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• All studied rheumatic diseases impose an elevated risk for cardiovascular (CV) comorbidities with highest risks observed in patients with SLE and gout. • Risk of CV diseases is highest within one year before and/or after the diagnosis of a rheumatic disease. • Among CV comorbidities, the risk for venous thromboembolism was most evident in several rheumatic diseases. To elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases. Patients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases. The RR for 'any CVD' varied from 1.14 (95 % confidence interval [CI] 1.02–1.26) in PsA to 2.05 (95 % CI 1.67–2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis. The risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim was to study the association between snoring and development of occlusion, maxillary dental arch, and soft tissue profile in children with newly completed deciduous dentition. Thirty-two (18 female, 14 male) parent-reported snorers (snoring ≥3 nights/week) and 19 (14 female, 6 male) nonsnorers were recruited. Breathing preference (nose or mouth) was assessed at the mean age of 27 months by otorhinolaryngologist. At the mean age of 33 months, an orthodontic examination was performed, including sagittal relationship of second deciduous molars, overjet, overbite, and occurrence of crowding and lateral crossbite. Bite index was obtained to measure maxillary dental arch dimensions (intercanine and intermolar width, arch length). A profile photograph was obtained to measure facial convexity. No significant differences were found between nonsnorers and snorers in any of the studied occlusal characteristics or in measurements of maxillary dental arch dimensions. Snorers were found to have a more convex profile than nonsnorers. Occurrence of mouth breathing was more common among snorers. Parent-reported snoring (≥3 nights/week) does not seem to be associated with an adverse effect on the early development of deciduous dentition, but snoring children seem to have more convex profile than nonsnorers. Snoring is a mild sign of sleep-disordered breathing, and in the present study its short time lapse may not have had adequate functional impact on occlusion. • Association between snoring and occlusion was studied in 33-month-old children. • Studied children formed a homogenous group in terms of occlusal development. • Parent-reported snoring (≥3 nights/week) does not seem to be associated with an adverse effect on the early development of primary dentition. • Snoring children seem to have more convex profile than nonsnorers. [ABSTRACT FROM AUTHOR]

Purpose: To study volumetric changes in the upper airway in patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) and compare those findings with polysomnographic (PSG) data of the same patients.Materials and Methods: The study included 20 patients with OSA (1 woman and 19 men; mean age, 48 yr; range, 31 to 59 yr). Mean values of angles formed by the sella, nasion, and B point and the sella, nasion, and A point before surgery indicated mandibular and maxillary retrognathia, respectively. All patients were treated with MMA and pre- and postoperative orthodontics. Pre- and post-treatment cone-beam computed tomograms were used to measure upper airway volume and PSG data were used to examine the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI-3 or ODI-4). In addition, Epworth Sleepiness Scale (ESS) score, General Health Questionnaire (GHQ-12) score, and amount of MMA were collected from patients' files.Results: Mean maxillary and mandibular advancement was 4.6 ± 1.9 and 9.3 ± 1.7 mm, respectively. A statistically relevant increase (mean, 64.1%) in airway volume was found, with large individual variation. ODI-3 or ODI-4 and AHI values showed statistically relevant improvements from before to after surgery. ODI-3 or ODI-4 score decreased from 12.3 ± 9.8 to 4.0 ± 4.2 and AHI score decreased from 21.4 ± 13.8 to 5.8 ± 7.2. ESS scores showed improvement (lower scores) after surgery for most patients (n = 15), whereas GHQ-12 scores showed improvement (lower scores) for only 6 patients.Conclusion: MMA increases upper airway volume and lessens OSA symptoms according to PSG data. MMA can be considered curative treatment for OSA; however, residual apnea as measured by the AHI can be found in many patients. [ABSTRACT FROM AUTHOR]

Abstract Purpose The purpose of this study was to explore changes in HRQoL (health-related quality of life) and identify the associated factors in patients with prostate cancer and their spouses during the year following their diagnosis of prostate cancer. Methods The longitudinal study design consisted of 179 patients and 166 spouses, using discretionary sampling, at five Finnish central hospitals. Participants completed a self-reported RAND-36-Item Health Survey at three time-points: time of diagnosis and 6 and 12 months later. Changes in HRQoL were analysed using descriptive statistics and non-parametric tests. Linear mixed-effects models were used to identify the factors associated with the changes in HRQoL in the patients and their spouses. Results On average, the HRQoL of patients with prostate cancer changed in physical functioning (p = 0.015), emotional well-being (p = 0.029) and general health (p = 0.038) were statistically significant over the 12-month study period. In spouses, statistically significant changes in HRQoL were not observed. Interaction between the age of participants and changes in HRQoL were statistically significant. Conclusions Findings in this study suggest that interventions aimed at improving the HRQoL of patients should support a few different dimensions of HRQoL for the patients themselves than for their spouses. Nurses should pay more attention to elderly couples. Highlights • A simultaneous follow-up of the HRQoL of these patients and their spouses is worth investigating. • Intervention aimed at improving the HRQoL of patients should support for the patients themselves than for their spouses. • Additional, nurses should pay more attention to elderly prostate cancer patients and their spouses. [ABSTRACT FROM AUTHOR]

Abstract Introduction Aim of this study was 1) to evaluate long-term dental/skeletal stability in patients with mandibular retrognathia corrected by BSSO, and 2) to examine factors associated with relapse. Materials and methods Seventy-seven of initial 151 study cohort subjects who had undergone orthognathic surgery in 2007–2011 agreed to participate. Present paper presents data on dental/skeletal stability in 46 patients; 31 patients were excluded because of missing calibration indicator in one of the patients' pre-operative cephalometric radiographs, or because of pregnancy. Pre-operative (T1), post-operative (T2) and long-term follow-up (T3) radiographs and patient's files were used in the study. Results Based on overjet measurements, mean mandibular advancement was 5.7 mm and mean relapse 0.1 mm. Mean pre-operative overbite was 5.4 mm, reduction at surgery 3.4 mm and mean relapse 1.1 mm, a statistically significant change. Mean mandibular advancement measured from condyle tognathion (Co-Gn) was 6.5 mm. Relapse in Co-Gn was 1.6 mm on average, i.e., about 25% of the advancement. Amount of advancement, fixation method, patient's age or gender or orthodontist/surgeon experience did not have influence on relapse. Conclusions Mandibular advancement with BSSO in healthy Class II patients is considered a stable procedure. 25% skeletal relapse was found with clinically non-significant dental changes. [ABSTRACT FROM AUTHOR]

Student healthcare providers are the type of primary healthcare professionals who usually have first contact with young women who have problems with intimacy, such as vulvar pain – known as vulvodynia. However, a need to increase healthcare professionals' level of knowledge of vulvodynia and its care has been identified. This study aimed to assess the awareness and knowledge of vulvodynia and its care among student healthcare providers, before and after Web-based education. The study design was national, descriptive and quasi-experimental, and was conducted across Finland. A total of 79 participants completed baseline measurements, 58 completed web-based education and 30 took part in a follow-up survey. A survey instrument called ‘Awareness and knowledge of vulvodynia and its care’ was developed for this study, and the data were collected using a web-based questionnaire. Descriptive statistical methods were used to evaluate the participants' awareness and knowledge of vulvodynia and its care before and after web-based education. The primary results indicated that the participants' awareness and knowledge of vulvodynia and its care was statistically significantly improved following web-based education. [ABSTRACT FROM AUTHOR]

In this study, the objective was to describe and analyse reasons for obstetric admissions to the ICU, severity of illness, level and types of interventions, adverse events and patient outcomes. In a retrospective database study, we identified 291 obstetric patients during pregnancy and puerperium from four Finnish university hospitals. Most were admitted in the post-partum period and hypertensive disorders were the main indications for admissions, followed by obstetric haemorrhage. The median length of stay was 21 hours. The most common intervention was blood transfusion and mechanical ventilation was required in nearly one fifth of the patients. Three patients had a prolonged stay and nine had re-admissions. One maternal death was recorded. This study found that severity of illness and organ failure scores describe the obstetric patient as having a good probability of recovery and a short length of stay. However, the obstetric patients reason for admission and their type of delivery were associated with both the severity of illness scores and level of intervention required. Those admitted for non-obstetric reasons and having had a vaginal delivery demonstrated higher severity of illness scores, organ failure scores, and levels of intervention when compared to those admitted for obstetric reasons or those who had delivered by caesarean section. In conclusion, care of these patients can be improved by understanding the severity of illness scores, common ICU interventions and patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction Older patients are a major patient group in emergency settings in Finland. Family members have a crucial part to play when older people are discharged home. Discharge education is common practice within discharge planning in emergency department (ED). Discharge planning is associated with patient outcomes, but little is known about discharge education as such. The purpose of this study was to examine the association of discharge education with discharge readiness among older patients and their family members in an emergency setting in Finland. Methods This cross-sectional study was performed in two EDs. Questionnaire data were collected from patients over 75 (N = 135) and their family members (N = 128) to examine the level of discharge education, and to see how discharge education was associated with discharge readiness. Descriptive and non-parametric methods were used. Results One in four older patients and 40 per cent of family members received no discharge education. Nevertheless, discharge education was associated with a higher level of discharge readiness, both among patients and family members. Discussion ED personnel should give more focus to discharge education when planning the discharge of older patients in order to facilitate better discharge readiness. [ABSTRACT FROM AUTHOR]

Summary Background and aim It has been shown that the myocutaneous latissimus dorsi flap volume and consistency remain mainly the same regardless the nerve is cut or not in breast reconstruction. It is controversial how big an impact the flap innervation has on the muscle activity of the flap. The aim of the study was to prospectively evaluate the influence of latissimus dorsi flap innervation on the functional and aesthetic outcome of delayed breast reconstruction. Methods Between 2007 and 2008, 28 breast reconstructions were performed and randomly divided into denervation group (surgical denervation by excision of 1 cm of proximal thoracodorsal nerve, n = 14) and innervation group (thoracodorsal nerve saved intact, n = 14). Patients were clinically evaluated and a questionnaire considering functional and aesthetic outcome was filled 1-year after operation. Muscular twitching, pain, tightness, shape and symmetry of the breasts were evaluated. In addition, the mobility of the shoulder joint on the operated side was evaluated and the patients self-estimated the activities of daily living. Results There was no significant difference in latissimus dorsi flap twitching, pain and tightness of the breast and symmetry and shape of the breasts between denervated and innervated groups. The shoulder joint mobility was not found to be changed significantly in either of the groups and there were no limitations in activities of daily living. Conclusions Thoracodorsal nerve division or preservation does not significantly affect muscle contraction activity of the latissimus dorsi flap and distortion of the breast when latissimus dorsi muscle humeral insertion is also detached. Therefore, both cutting and saving the nerve are justified in latissimus dorsi flap breast reconstruction depending on whether the humeral insertion of the muscle is preserved intact or divided and the flap islanded. The study shows that there is no tangible benefit in dividing the nerve when the flap is islanded. Clinical trial has been registered in public trials registry. Trial registry name is ‘The significance of latissimus dorsi flap innervation in delayed breast reconstruction’. Registration number is NCT01239524 and URL is https://register.clinicaltrials.gov . [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Early-stage diagnosis of Parkinson’s disease (PD) is essential in making decisions related to treatment and prognosis. However, there is no specific diagnostic test for the diagnosis of PD. The aim of this study was to evaluate the role of texture analysis (TA) of magnetic resonance images in detecting subtle changes between the hemispheres in various brain structures in patients with early symptoms of parkinsonism. In addition, functional TA parameters for detecting textural changes are presented. Materials and Methods: Fifty-one patients with symptoms of PD and 20 healthy controls were imaged using a 3-T magnetic resonance device. Co-occurrence matrix–based TA was applied to detect changes in textures between the hemispheres in the following clinically interesting areas: dentate nucleus, basilar pons, substantia nigra, globus pallidus, thalamus, putamen, caudate nucleus, corona radiata, and centrum semiovale. The TA results were statistically evaluated using the Mann-Whitney U test. Results: The results showed interhemispheric textural differences among the patients, especially in the area of basilar pons and midbrain. Concentrating on this clinically interesting area, the four most discriminant parameters were defined: co-occurrence matrix correlation, contrast, difference variance, and sum variance. With these parameters, differences were also detected in the dentate nucleus, globus pallidus, and corona radiata. Conclusions: On the basis of this study, interhemispheric differences in the magnetic resonance images of patients with PD can be identified by the means of co-occurrence matrix–based TA. The detected areas correlate with the current pathophysiologic and neuroanatomic knowledge of PD. [Copyright &y& Elsevier]

The first aim of this study was to describe mothers' self-efficacy, satisfaction and perceptions when parenting their infants during the first days postpartum. Furthermore, the study aimed to explore the distinct sociodemographic as well as mother and infant related factors that are associated with the above parenting aspects. A descriptive and cross-sectional study design was used. Three separate postpartum wards 1-7 days after childbirth in one university level hospital in Finland. All mothers who gave birth during March 1st to May 20th, 2019 and filled the inclusion criteria, were invited to participate in this study. A convenience sample of 250 mothers with healthy singleton infants agreed to participate. The following instruments were used: The Parenting Self-Efficacy (PSE) scale, the Evaluation subscale of What Being the Parent of a New Baby is Like-revised (WBPL-R) and the Perception of Infant scale. Mothers' parenting self-efficacy and parenting satisfaction were high during the first days postpartum. Age, marital status, education and type of birth were not associated with parenting self-efficacy nor satisfaction. Mothers who were unemployed or working only part-time reported higher scores across all categories of parenting self-efficacy, compared to full time employed mothers (p <.001). A higher number of children (≥ 3) were positively associated with both parenting self-efficacy and satisfaction. Mothers who reported poor breastfeeding initiation success also reported significantly lower scores in parenting self-efficacy and parenting satisfaction across all categories. Mothers' perceptions of their infants' fussiness were not associated with parenting self-efficacy (p =.113) nor parenting satisfaction (p =.091). The results of this study can benefit postpartum maternity health care professionals by suggesting factors that could be focused on during the very short period that mothers stay in hospital. Discussing prior mothering experiences, work life before maternity leave, breastfeeding initiation experiences and perception of infant with the mothers after childbirth, may lead to better PSE and PS during the postpartum period. [ABSTRACT FROM AUTHOR]

The potential of diffusion tensor imaging (DTI) indices and volumes of focal lesions on conventional magnetic resonance imaging to predict conversion to multiple sclerosis (MS) was analyzed in subjects with clinically isolated syndrome (CIS) over 4 years. Twenty patients with CIS and 10 healthy controls were included in the study. The data showed an association between the volumes of T1 and fluid-attenuated inversion recovery (FLAIR) lesions and conversion to MS (T1: P=.02; FLAIR: P=.02).The worsening of DTI indices (mean diffusivity andfractional anisotropy) was primarily seen in patients progressing to MS, but clear-cut association with conversion could not be detected. [ABSTRACT FROM AUTHOR]

Abstract We tested whether intervention with atorvastatin affects the prostate beneficially compared with placebo in men with prostate cancer in a randomized clinical trial. A total of 160 statin-naïve prostate cancer patients scheduled for radical prostatectomy were randomized to use 80 mg atorvastatin or placebo daily from recruitment to surgery for a median of 27 d. Blinding was maintained throughout the trial. In total, 158 men completed the follow-up, with 96% compliance. Overall, atorvastatin did not significantly lower tumor proliferation index Ki-67 or serum prostate-specific antigen (PSA) compared with placebo. In subgroup analyses, after a minimum of 28 d of atorvastatin use, Ki-67 was 14.1% lower compared with placebo (p = 0.056). Among high-grade cases (International Society of Urological Pathology Gleason grade 3 or higher), atorvastatin lowered PSA compared with placebo: median change –0.6 ng/ml; p = 0.024. Intraprostatic inflammation did not differ between the study arms (p = 0.8). Despite a negative overall result showing no effect of statins on Ki67 or PSA overall, in post hoc exploratory analyses, there appeared to be benefit after a minimum duration of 28 d. Further studies are needed to verify this. Patient summary Cholesterol-lowering atorvastatin does not lower prostate cancer proliferation rate compared with placebo overall, but exploratory analyses suggest a benefit in longer exposure. Take Home Message Atorvastatin at a dose of 80mg/d does not significantly change prostate cancer Ki-67 or prostate-specific antigen (PSA) overall compared with placebo in a randomized trial. However, a minimum intervention duration of 28 d lowers Ki-67 by 14%. Among high-grade cases, atorvastatin lowers PSA compared with placebo, [ABSTRACT FROM AUTHOR]

Background Context: Laryngeal penetration-aspiration, the entry of material into the airways, is considered the most severe subtype of dysphagia and is common among patients with acute cervical spinal cord injury (SCI).Purpose: The aim of this study was to investigate risk factors for penetration-aspiration in patients with acute traumatic cervical spinal cord injury (TCSCI).Study Design: This is a prospective cohort study.Patient Sample: Thirty-seven patients with TCSCI were included in the study.Outcome Measures: The highest Rosenbek penetration-aspiration scale (PAS; range 1-8) score of each patient was the primary outcome measure. The risk factors consisted of patient characteristics, demographics, and clinical signs observed during a clinical swallowing trial.Materials and Methods: A clinical swallowing trial and videofluoroscopic swallowing study (VFSS) was performed on all patients within 28 days post injury. For group comparisons, the patients were divided into two groups: (1) penetrator-aspirators (PAS score ≥3) and (2) non-penetrator-aspirators (PAS score ≤2).Results: Of the 37 patients, 83.8% were male. The mean age at the time of the injury was 61.2 years. Most patients had an incomplete TCSCI (78.4%) caused by a fall (75.7%). In the VFSS, 51.4% of the patients were penetrator-aspirators, and 71.4% had silent aspiration. The risk factors for predicting penetration-aspiration were (1) necessity of bronchoscopies, (2) lower level of anterior cervical operation, (3) coughing, throat clearing, choking related to swallowing, and (4) changes in voice quality related to swallowing. Binary logistic regression identified coughing, throat clearing, choking, and changes in voice quality related to swallowing as independent risk factors for penetration-aspiration.Conclusions: The necessity of bronchoscopies, postinjury lower cervical spine anterior surgery, coughing, throat clearing, choking, and changes in voice quality related to swallowing was a markedrisk factor for aspiration and penetration following a cervical SCI. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and to initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration. [ABSTRACT FROM AUTHOR]