalized with respiratory symptoms.Peer reviewe

Quantifying ADHD Symptoms in Open-Ended Everyday Life Contexts With a New Virtual Reality Task

Objective: To quantify goal-directed behavior and ADHD symptoms in naturalistic conditions, we developed a virtual reality task, EPELI (Executive Performance in Everyday LIving), and tested its predictive, discriminant and concurrent validity. Method: We collected EPELI data, conventional neuropsychological task data, and parent-ratings of executive problems and symptoms in 38 ADHD children and 38 typically developing controls. Results: EPELI showed predictive validity as the ADHD group exhibited higher percentage of irrelevant actions reflecting lower attentional-executive efficacy and more controller movements and total game actions, both indicative of hyperactivity-impulsivity. Further, the five combined EPELI measures showed excellent discriminant validity (area under curve 88 %), while the correlations of the EPELI efficacy measure with parent-rated executive problems (r = .57) and ADHD symptoms (r = .55) pointed to its concurrent validity. Conclusion: We provide a proof-of-concept validation for a new virtual reality tool for ecologically valid assessment of ADHD symptoms.Peer reviewe

Respiratory tract virus infections in the elderly with pneumonia

Abstract Background In children suffering from severe lower airway illnesses, respiratory virus detection has given good prognostic information, but such reports in the elderly are scarce. Therefore, our aim was to study whether the detection of nasopharyngeal viral pathogens and conventional inflammatory markers in the frail elderly correlate to the presence, signs and symptoms or prognosis of radiographically-verified pneumonia. Methods Consecutive episodes of hospital care of patients 65 years and older with respiratory symptoms (N = 382) were prospectively studied as a cohort. Standard clinical questionnaire was filled by the study physician. Laboratory analyses included PCR diagnostics of nasopharyngeal swab samples for 14 respiratory viruses, C-reactive protein (CRP) and white blood cell count (WBC). Chest radiographs were systematically analysed by a study radiologist. The length of hospital stay, hospital revisit and death at ward were used as clinical endpoints. Results Median age of the patients was 83 years (range 76–90). Pneumonia was diagnosed in 112/382 (29%) of the studied episodes. One or more respiratory viruses were detected in 141/382 (37%) episodes and in 34/112 (30%) episodes also diagnosed with pneumonia. Pneumonia was associated with a WBC over 15 × 109/L (P = .006) and a CRP value over 80 mg/l (P < .05). A virus was detected in 30% of pneumonia episodes and in 40% of non-pneumonia episodes, but this difference was not significant (P = 0.09). The presence of a respiratory virus was associated with fewer revisits to the hospital (P < .05), whereas a CRP value over 100 mg/l was associated with death during hospital stay (P < .05). Respiratory virus detections did not correlate to WBC or CRP values, signs and symptoms or prognosis of radiographically-verified pneumonia episodes. Conclusion Among the elderly with respiratory symptoms, respiratory virus detection was not associated with an increased risk of pneumonia or with a more severe clinical course of the illness. CRP and WBC remain important indicators of pneumonia, and according to our findings, pneumonia should be treated as a bacterial disease regardless of the virus findings. Our data does not support routine virus diagnostics for the elderly patients with pneumonia outside the epidemic seasons

Merkel cell polyomavirus and trichodysplasia spinulosa-associated polyomavirus DNAs and antibodies in blood among the elderly

Peer reviewe

The Relationship between Self-rated Psychopathic Traits and Psychopathology in a Sample of Finnish Community Youth: Exploration of Gender Differences

Peer reviewe

Self-reported psychopathic traits among non-referred Finnish adolescents : psychometric properties of the Youth Psychopathic traits Inventory and the Antisocial Process Screening Device

Background: In general psychiatric services, cost benefit screening instruments for psychopathic traits in adolescents are needed. The aim of the present study was to study the psychometric properties of the Finnish versions of the Youth Psychopathic traits Inventory (YPI) and the Antisocial Process Screening Device (APSD-SR) in community youth. As gender-specific differences exist in psychopathic traits, we analyzed the data separately in girls and boys. Methods: The YPI and the APSD-SR were administered to 372 9th graders (174 boys and 198 girls) with a mean age of 15.06 years (SD 0.28). Cronbach's alphas were used to study internal consistency. The factor structures of the self assessments were studied using both Confirmatory Factor Analysis (CFA) and Principal Component Analysis (PCA). Results: In both self-assessments, boys scored significantly higher in the total scores, Interpersonal and Affective dimension scores as well as in most sub-dimensions. In the YPI, the alpha values for total and dimensional scores ranged from 0.55 to 0.91 in boys and from 0.74 to 0.89 in girls and, in the APSD-SR, respectively, from 0.38 to 0.78 and from 0.29 to 0.78. In CFA, the three-factor model produced poor fit for both self-assessments. For the ten sub-dimensions of the YPI, the PCA suggested two factors. Extending the model into three components showed sub-dimension loadings according to the original dimensions. For the APSD-SR, the PCA revealed a five-factor structure in the male sample and a six-factor one in the female group. When limiting the model to a three factor-model, we obtained a structure, which resembled the original dimensions. Conclusions: Both the YPI and the APSD-SR are promising tools of screening for psychopathic features in Finnish community youth. The YPI turned out to be slightly better than the APSD-SR in both reliability and factor structure. However, the original three-factor models did not find support. Both self-assessments were somewhat weak for tapping the callous-unemotional traits of the psychopathic character, but, again, the YPI worked better than the ASPD-SR. Both self assessments revealed significant gender differences in psychopathic character traits.Peer reviewe