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The aim was to examine the impact of high-risk alcohol consumption on health care service utilization and causes of death after ICU discharge. This retrospective cohort study included non-trauma admissions to ICU in 2014 in Oulu University Hospital, Finland. The National Institution for Health and Welfare provided the data of health care contacts and causes of death. There was a total of 715 ICU survivors, 234 (32.7%) in the alcohol group and 481 (67.3%) in the non-alcohol group. There were no differences between groups in the mortality, median number of primary health care visits, or hospital admissions, but alcohol- and trauma-related visits were more frequent in the alcohol group. 22.5% (vs 2.2%, p <.001) of the patients in the alcohol-group died due to traumas and 29.6% (vs 0.7%, p <.001) due to alcohol-related causes, whereas malignancies and cardiovascular causes (79.4% vs 35.2%, p <.001) were the most common causes in the non-alcohol group. One-third of the patients with high-risk alcohol consumption died due to alcohol-related causes and one-fifth due to traumas. High-risk consumption of alcohol did not have a significant impact on the health care resource use after ICU discharge. [ABSTRACT FROM AUTHOR]

Our aim in this comparison study was to describe the continuation of domestic violence and to assess changes in the association among family functioning, health, and social support for participants who have or have not experienced violence for the years 2012 and 2015. We collected the data using a family functioning, health, and social support (FAFHES) questionnaire. We collected the baseline questionnaires (N = 188) from patients who visited a Finnish central hospital and mailed the follow-up survey (N = 71). The prevalence of violence remained constant. However, the violence varied and changed. Our findings should encourage health care professionals to better identify and intervene in violence. [ABSTRACT FROM AUTHOR]

Background: Infections greatly influence the outcome of acute myeloid leukemia (AML) patients receiving intensive treatment. The aim of this study was to establish the incidence, microbial etiology, risk factors and prognosis of bloodstream infections (BSIs) in patients with AML and compare the results with the previous treatment protocol (AML-92). Methods: Registery data were gathered prospectively from 357 patients aged 16–65 years recruited on the AML-2003 treatment protocol between November 2003 and November 2011 during different treatment cycles. Results: Blood culture data were available on 977 treatment episodes, in which there were 503 BSIs (51%). The overall incidence rate (IR) for BSIs (per 1000 hospital days) was 16.7. Twenty patients (5.6%) died due to an infection and 16 of them (80%) had a BSI. The most commonly detected microbes (polymicrobial episodes included) in blood cultures were coagulase-negative staphylococci (CoNS, 24.7%), viridans group streptococci (VGS, 19.1%), enterococci (13.9%) and Enterobacteriacae group (25.9%). The etiology of BSIs varied greatly from treatment cycle to cycle. Conclusions: Enterococcal BSIs have increased compared to our previous treatment protocol, and they represent significant pathogens in blood cultures. Infection-related mortality has decreased despite the increase in the IR of BSIs. Enterococci seem to be an increasingly prominent pathogen underlying BSIs in the AML patients, especially during induction therapy (20%). [ABSTRACT FROM AUTHOR]

Objective: Young people regularly expose themselves to leisure noise and are at risk of acquiring tinnitus. This study examined the prevalence of leisure noise-induced tinnitus among Flemish young adults as well as the relation with sociodemographic factors, healthrelated variables and attitudes and beliefs towards noise. Design: A self-administered questionnaire was used to evaluate the presence of noise-induced tinnitus, the amount of leisure noise and attitudes towards noise and hearing protection. Study sample: 517 subjects between 18 and 30 years were included. Results: Temporary and chronic tinnitus occurred in 68.5% and 6.4% of the sample, respectively. Chronic tinnitus was more prevalent in male subjects and associated with more hearing-related symptoms. Furthermore, subjects with chronic tinnitus were more aware of the risks of noise and the importance of hearing protection. Finally, higher levels of leisure noise were independently associated with chronic tinnitus. Conclusions: Tinnitus is observed frequently in young adults. Results also indicate that persons with chronic tinnitus were exposed to a higher noise dose during their lives. Longitudinal studies may be useful to evaluate whether the experience of chronic tinnitus has led to behavioural changes. These findings further underpin the importance of educating youth about the risks of leisure noise exposure. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections are major causes of morbidity in hospitalized patients. Methods: Retrospective laboratory-based surveillance during 1999-2001 and 2005-2010 identified 2175 cases of nosocomial bloodstream infections (BSIs) in Tampere University Hospital (TAUH), Finland. Results: Analysis revealed that 57% of BSIs were caused by a gram-positive organism, 27% by a gram-negative organism, 5% by a fungal organism, and 11% were polymicrobial. The most common cause of nosocomial BSI was coagulase-negative staphylococci (23%). Candida species caused 5% of the infections. The 7-day and 30-day case fatalities were 8% (161/2158) and 15% (313/2175), respectively, and were highest in BSIs caused by Candida albicans (22% and 44%) and Pseudomonas aeruginosa (17% and 25%). The median age of patients was 54 years in 1999-2001, 57 years in 2005-2007, and 60 years in 2008-2010 (p < 0.001). The median time from hospital admission to the onset of BSI was 11 days (quartiles 5-18 days). This period was shortest for Streptococcus agalactiae BSI and longest for Candida non-albicans fungemia (1 vs 19 days). The case fatality rate in nosocomial BSI decreased during the years studied: 7-day and 30-day case fatalities were 9% and 16% during 1999-2001, 8.5% and 16% during 2005-2007, and 5% and 12% during 2008-2010, respectively (p < 0.003 and p = 0.022, respectively). Conclusions: Gram-positive infections predominate in nosocomial BSIs. The median age of patients with nosocomial BSI has risen during the study years. The case fatality associated with nosocomial BSI has decreased. [ABSTRACT FROM AUTHOR]

Patients with neurological diseases often suffer from sleep disturbances. Insomnia among adult brain tumor patients has usually been studied as part of quality-of-life studies, or some case reports on insomnia in these patients have been described. The authors aimed to study insomnia in a prospective study setting among patients with primary brain tumors and evaluate whether insomnia is related to tumor laterality. Entire study population consisted of 70 patients with a solitary primary supratentorial brain tumor treated surgically at the Clinic for Neurosurgery, Oulu University Hospital. The overall functional state of the patients was assessed by the Karnofsky Performance Scale, depression was measured by Beck Depression Inventory, and insomnia by Nottingham Health Profile. Repeated measurements were assessed before tumor operation as well as 3 months and one year after surgery. Prevalence of insomnia among patients with a primary brain tumor waiting for surgery was higher compared to general population, but level of insomnia significantly decreased as soon as 3 months after tumor operation. Patients with a bilateral primary brain tumor had significantly more often insomnia without comorbid depression compared to patients with a left or right tumor for up to one year after operation. The authors suggest that insomnia among patients with a bilateral brain tumor may not be associated with depression but have other biological background. [ABSTRACT FROM PUBLISHER]

Objectives: First, to compare multilevel emotion processing (EP) of pregnancy between substance-abusing and non-using women, and, second, to analyse whether different types of interventions can increase positive and functional EP and decrease negative and dysfunctional EP among substance-abusing mothers. EP was conceptualised according to the multifocal theory of emotions proposed by Frijda in 1986, comprising feeling states, behavioural urges to act, cognitive appraisals, and meta-emotions. Method: Participants were 101 women, 51 with substance abuse disorder and 50 comparisons. The substance-abusing women were provided with either intensive psychodynamic mother–infant group therapy (PGT; n = 25) or individually tailored psychosocial support (PSS; n = 26). All women reported their EP once during pregnancy (T1; N = 94), and twice postpartum, when the child was four (T2; N = 84) and twelve (T3; N = 76) months. Results: As hypothesised, the results indicated that the pregnancy-related EP of substance-abusing women was characterised by more negative and fewer positive feeling states, by more intense behavioural urges to act and by lower levels of cognitive appraisals of agency and predictability than the EP of the comparison women. As far as the interventions' effects on EP, intense behavioural urges to act decreased only in the PGT group, while negative feeling states decreased and agency and predictability appraisals increased from pregnancy to postpartum in the PSS group alone. Conclusions: The importance of helping substance-abusing mothers enhance optimal emotional quality as they prepare for and enter motherhood should be emphasised. [ABSTRACT FROM AUTHOR]

Background: Cofactors of high-risk (HR) human papillomavirus (HPV) in the progression of cervical intraepithelial neoplasia (CIN) are incompletely characterized. In this study these cofactors were investigated in a longitudinal setting. Methods: A cohort of 329 women (mean age 25.5 y) were enrolled in the Finnish Family HPV Study, and followed-up for 6 y with serial cervical samples for HPV genotyping, virus integration status, and HPV serology. Hospital records were reviewed until March 2010 and linked with HPV detection data. All incident CIN lesions were subjected to HPV genotyping. HPV covariates were studied in an age- and HPV-matched nested case-control (1:4) setting. Results: Twelve of the 329 women developed an incident CIN: 2 CIN1, 3 CIN2, and 7 CIN3. HPV16 was detected most frequently (7/12), followed by HPV58 (2/12), HPV18, HPV31, and HPV42. HPV integration was present in 4/12 cases. Long-lasting persistence of HPV31 and HPV16 preceded incident CIN2 and CIN3. In multivariate conditional logistic regression, the risk for incident CIN increased up to 4-fold with increasing number of deliveries ( p == 0.024) and decreased with history of genital warts ( p == 0.036). Conclusion: Baseline HR-HPV infections and their persistence precede incident CIN by several years. The 2 independent covariates of HR-HPV were (1) number of deliveries (increasing the risk), and (2) history of genital warts (protective effect). [ABSTRACT FROM AUTHOR]

Objective: To evaluate the occurrence of axis I and II psychiatric disorders among patients with traumatic brain injury (TBI). Design: Prospective observational study. Forty-five adult patients, who had attended an emergency unit because of TBI, were recruited. At 12 months, 38 patients were interviewed. Measures: Psychiatric disorders were evaluated using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). Results: Before TBI, the 12-month rate of axis I psychiatric disorders was relatively high (39.5%%) and the rate of alcohol dependence was especially elevated (18.4%%). During the 12 months after TBI, axis I disorders were found in 47.4%% of subjects. Six patients (15.8%%) were found to have a disorder with an onset after TBI. Of these, five patients had depressive disorders (13.2%%). Almost one third of the subjects (29.0%%) had personality disorders. Antisocial and obsessive-compulsive personality disorders were the most frequent (10.5%%). Conclusions: Both axis I and II psychiatric disorders are common among patients with TBI. Alcohol dependence and personality disorders are prevalent in individuals prone to TBI, whereas depressive disorders typically develop after injury. Psychiatric disorders should be addressed in rehabilitation, as otherwise they will hinder the recovery after TBI. [ABSTRACT FROM AUTHOR]

Objective: This study explored 12-month outcome and its associations to social adjustment-related variables in patients with first-episode non-affective psychosis in Finland and Spain. Methods: Forty-nine Finnish and 37 Spanish patients were evaluated at admission on various characteristics of social adjustment. Outcome was measured for 68 (79%) patients by the Brief Psychiatric Rating Scale, Global Assessment Scale, and Grip on Life. Results: One-fourth of the patients experienced psychotic symptoms at follow-up. Sixty per cent of the patients showed good global functioning and Grip on Life. In both patient groups, poor earlier global functioning, weak social network, poor Grip on Life, and psychological dependence on family of origin were associated with poor outcome. In the Finnish group, few social contacts, lack of social recreational activities, and lack of stability in couple relations were related to poor outcome. In the Spanish group, low parental criticism was associated with poor outcome. Conclusion: Our findings support the notion that the level of earlier social adjustment is important in recovery from first-episode psychosis. However, different aspects of social adjustment, i.e., peer relations in the Finnish group and family relations in the Spanish group, appear to have prognostic importance in these two social environments. [ABSTRACT FROM AUTHOR]