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Reijo Tilvis

Publications and source records attributed to Reijo Tilvis.

10 recordsLinked to original sources
PubMed2006

Clinical significance of widespread gastric metaplasia in the duodenal bulb.

BACKGROUND: All the risk factors of peptic ulcer disease are not thoroughly understood. GOALS: To assess duodenal gastric metaplasia (DGM) in relation to Helicobacter pylori status and endoscopy findings with special reference to the effects of highly selective vagotomy. STUDY: The study population consisted of 1056 adult patients and an additional 154 patients who had had a highly selective vagotomy. Their clinical and endoscopy records as well as the histology of gastric and duodenal biopsies were evaluated retrospectively. H. pylori infection had been determined by serology and culture. RESULTS: Widespread (more than 20%) DGM was strongly associated with H. pylori positive duodenal ulcer disease (in 59.7% of patients). The prevalence of DGM diminished progressively the more proximally the ulcer was located in the stomach, and was 2.5% in proximal gastric ulcers patients. In vagotomized patients, the prevalence of widespread DGM (8.4% of patients, median 14 years after operation and the majority still H. pylori positive) was close to that of patients with H. pylori gastritis without peptic ulcer disease (4.5%). CONCLUSIONS: Widespread DGM is an indicator for an increased risk of duodenal ulcer among H. pylori positive patients and it could be used to select patients for eradication therapy.

Adolescent↗
PubMed2006

A network-based geriatric rehabilitation programme: study design and baseline characteristics of the patients.

The objective of this paper is to present the design and participants of an ongoing randomized controlled trial on a network-based geriatric rehabilitation programme, targeted at frail elderly persons with progressively declining health and a high risk of institutionalization. Forty-one municipalities, seven rehabilitation centres and a total of 741 frail elderly (65+years) community-living persons participated in the study. Assessments included measurements of physical capacity (balance, handgrip strength, walking speed), Functional Independence Measure, Geriatric Depression Scale, 15 Dimension quality of life questionnaire and Mini Mental State Examination. Questionnaires covered physical, social and psychological factors. The participants were old (mean age 78 years, range 65-96) and mainly female (86%). They were physically frail and most of them (66%) had experienced deterioration of health within 1 year. The majority lived alone (72%) and received regular help from other people (99%). The mean Mini Mental State Examination and Geriatric Depression Scale scores were 25.2 and 4.1 points, respectively. Depressive mood (Geriatric Depression Scale>6 points) was found in 17% and declined cognitive function (Mini Mental State Examination<24 points) in 28% of the participants. Differences between the randomized intervention and control groups were insignificant. Since the number of participants is sufficient statistically, the prospects for evaluating the effectiveness of the programme, and identifying potential benefactors, are good.

Activities of Daily Living↗
PubMed2006

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Journal Article↗
PubMed2005

Interaction of herpesviridae, APOE gene, and education in cognitive impairment.

While high age, low level of education and APOE epsilon4 allele are known to predict dementia, there is recent data suggesting that certain viruses and subtypes of APOE epsilon3 could be involved, too. We investigated these relationships in a home-dwelling cohort of 357 elderly people with various cardiovascular diseases (DEBATE study). MMSE score below 24 was used to define cognitive impairment (n = 58). When adjusted for age and the presence of diabetes, multivariate analysis demonstrated maximally increased risk of cognitive impairment in association with a combination of three factors: seropositivity for herpesviridae, presence of APOE epsilon4, and low education (risk ratio 6.1, 95% CI 2.4-15.2). In the subcohort of APOE3/3 individuals (n = 216) homozygosity for the -219G epsilon3 haplotype showed a similar association (risk ratio 8.8, 95% CI 2.6-29.8). These results demonstrate an interaction of specific genetic (APOE) and environmental (education and herpesviridae) risk factors in the development of cognitive impairment and indicate that not only the epsilon4 allele of APOE but also the epsilon3 haplotype is a risk factor for dementia.

Aged↗
PubMed2005

CYP3A5 genotype is associated with diagnosis of hypertension in elderly patients: data from the DEBATE Study.

OBJECTIVE: The aim of this study was to address the presently controversial question of whether cytochrome P450 (CYP) 3A5 polymorphism is associated with hypertension. METHOD: We studied 373 elderly (age > or =75 years) Finnish (Caucasian) patients from the ongoing DEBATE (Drugs and Evidence Based Medicine in the Elderly) trial. The patients were classified into those with a history of hypertension (n = 229) and those without a history of hypertension (n = 144) on the basis of a detailed questionnaire on each patient's medical history and an interview. The patients were genotyped for the CYP3A5 6986A/G single nucleotide polymorphism (SNP) [CYP3A5*1/*3 alleles]. RESULTS: The proportion of individuals with the CYP3A5*1/*3 genotype, i.e. CYP3A5 expressors, was significantly higher among patients with a diagnosis of hypertension than among patients without (18.3% vs 9.0%, p = 0.016). The corresponding odds ratio was 2.26 (95% CI 1.17, 4.38). The allele and genotype frequencies for the two control SNPs, ABCB1 (MDR1) 3435C/T and SLCO1B1 521T/C, did not differ between the two groups. CONCLUSION: This work lends support to the theory that the polymorphic CYP3A5 enzyme may be involved in regulation of blood pressure. The possible role of CYP3A5 as a genetic contributor to hypertension susceptibility warrants further study.

Aged↗
PubMed2004

Left ventricular hypertrophy and blood pressure as predictors of cognitive decline in old age.

BACKGROUND AND AIMS: The relationships between blood pressure (BP) and cognition are complex and are still partly unclear. The impact of history of hypertension, present BP levels, and left ventricular hypertrophy (LVH) on cognition was investigated in a 10-year follow-up study of an aged population. METHODS: The population-based sample consisted of 75-, 80- and 85-year-old individuals at baseline (N=650). Their history of hypertension was investigated, and present BP values were recorded several times. Echocardiographic examinations were performed twice at 3-year intervals, and electrocardiography (ECG) at entry. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at baseline and at 10 years, and by the Clinical Dementia Rating (CDR) at baseline, at 1, 5 and 10 years. RESULTS: At baseline, elderly individuals with impaired cognition or dementia had lower BP, but thicker left ventricle posterior wall (LVPW), greater cardiac mass, and more often signs of LVH in ECG than those without cognitive deficits. Echocardiographic LVH, but not BP, predicted cognitive decline in a 5-year follow-up. Patients who died demented within 5 years were characterized by low BP and thin LVPW. Baseline BP and echocardiographic variables were not significantly different between those who had and had not cognitive decline at 10 years, but declining BP tended to precede cognitive deficits. CONCLUSIONS: Results indicate that, the closer cognitive decline, the lower the BP, and suggest that, although LVH is a risk factor of cognitive decline, it loses its predictive value in old age.

Aged↗
PubMed2004

Lipid-lowering response to statins is affected by CYP3A5 polymorphism.

Individuals expressing the polymorphic CYP3A5 enzyme might show a more than average efficiency in the metabolism of lovastatin, simvastatin and atorvastatin. We studied whether the expression of CYP3A5 is associated with an impaired lipid-lowering response to statins in 69 Caucasian patients. Lovastatin, simvastatin and atorvastatin were significantly less effective in CYP3A5 expressors than in non-expressors. The mean serum total cholesterol concentration at 1 year was 23% higher (P = 0.0014) and the mean serum low-density lipoprotein cholesterol concentration was 24% higher (P = 0.036) in subjects possessing the CYP3A5*1 allele (CYP3A5 expressors, n = 7) than in subjects homozygous for the CYP3A5*3 allele (non-expressors, n = 39). The mean percentage reduction in serum total cholesterol from baseline was significantly smaller in CYP3A5 expressors than in non-expressors (17% versus 31%, P = 0.026). No association between hypolipidemic efficacy and CYP3A5 polymorphism was observed among 23 subjects taking statins that are not dependent on CYP3A5 (fluvastatin, pravastatin). These findings suggest that CYP3A5 may be a genetic determinant of interindividual differences in response to certain statins.

Aged↗
PubMed2003

Benefits of optimising drug treatment in home-dwelling elderly patients with coronary artery disease.

Coronary artery disease (CAD) is prevalent in the elderly and often leads to disability. Consequently, strategies for optimising the prevention and treatment of CAD in the elderly are important from both the individual and societal perspectives. Although it is common knowledge that the elderly are heavy consumers of drugs, there is evidence to show that there is under-prescribing of evidence-based medical therapies in the home-dwelling elderly coronary patient and there may be overuse of some non-evidence-based (antioxidants) and purely symptomatic treatments. In particular, aspirin (acetylsalicylic acid), beta-adrenoceptor antagonists, ACE inhibitors and HMG-CoA reductase inhibitors are under-utilised. Although the evidence base is largely drawn from trials including patients younger than 75 years, it is reasonable to assume that the data applies to patients aged over 75 years and that better use of evidence-based medicines would provide benefits to the home-dwelling aged patient. Evidence from the few multifactorial studies available suggest possible benefits including reduction of cardiovascular events, less disability and better quality of life in old age. At the societal level, this would be reflected in fewer hospitalisations and institutionalisations, which means decreased cost of elderly care.

Adrenergic beta-Antagonists↗