Glomerulonephritis with pulmonary haemorrhage. (Goodpasture's syndrome).
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Adult↗
Biomedical subjects
J Takala
Publications and source records attributed to J Takala.
[Localized interlobar effusion in congestive heart failure].
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Aged↗
Health care priorities as a problem of local resource allocation.
The aim of this study was to examine attitudes to prioritization in health care among the general public, politicians, doctors and nurses. The focus in this paper is on the types of services from a perspective that is 'policy analytical'. This study forms part of the wider 'Prioritization in Health Care Project' carried out at the University of Kuopio exploring patient treatment level prioritizations. Data were collected by a postal questionnaire in 1995. Four groups were established for the study: (1) a general public sample of 2000 subjects, (2) a random sample of 1000 nurses, (3) a random sample of 1500 medical doctors and (4) a sample of 2200 politicians involved in social and health care administration. Respondents were asked to make value choices between specialized and primary health care services in a real budget situation. One of the most salient findings in this study was that attitudes towards priorities are context-dependent. Certain differences were observed between the groups studied. The attitudes of the general public and nurses were quite similar, while similar views were shared by politicians and doctors. The attitudes of the respondents reflect well what has actually happened in Finnish health care, with the exception of psychiatric services which have undergone drastic cuts.
Adult↗
Primary health care ICD--a tool for general practice research.
The International Classification of Diseases (ICD) has become the only diagnostic classification system of international standard that allows reliable comparisons of epidemiological data between countries, parts of a country, levels of health care systems, or different periods of time. However, for primary health care purposes it is too specific to describe problems relevant to the work of general practitioners (GPs). Tools are thus needed to 'compress' data in primary health care for educational, administrative and research purposes. The objective of this paper was to introduce a diagnosis coding system that can be used in primary health care settings for these purposes. Principal diagnoses, as assessed by medical doctors, were collected from 20,648 patient visits. After primary coding, according to the ICD on a five-digit scale, the diagnoses were grouped into larger entities, which reduced the number of diagnoses to one eighth of the original number. The ten most common original five-digit diagnoses accounted for one quarter of all consultations, whereas the ten most common diagnoses counted for one half of all consultations after compressing the data into new categories. Analysing epidemiological data in the records of primary health care by the ICD offers benefits because of the latter's wide use. These are discussed below.
Adult↗
Drug treatment for hypertension in Finnish primary health care.
OBJECTIVE: To analyse the prescribing patterns of antihypertensive drugs in Finnish primary health care and to describe the profiles of monotherapy and combination therapy in relation to the duration of high blood pressure. METHODS: Thirty out of 250 primary health care centres were randomly selected for the study. All doctors (n=337) from the participating health centres recorded all hypertensive patients (n=4405) during a 2-week period in May 1995. Adequate information was obtained concerning 4294 hypertensives, of whom 65% were women with a mean age for the total study population of 64 years. 85% of the patients (n=3638) had antihypertensive medication which was classified into five main categories: diuretics, beta blocking agents, calcium channel blockers, ACE inhibitors and hypotensives. RESULTS: Of the patients using antihypertensive medication, 48% were undergoing monotherapy and 52% combination therapy. Beta blocking agents were the most frequently prescribed drugs for hypertension, being used by half of the patients. ACE inhibitors and diuretics were prescribed in a different manner for male and female hypertensives, with men receiving more ACE inhibitors and women more diuretics. The number of antihypertensive drugs increased with the duration of hypertension, though 38% of the patients having hypertension for over 10 years were still undergoing monotherapy. Among patients undergoing combination therapy, 75% received two different agents, most often a diuretic with a beta blocking agent. CONCLUSIONS: With increasing duration of hypertension, the number of antihypertensive drugs also increased. Beta blocking agents were the drug of choice for all patients. For women, combination therapy more frequently included diuretics, whereas ACE inhibitors were favoured for men.
Age Factors↗
A clinical description of the IMPROVE Data Library.
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Aged↗
Monitoring the autonomic nervous system in the ICU through cardiovascular variability signals.
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Adult↗
Growth failure due to uremia and congenital nephrosis: growth enhancement by aggressive nutritional therapy.
The metabolic and nutritional effects of long-term parenteral and enteral nutrition were studied in two infants and one child with severe growth failure due to chronic renal failure (two patients) and congenital nephrosis (one patient). Six periods of treatment were analyzed. Both the parenteral nutrition and continuous enteral nutrition were found efficient in enhancing growth and correcting the metabolic abnormalities of uremia. The beneficial effects of this intensive nutrition were smaller in congenital nephrosis, although growth accelerated. Nitrogen balance studies confirmed effective nutrient utilization. The serum levels of calcium and phosphate were normalized as anabolism was achieved in the uremia. In fact, the rapid development of severe hypophosphatemia in one of the patients proved that the "fatal hyperalimentation syndrome" appears to be a specific threat in parenteral nutrition applied in uremia.
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Parenteral nutrition in anuria of infancy: evidence for sustained net protein synthesis.
The effects of total parenteral nutrition were studied in two anuric neonates and an anuric infant. Based on the observations of urea production, nitrogen balance, and serum osmolality, the bulk of the infused nitrogen appeared to be incorporated into the body proteins. The need for potassium, calcium, phosphorous, and magnesium substitution was also indicative of net anabolism. Despite effective utilization of the amino acids, high plasma levels of phenylalanine and methionine, and extremely low levels of the urea cycle intermediates were measured. We conclude that the application of carefully planned parenteral nutrition may aid in the management of newborns with failing kidneys and that it influences considerably the indications of dialysis in early infancy.
Acid-Base Equilibrium↗
Total plasma clearance of intravenous essential amino acids: evidence of abnormal metabolism of amino acids in chronic renal failure.
The total plasma clearance of essential amino acids was studied in 9 non-dialyzed patients with stabile chronic renal failure and 20 healthy young adult volunteers after a bolus infusion of 0.28 g amino acids per kg of body weight in a solution containing essential L-amino acids in the proportions suggested by Rose and supplemented by L-histidine. After the infusion, the plasma concentrations of amino acids were observed for 6 hr. The pharmacokinetic analysis was performed by a polyexponential parameter estimate computer program, capable of analyzing up to five-compartment models. Wide individual variation in the capability to clear the given amino acid load from the plasma was observed. Expressed as a fraction of the sum of the total plasma clearances of the infused amino acids, the total plasma clearance of valine and phenylalanine had decreased in renal failure while that of histidine had increased. These alterations reflect the complex disorder of the protein metabolism and the observations may be of help in designing optimal nutritional regimens in renal failure.
Adult↗
Total parenteral nutrition in experimental uremia: studies of acute and chronic renal failure in the growing rat.
The effects of total parenteral nutrition (TPN) on experimental acute and chronic renal failure were studied with special reference to age in the rat. TPN prolonged survival in acute renal failure. The young experimental animals benefitted more than the TPN. The accumulation of urea in the body was inhibited during TPN. In chronic renal failure, the low nitrogen TPN with essential amino acids as the source of nitrogen had no advantages over a regular diet fed ad libitum. Instead the TPN-rats had a markedly less positive nitrogen balance than the uremic and healthy controls. This difference was accentuated in the rapidly growing young animals. The results of this study suggest that TPN has a crucial role in the treatment of acute renal failure at an early age and are against the use of low protein diets in chronic renal failure if rapid growth is expected.
Acute Kidney Injury↗
Postoperative parenteral nutrition with high supply of branched-chain amino acids: effects on nitrogen balance and liver protein synthesis.
Branched-chain amino acids (BCAA) stimulate muscle and liver protein synthesis in vitro. The significance of this action in catabolic conditions in vivo remains controversial. The effects of a high supply of BCAA in total parenteral nutrition (TPN) on nitrogen balance and liver protein synthesis were studied in a postoperative rat model. After standard operative trauma TPN was commenced with one of two isocaloric programs (I: 20.1% BCAA and II: 50% BCAA) and continued for 48 hr. The relative rate of liver protein synthesis, measured after TPN in vitro by perfusion with 14C-leucine, was similar in both groups (I: 53.4 +/- 17.3 and II: 49.0 +/- 27.3 arbitrary units of synthesis rate, mean +/- SD). The cumulative nitrogen balance was positive with both regimens and was not improved by the high supply of BCAA (I: 2.02 +/- 0.81 and II: 1.87 +/- 0.63 gN/kg/48 hr mean +/- SD). We conclude that after moderate surgical trauma TPN with a high supply of BCAA offers no advantage over conventional TPN.
Albumins↗
International agency efforts to protect workers and the environment.
Every year 335,000 workers die in occupational accidents and altogether 1.1 million fatalities are caused by work-related factors. Some 250 million nonfatal accidents causing absence from work are aggravated by permanent disabilities, reduced capacity of life and work, and economic losses amounting to 4% of gross national product. The role of the International Labour Office (ILO) in promoting social justice is based on ethical principles and demonstrated by the ILO's standard-setting work, information exchange, and proposed Global Program on Occupational Safety, Health and the Environment, Ethical and policy dimensions of the ILO's practices are targeted to a participatory process aimed at better legislation and enforcement, as well as trained and well-informed specialists to modify work environments and cultures to eliminate or reduce the problems and suffering. The ILO's key present and new activities and outputs, such as the new 4th edition of the Encyclopedia on Occupational Health and Safety, are described. A better system of collaboration and networking in occupational safety and health is still needed.
Accidents, Occupational↗
Pulmonary capillary pressure. A review.
Pulmonary capillary pressure (Pcap) is the predominant force that drives fluid out of the pulmonary capillaries into the interstitium. Increasing hydrostatic capillary pressure is directly proportional to the lung's transvascular filtration rate, and in the extreme leads to pulmonary edema. In the pulmonary circulation, blood flow arises from the transpulmonary pressure gradient, defined as the difference between pulmonary artery (diastolic) pressure and left atrial pressure. The resistance across the pulmonary vasculature consists of arterial and venous components, which interact with the capacitance of the compliant pulmonary capillaries. In pathological states such as acute respiratory distress syndrome, sepsis, and high altitude or neurogenic lung edema, the longitudinal distribution of the precapillary arterial and the postcapillary venous resistance varies. Subsequently, the relationship between Pcap and pulmonary artery occlusion pressure (PAOP) is greatly variable and Pcap can no longer be predicted from PAOP. In clinical practice, PAOP is commonly used to guide fluid therapy, and Pcap as a hemodynamic target is rarely assessed. This approach is potentially misleading. In the presence of a normal PAOP and an increased pressure gradient between Pcap and PAOP, the tendency for fluid leakage in the capillaries and subsequent edema development may substantially be underestimated. Tho-roughly validated methods have been developed to assess Pcap in humans. At the bedside, measurement of Pcap can easily be determined by analyzing a pressure transient after an acute pulmonary artery occlusion with the balloon of a Swan-Ganz catheter.
Algorithms↗
The contribution of occupational risks to the global burden of disease: summary and next steps.
BACKGROUND: The Comparative Risk Assessment (CRA) project of the World Health Organization (WHO) assessed worldwide mortality and morbidity in the year 2000 resulting from exposures to selected occupational hazards. This article summarizes findings of the WHO CRA project, presents the estimates of the International Labor Organization (ILO) for total deaths due to workplace risks, and calls for action. OBJECTIVES: Global burden estimates and counts of deaths assist ministers and other decision and policy makers to make informed decisions and to take action regarding risk reduction. METHODS: The WHO CRA methodology combined the proportions of the population exposed to five occupational hazards (excluding numerous risks due to inadequate global data) with relative risk measures to estimate attributable fractions of the selected health outcomes for both morbidity and mortality. ILO estimates of total numbers of global work-related injury deaths apply national fatality rates to employment data for the particular country; for disease deaths ILO uses an attributable risk approach. RESULTS: In 2000, the selected occupational risk factors were responsible worldwide for 37% of back pain, 16% of hearing loss, 13% of chronic obstructive pulmonary disease (COPD), 11% of asthma, 8% of injuries, 9% of lung cancer and 2% of leukemia, and about 100% of pneumoconioses and mesothelioma. These selected risks at work resulted in the loss of about 24 million years of healthy life and caused 850,000 deaths worldwide, about 40% of the ILO estimate of 2.2 million total deaths. CONCLUSIONS: These global and regional analyses have identified areas where specific preventive actions are required.
Accidents, Occupational↗
Strategies for improving compliance in hypertensive patients.
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Adult↗
Branched-chain and mixed amino acid solutions and thermogenesis in postoperative patients.
The effect of amino acid composition on the thermogenic response to amino acid infusion was studied in 20 spontaneously breathing postoperative coronary bypass patients and 6 healthy volunteers. On the 1st postoperative day, patients received either a balanced amino acid solution (2510 kJ/24 h) or an amino acid solution consisting primarily (88.8%) of branched-chain amino acids (BCAAs; 2510 kJ/24 h) for 6 h. Another group of patients receiving only hypocaloric glucose served as control subjects. The volunteers randomly received the same balanced amino acid solution (2510 kJ/24 h) or the same BCAA-enriched solution (2510 kJ/24 h) for 6 h. In the coronary bypass patients, both infusion regimens resulted in an increase in resting energy expenditure (REE) (p < 0.01). The thermogenic response to nutrition was 28.5 +/- 5.8 and 46.9 +/- 4.3% (mean +/- SE) in the patients receiving the balanced and BCAA-enriched solutions, respectively (p < 0.05). REE did not change in the control group. Alveolar ventilation increased in both groups (p < 0.05), and the change was more prominent in patients receiving the BCAA-enriched solution. PaCO2 decreased significantly in both nutrition groups. In the healthy subjects, REE increased only during the balanced amino acid infusion (p < 0.05). The thermogenic response to the balanced amino acid solution was 20.7 +/- 4.2% (p < 0.05), whereas no thermogenic response to the BCAA-enriched solution was observed (-5.6 +/- 3.3%, NS). This difference was probably due to the smaller energy cost of BCAA metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Nutrition status, severity of illness, and thermogenic response to parenteral nutrition.
The effect of the degree of metabolic stress on the thermogenic response to parenteral nutrition was studied in surgical and intensive-care patients. Indirect calorimetry was measured before and 3 h after the start of parenteral nutrition. The following patient groups were studied: depleted ward patients before and after surgery for gastrointestinal malignancy (n = 16), mechanically ventilated sepsis/injury patients (n = 21), and spontaneously breathing intensive-care sepsis/injury patients (n = 8). The patients received either nonprotein energy alone (glucose/fat 30/70%) at a rate corresponding to 1.4-1.6x baseline resting energy expenditure (REE) or amino acids (1.5 g.kg-1.day-1) and hypocaloric glucose. There was no correlation between the thermogenic effect of nutrition and the degree of hypermetabolism or degree of malnutrition. There was no significant thermogenic response to either amino acids or hypercaloric lipids and glucose preoperatively. In the depleted patients, REE increased because of the operation (p < 0.05); postoperatively, only amino acids increased REE significantly (p < 0.05). The operation enhanced the thermogenic response, which was higher to amino acids than to nonprotein energy (27.2 +/- 9 vs. 5.3 +/- 2.2%, means +/- SE, p < 0.05). In the sepsis/trauma patients, REE increased in both nutrition groups (p < 0.05). The thermogenic response (19.7 +/- 6.5 and 8.0 +/- 3.2% in patients receiving amino acids and nonprotein energy, respectively) was similar to that of the depleted patients postoperatively and was similar in sepsis and trauma patients. We conclude that the thermogenic response to parenteral amino acids and nonprotein energy is minor in depleted patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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