Biomedical subjects

H Helenius

Publications and source records attributed to H Helenius.

At least 109 records · Page 6Linked to original sources

PubMed1999

Respiratory insufficiency in postmenopausal women: sustained improvement of gas exchange with short-term medroxyprogesterone acetate.

STUDY OBJECTIVES: The degree and duration of respiratory stimulation of medroxyprogesterone acetate (MPA) in postmenopausal women. DESIGN: A placebo-controlled single-blind trial. SETTING: University hospital in Turku, Finland. PATIENTS: Fourteen postmenopausal women with permanent or previous episodic hypercapnic or hypoxemic respiratory failure. INTERVENTIONS: A 12-week trial including 14-day treatment periods with placebo and MPA (60 mg daily) and a 6-week follow-up. RESULTS: Thirteen of 14 patients completed the trial. The mean (+/- SD) PaCO2 at baseline was 42.8+/-4.5 mm Hg and the mean PaO2 was 71.2+/-9.0 mm Hg. The average reduction of PaCO2 was 6.3 mm Hg (14.7%, p < 0.001) on MPA and 3.0 mm Hg (6.1%, p = 0.001) after a 3-week washout. At 6 weeks after MPA, the PaCO2 had returned to baseline. The mean changes in PaO2 (+6.0+/-18.0 mm Hg on MPA and +3.8+/-22.5 mm Hg after a 3-week washout) were not significant. The PaO2/PaCO2 ratio increased, and bicarbonate and base excess decreased (p < 0.001) on MPA but not during washout. The systolic BP did not change on MPA but decreased on average 14.8+/-15.0 mm Hg (p = 0.016) after a 3-week washout. The diastolic BP remained unchanged. CONCLUSIONS: Our results suggest that postmenopausal women with chronic respiratory insufficiency consistently improve on MPA at a dose of 60 mg daily for 14 days. Lower PaCO2 is sustained for at least 3 weeks after cessation of MPA. The sustained effects in gas exchange and favorable after-effects in BP warrant further studies into the therapeutic efficacy and possible benefits of MPA pulse therapy.

Blood Gas Analysis↗

PubMed1998

Schizophrenia among patients treated for rheumatoid arthritis and appendicitis.

The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is based on the results of investigations which sought RA in large samples of schizophrenic patients. Using a discharge register, we examined the frequency of schizophrenia in a sample of 5626 RA patients. Appendicitis patients (n = 5330) were used as a comparison group. The cumulative incidence of hospital care with the diagnosis of schizophrenia during 8 years was higher in the RA group (0.64%) than in the appendicitis group (0.47%). Schizophrenia was significantly more common in the RA group than in the appendicitis group among the young. The age-adjusted prevalence of schizophrenia was 0.96% in the RA group and 0.51% in the appendicitis group. Because of this unexpected finding, we examined the incidence of RA and appendicitis among a birth cohort born in 1966. The frequencies of RA and appendicitis among schizophrenic cohort members (n = 76), cohort members with psychiatric diagnosis other than schizophrenia (n = 438), and members without psychiatric diagnosis (n = 10503) were similar. These findings do not support the negative association between schizophrenia and RA. Prolonged institutionalization per se may have been the protective factor against RA in the previous studies. The findings also raise the hypothesis that genes that predispose to schizophrenia provide protection from appendicitis, historically a common cause of mortality.

Adolescent↗

PubMed1998

Patterns of psychiatric hospital service use in Finland: a national register study of hospital discharges in the early 1990s.

We were interested in studying the possible concurrent changes in the psychiatric inpatient population during a rapid phase of deinstitutionalisation, and severe economic recession with a record level unemployment rate, and after the amendment of the mental health legislation. Although there were 4540 fewer beds in the psychiatric hospitals in 1993 compared to 1990, the rate of patient admissions remained the same. There was a significant increase in readmissions (P < 0.001) to the psychiatric hospitals, and particularly in multiple (three or more) readmissions among new inpatients (P < 0.001). The prevalence of inpatients with major depression increased by 0.2/1000 in the whole cohort and by 0.12/1000 among first-timers from 1990 to 1993 (P < 0.001). In addition, the rate of involuntary admissions decreased significantly (P < 0.001).

Adolescent↗

PubMed1998

Frequently hospitalised psychiatric patients: a study of predictive factors.

The purpose of this study was to investigate the factors predicting readmission and the interval between readmissions to psychiatric hospital during the early 1990s in Finland. Data were retrieved using the national register of all discharges from psychiatric hospitals during the early 1990s. Frequently admitted patients were an identifiable group. The factors associated with an increased risk of multiple readmissions were: previous admissions, long length of stay (LOS) and diagnosis of psychosis or personality disorder. Patients with psychosis or personality disorder were also readmitted more rapidly than patients with an organic disorder. There seemed to be a small proportion of psychiatric patients in need of frequent or lengthy hospital treatment. The expansion of community care did not as such seem to have diminished the need and use of psychiatric hospital care. However, the differences between the years 1990 and 1993 were less important than the other factors that predicted readmission, namely LOS and diagnosis.

Adult↗

PubMed1998

When does estrogen replacement therapy improve sleep quality?

OBJECTIVE: Our purpose was to evaluate the effect of estrogen replacement therapy on sleep complaints by postmenopausal women and to assess the predictive factors involved. STUDY DESIGN: Sixty-three postmenopausal women entered a 7-month prospective, randomized, double-blind, crossover study consisting of two 3-month treatments with estrogen and placebo with a 1-month washout period between. Eight Visual Analogic Scale statements about different sleep complaints, the Basic Nordic Sleep Questionnaire, scoring of climacteric symptoms, The Beck Depression Inventory, and serum estradiol and follicle-stimulating hormone level controls were the main outcome measures. RESULTS: Estrogen replacement therapy improved sleep quality, facilitated falling asleep, and decreased nocturnal restlessness and awakenings (p < 0.001). The subjects were less tired in the mornings and in the daytime (p < 0.001) when taking estrogen replacement therapy. Estrogen-induced sleep improvement was associated with alleviation of vasomotor symptoms (r range 0.27 to 0.55), alleviation of somatic symptoms (palpitations and muscular pain, r range 0.26 to 0.36), and alleviation of mood symptoms (r range 0.28 to 0.37) on estrogen replacement therapy. The severity of initial insomnia predicted only one estrogen-induced sleep improvement effect: the more the subjects experienced insomnia, the better the estrogen replacement therapy facilitated falling asleep (r = 0.26, p = 0.040). Estrogen-induced sleep improvement was also reported by the 15 climacterically asymptomatic subjects. In these subjects initial insomnia scores strongly predicted estrogen-induced sleep improvement (r range 0.50 to 0.75). CONCLUSIONS: Estrogen replacement therapy significantly diminished sleep complaints among postmenopausal women. Alleviation of climacteric symptoms was the most important predictive factor for the beneficial effect of estrogen replacement therapy on sleep complaints. The use of estrogen replacement therapy in women without self-reported climacteric symptoms could also be considered because women do not always recognize their climacteric symptoms or they ignore them.

Climacteric↗

PubMed1998

The effect of short-term estrogen replacement therapy on cognition: a randomized, double-blind, cross-over trial in postmenopausal women.

OBJECTIVE: To evaluate the effect of estrogen replacement therapy on cognitive functioning. METHODS: The study consisted of two 3-month treatment periods, one with estrogen and one with the placebo, in random order, separated by a 1-month wash-out period. The study group comprised 70 healthy postmenopausal women, aged 47-65 years, with previous hysterectomy. Sixty-two women completed the study. Cognitive speed and accuracy, attention, and memory were evaluated. Serum estradiol (E2) and FSH levels were controlled at the end of the estrogen, placebo, and wash-out periods. RESULTS: Most of the cognitive tests correlated with age: older women were slower and made more errors than younger women. Estrogen replacement therapy was not superior to the placebo in any test of cognitive performance. In two out of ten visual detection tasks, recognition thresholds were longer with estrogen than with the placebo (P < .001 and P = .004). On the most demanding test of working memory, the reaction times (P = .045) and error rates (P = .043) differed between treatments, yet this finding proved to be an effect of learning rather than treatment. There was no correlation between cognitive performance and serum E2 levels. CONCLUSION: Cognitive performance decreased with age. Short-term estrogen replacement therapy did not provide any advantage over the placebo in terms of improving the performance.

Aged↗

PubMed1998

Bioactive glass granules and polytetrafluoroethylene membrane in the repair of bone defects adjacent to titanium and bioactive glass implants.

An experimental animal model was used to investigate the effect of bioactive glass (BG) granules and nonresorbable polytetrafluoroethylene (PTFE) membrane on the repair of cortical bone defects adjacent to titanium and BG implants. Thirty-two Astra(R) (diameter 3.5 mm) dental implants were inserted bicortically and 42 conical BG implants (diameter 2.5-3.0 mm) monocortically, into fitted holes of rabbit tibia. Before implantation, a standardized bone defect was created by drilling an extra hole (diameter 3.0 mm) adjacent to each implant site. Twenty-eight defects were filled with BG granules (diameter 630-800 microm) (BG group) and 28 defects were left empty but covered with PTFE membrane (PTFE group). No material was used in 18 control defects (control group). Morphometrical evaluation with a digital image analysis system was used to measure bone repair as percentages of the defect area on scanning electron microscopy (SEM) and light microscopy pictures. Bone-implant contact was measured as percentages of the thickness of the cortical bone. At 6 and 12 wk, bone repair in defects in connection with titanium implants was 23.2% and 36.6% in the BG group, 23.2% and 32.4% in the PTFE group, and 47.2% and 46.2% in control defects. Corresponding figures for BG implants were 33.2% and 40.1% in the BG group, 16.6% and 33.5% in the PTFE group, and 25.7% and 54.9% in control defects, BG granules and new bone together filled 82.7% and 68.5% of the defect area adjacent to titanium implants, and 75.9% and 74.4% of the defect adjacent to BG implants at 6 and 12 wk, respectively. Better bone-implant contact was achieved at the defect side with BG than titanium implants (77.0% versus 45.0% at 12 wk). The results indicate that BG granules are useful in treatment of bone defects adjacent to dental implants. BG coating of the implant seems to improve osseointegration in the defect area.

Journal Article↗

PubMed1998

Factors of early life as predictors of headache in children at school entry.

To study the main predictors of childhood preschool headache, 1443 families expecting their first child were followed from the onset of pregnancy to the child's sixth year of life. Subject selection was based on stratified randomized cluster sampling. Of the children, 14.9% (144) suffered from headache disturbing daily activities at the age of 6 years. The mother's assessment of the infant's poor health (OR 2.5, 95% CI 1.1 to 5.8) and feeding problems (OR 1.9, 95% CI 1.1 to 3.2) at the age of 9 months predicted later occurrence of headache. At 3 years, depression and sleeping difficulties (according to Achenbach's psychological test) and recurrent difficulties in falling asleep (OR 3.2, 95% CI 1.5 to 7.2) were strong predictors. Headache in other family members (OR 3.5, 95% CI 2.0 to 5.9), especially in the mother (OR 1.7, 95% CI 1.2 to 2.4), predicted preschool headache in a child. At the age of 5 years, travel sickness (OR 2.8, 95% CI 1.5 to 5.1), nocturnal enuresis (OR 1.8, 95% CI 1.1 to 3.0), and the presence of long-term disease (OR 1.8, 95% CI 1.1 to 3.0) were strong predictors of later headache. At the same age, concentration difficulties (OR 2.3, 95% CI 1.3 to 4.2), behavioral problems (OR 2.7, 95% CI 1.1 to 6.4), unusual tiredness (OR 3.8, 95% CI 1.0 to 13.5), and, conversely, high sociability (OR 1.5, 95% CI 1.0 to 2.2) predicted headache. The three last-mentioned psychological factors seemed to be associated with concentration difficulties at the age of 5, which was found to be the strongest predictor. The parents of child headache sufferers often became aware of the child's problems long before the emergence of headache.

Adult↗

PubMed1998

Contagion of deliberate self-harm among adolescent inpatients.

OBJECTIVE: To explore the quantitative importance and clinical features of deliberate self-harm (DSH) contagion in a closed adolescent psychiatric unit. METHOD: The authors investigated with statistical methods and a sociogram whether acts of DSH were clustered during a 12-month study period. Twelve subjects were involved in acts of DSH, and their mean length of hospitalization during the study period was about 90 days. Six adolescents with four or more contagion incidents were interviewed. RESULTS: DSH incidents were clustered during the study period (p < .05). Most DSH incidents were skin cutting committed by depressed female subjects with borderline personality disorder. The majority of DSH contagion can be understood in terms of small-group rites for feelings of togetherness. CONCLUSIONS: Even a majority of DSH events in closed adolescent units may be triggered by contagion, and DSH can spread to previously DSH-naive adolescents.

Adolescent↗

PubMed1998

Regional differences in the use of psychiatric hospital beds in Finland: a national case-register study.

We investigated the possible differences in the utilization of psychiatric hospital beds among five social security areas in Finland, and the association between the variables related to the psychiatric services and the use of hospital beds. The use of hospital beds varied quite distinctly among these areas, as did the total rate of in-patients, readmissions, and rates of in-patients with psychotic and affective disorders. The treatment practices appeared to vary as the length of stay (LOS) and the rate of committal differed regionally in a significant manner. There was a significant positive correlation between the total rate of in-patients and the rate of readmitted patients (r=0.92, P<0.001), and a significant negative correlation between the number of visits per worker in out-patient care and the rate of readmissions (r=-0.94, P<0.001).

Adult↗

PubMed1998

Tooth and tooth surface survival rates in birth cohorts from 1965, 1970, 1975, and 1980 in Lahti, Finland.

Differences in the tooth and tooth surface survival rates between four cohorts born in 1965, 1970, 1975, and 1980 were analysed in a historical cohort study including data on the permanent teeth of children aged 5-7 years at baseline and 19 years at the end of the study. A statistically significant reduction in caries occurrence in fissured surfaces in the three oldest cohorts was seen during the 3 years after the eruption of the teeth. Caries occurrence in the cohorts born in 1975 and 1980 did not differ from each other. The occurrence of caries in smooth surfaces was low in all age cohorts. Therefore, despite a systematic decrease in caries occurrence towards the younger cohorts, no significant differences were found between the cohorts in smooth surface decay. After the 3 first posteruptive years, practically no differences in survival rates between the cohorts were observed. In the two youngest cohorts, the figures during the 3 first years after eruption did not differ from the figures for the later years. Throughout the study, caries occurrence was symmetric and no gender differences were observed. No postponement of decay was found by the end of the follow-up time.

Adolescent↗

PubMed1998

Improved diagnostic assessment of major depression in psychiatric outpatient care in Finland.

The accuracy of diagnosis of major depression by psychiatrists, psychiatric residents, and other physicians in outpatient psychiatric care settings in Finland was examined. A total of 232 patients who visited four mental health centers in the hospital district of Satakunta during three years (1989, 1992, and 1995) were retrospectively given a diagnosis of first-episode major depression by researchers, based on chart reviews. These diagnoses were compared with those made by the evaluating clinicians. Accurate diagnosis was associated with the specialty of the physician and the location of the mental health center. Recognition of major depression significantly improved over the time period, which could be attributed to educational efforts, increasing familiarity with DSM-III-R criteria, and use of new antidepressants.

Adult↗

PubMed1998

Childhood headache at school entry: a controlled clinical study.

OBJECTIVE: Our objective was to study the prevalence of different headache types, characterizations, and triggers of headache in Finnish children starting school. METHODS: Questionnaires were sent to 1,132 families with 6-year-old children. Children with headache disturbing their daily activities (n=96) and an asymptomatic control group of children (n=96) participated in a clinical interview and examination. RESULTS: Children with headache had significantly more bruxism (odds ratio [OR], 1.9; 95% CI, 1.0 to 3.4), tenderness in the occipital muscle insertion areas (OR, 4.8; 95% CI, 1.8 to 12.7), and tenderness in the temporomandibular joint areas (OR, 2.8; 95% CI, 1.3 to 6.0). They also had more travel sickness (OR, 3.4; 95% CI, 1.7 to 6.7) than control children. Eating ice cream (OR, 5.3; 95% CI, 1.4 to 20.3), fear (OR, 3.7; 95% CI, 1.2 to 11.2), and anxiety (OR, 3.2; 95% CI, 1.0 to 10.8) triggered headache more often in migraineurs than in children with tension-type headache. Children with migraine also reported more frequently abdominal (OR, 5.6; 95% CI, 1.7 to 18.1) and other (OR, 3.5; 95% CI, 1.2 to 9.8) pain concurrently with headache, and they used medication for pain relief more often (OR, 3.1; 95% CI, 1.0 to 9.5). CONCLUSIONS: Headache classification in children may be improved by palpation of occipital muscle insertions and temporomandibular joint areas, and by discerning a history of triggering events and concurrent symptoms.

Bruxism↗

PubMed1998

On what grounds do women participate in prenatal screening?

Along with the rapid biomedical development of prenatal screening tests, target groups' attitudes and decision-making about, and the acceptance of, screening procedures have come into focus. To understand users' decision-making, it is essential to understand users' knowledge and perceptions of a procedure. The aim of this study was to examine Finnish women's knowledge and perceptions of, and stated reasons to participate in, two prenatal screening tests: serum screening and mid-trimester ultrasound screening. Subjects (n=1035) for the serum screening survey were catered for in the maternity care centres of two Finnish towns, where serum screening is available for all pregnant women. After one reminder, 88 per cent returned the questionnaire. Subjects (n=497) for the mid-trimester ultrasound screening survey were catered for in the obstetrical and gynaecological outpatient clinic of the city hospital of another town; the response rate was 85 per cent. Women's perceptions of the studied prenatal screening tests, serum screening and mid-trimester ultrasound screening, differed significantly, even though both are used to detect fetal malformations. Serum screening was far more often perceived to be connected with finding diseases or abnormalities than ultrasound screening. Another interesting finding was that the stated reasons for screening in general and the subjective reasons for participation were different. Reassurance was the personal reason most often mentioned in both the serum screening and the ultrasound group. Almost all women had the most superficial knowledge about serum screening; they knew whether it had been offered and that it is done to screen for Down syndrome. The greatest gaps in knowledge concerned the sensitivity of serum screening, its use in screening for congenital nephrosis, and diagnostic tests and their risks. Knowledge was poorer among women without a high school education. When counselling women about prenatal screening tests, more emphasis should be given to the sensitivity of serum screening, all of its screening uses, and the possible diagnostic tests and their risks. The fact that ultrasound screening can detect conditions which may lead to the possibility of a selective abortion should also be explained more fully.

Amniocentesis↗

PubMed1998

[Disruptive behavior of elderly residents and the use of nursing methods].

This study is the first part of a larger research project concerned with disruptive behaviour and the use of physical restraints on elderly nursing home residents. This paper is focused on the types and prevalence of disruptive behaviour among elderly residents, nurses' experiences and the types of nursing interventions employed. Data was collected from nurses of varying qualifications (n = 173) in seven Swiss nursing homes by using a questionnaire. The most frequent behavioural problems reported by nurses were mobility, incontinence, getting dressed, verbal communication, passivity, withdrawal and continual requests. Nurses found physical aggression, continual shouting and verbal abuse the most difficult to manage with. The results also indicated that experiences varied between nurses. In particular, nursing staff always considered disruptive behaviour more disruptive against other residents rather then against themselves. The most frequently used interventions against disruptive behaviour were considering residents' wants and needs, getting close, adjustment to residents' background and organisation of activities. Physical and chemical restraints were also used.

Adult↗

PubMed1998

Tissue perfusion after intramedullary nailing of tibial shaft fracture.

BACKGROUNDS AND AIMS: To measure noninvasively the effect of circulative changes caused by fracture and intramedullary nailing on tibialis posterior (TPA), dorsalis pedis (DPA) and sum (TPA + DPA) arterial peak signals, transcutaneous oxygen tension (PtcO2) as well as local skin temperature (T) in patients with tibial shaft fractures. PATIENTS, MATERIAL AND METHODS: A total of thirty tibias consisting of ten closed, reamed, intramedullary nailed simple tibial shaft fractures (Type AO A), ten contralateral tibias and as controls, ten intact tibias of healthy volunteers. The measurements took place one day before and immediately after nailing, six hours later and during five days postoperatively. The values were compared to those of contralateral legs and to control legs. RESULTS: In the nailed legs the mean TPA and PtcO2 remained at a significantly lower level compared to the contralateral legs throughout the study (p < 0.003 in both cases). However, the alterations in DPA and TPA + DPA were not statistically significant. Additionally, skin temperature on the fracture site was averagely 3 degrees C warmer than that of the contralaterals (p < 0.001). All the measured parameters were statistically significantly higher in control legs compared to contralateral legs. There were no statistically significant differences between pre- and postoperative values in any measured parameters. CONCLUSION: The changes in the local tissue perfusion variables measured in the present study reflect rather the injury mechanism itself than the effect of reaming and intramedullary nailing in simple tibial fractures. Additionally, arterial circulation was reduced in the contralateral legs.

Adult↗

PubMed1997

The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. Finnish Study Group for Antimicrobial Resistance.

BACKGROUND: In the early 1990s there was an increase in erythromycin resistance among group A streptococci in Finland. In response, policies regarding outpatient antibiotic therapy were changed, and nationwide recommendations were issued that called for reductions in the use of macrolide antibiotics for respiratory and skin infections in outpatients. We studied the effect of this policy on the pattern of erythromycin resistance throughout Finland. METHODS: From 1991 through 1996, a total of 39,247 group A streptococcal isolates from throat swabs (82 percent of the isolates) and pus samples (18 percent) and 290 isolates from blood cultures were studied in regional microbiology laboratories. The susceptibility of the isolates to erythromycin was tested by the disk-diffusion or the screening-plate method. RESULTS: Consumption of macrolide antibiotics decreased from 2.40 defined daily doses per 1000 inhabitants per day in 1991 to 1.38 in 1992 (P=0.007) and remained near the lower level during the study period. The change in consumption was followed by a steady decrease in the frequency of erythromycin resistance among group A streptococcal isolates from throat swabs and pus samples, from 16.5 percent in 1992 to 8.6 percent in 1996 (odds ratio for 1996 as compared with 1992, 0.5; 95 percent confidence interval, 0.4 to 0.5). CONCLUSIONS: In Finland, after nationwide reductions in the use of macrolide antibiotics for outpatient therapy, there was a significant decline in the frequency of erythromycin resistance among group A streptococci isolated from throat swabs and pus samples.

Anti-Bacterial Agents↗

PubMed1997

Hormone replacement therapy and some salivary antimicrobial factors in post- and perimenopausal women.

OBJECTIVES: The effect of hormone replacement therapy (Cyclabil) on non-immunoglobulin (peroxidase) and immunoglobulin (total IgA, IgG, IgM) antimicrobial factors as well as on total protein and microorganisms in whole saliva was assayed in 19 postmenopausal and 8 perimenopausal women. METHODS: Paraffin-stimulated whole saliva was collected before as well as 3 and 5 months after the onset of the treatment. Time- and group-related differences between post- and perimenopausal women were analyzed. RESULTS: Peroxidase and total protein output per min increased significantly (P = 0.004 and 0.001) during the treatment in both groups. No significant time- or group-related differences in the mean concentrations of the respective variables were found. The mean concentrations of salivary IgA and IgG showed a significant time-related decrease in both groups (P = 0.012 and 0.010). Salivary IgM concentration in perimenopausal women also showed a significant time-related decline (P = 0.017) and the difference in changes of salivary IgM between the two groups was significant (P = 0.033). Total IgA output per min increased in perimenopausal whereas it decreased in postmenopausal women (interaction; P = 0.021). Hormone treatment had no effect on the amount of salivary bacterial floras. CONCLUSIONS: The composition of saliva in post- and perimenopausal women was found to be estrogen-dependent. The second finding was that all women participating in the study reported a sense of enhanced oral well-being including relief of oral dryness.

Adult↗