| 1. |
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
|
|
| 5. |
- Saavalainen, L, et al.
(författare)
-
Mortality of midlife women with surgically verified endometriosis-a cohort study including 2.5 million person-years of observation
- 2019
-
Ingår i: Human reproduction (Oxford, England). - : Oxford University Press (OUP). - 1460-2350 .- 0268-1161. ; 34:8, s. 1576-1586
-
Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTIONIs all-cause and cause-specific mortality increased among women with surgically verified endometriosis?SUMMARY ANSWERThe all-cause and cause-specific mortality in midlife was lower throughout the follow-up among women with surgically verified endometriosis compared to the reference cohort.WHAT IS KNOWN ALREADYEndometriosis has been associated with an increased risk of comorbidities such as certain cancers and cardiovascular diseases. These diseases are also common causes of death; however, little is known about the mortality of women with endometriosis.STUDY DESIGN, SIZE, DURATIONA nationwide retrospective cohort study of women with surgically verified diagnosis of endometriosis was compared to the reference cohort in Finland (1987–2012). Follow-up ended at death or 31 December 2014. During the median follow-up of 17 years, 2.5 million person-years accumulated.PARTICIPANTS/MATERIALS, SETTING, METHODSForty-nine thousand nine hundred and fifty-six women with at least one record of surgically verified diagnosis of endometriosis in the Finnish Hospital Discharge Register between 1987 and 2012 were compared to a reference cohort of 98 824 age- and municipality-matched women. The age (mean ± standard deviation) of the endometriosis cohort was 36.4 ± 9.0 and 53.6 ± 12.1 years at the beginning and at the end of the follow-up, respectively. By using the Poisson regression models the crude and adjusted all-cause and cause-specific mortality rate ratios (MRR) and 95% confidence intervals (CI) were assessed. Calendar time, age, time since the start of follow-up, educational level, and parity adjusted were considered in the multivariate analyses.MAIN RESULTS AND THE ROLE OF CHANCEA total of 1656 and 4291 deaths occurred in the endometriosis and reference cohorts, respectively. A lower all-cause mortality was observed for the endometriosis cohort (adjusted MRR, 0.73 [95% CI 0.69 to 0.77])—there were four deaths less per 1000 women over 10 years. A lower cause-specific mortality contributed to this: the adjusted MRR was 0.88 (95% CI 0.81 to 0.96) for any cancer and 0.55 (95% CI 0.47 to 0.65) for cardiovascular diseases, including 0.52 (95% CI 0.42 to 0.64) for ischemic heart disease and 0.60 (95% CI 0.47 to 0.76) for cerebrovascular disease. Mortality due to alcohol, accidents and violence, respiratory, and digestive disease-related causes was also decreased.LIMITATIONS, REASONS FOR CAUSATIONThese results are limited to women with endometriosis diagnosed by surgery. In addition, the study does not extend into the oldest age groups. The results might be explained by the characteristics and factors related to women’s lifestyle, and/or increased medical attention and care received, rather than the disease itself.WIDER IMPLICATIONS OF THE FINDINGSThese reassuring data are valuable to women with endometriosis and to their health care providers. Nonetheless, more studies are needed to address the causality.STUDY FUNDING/COMPETING INTERESTThis research was funded by the Hospital District of Helsinki and Uusimaa and The Finnish Medical Foundation. None of the authors report any competing interest in relation to the present work; all the authors have completed the disclosure form.
|
|
| 6. |
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Broman, J., et al.
(författare)
-
Association of post-stroke-initiated antidepressants with long-term outcomes in young adults with ischaemic stroke
- 2022
-
Ingår i: Annals of Medicine. - : Informa UK Limited. - 0785-3890 .- 1365-2060. ; 54:1, s. 1757-1766
-
Tidskriftsartikel (refereegranskat)abstract
- Objective We examined the association between initiation of antidepressants within the first year after ischaemic stroke (IS) in young adults and long-term fatal and non-fatal cardiovascular events, as well as all-cause mortality. Patients and methods The Helsinki Young Stroke Registry (HYSR) includes patients aged 15-49 years with their first-ever IS occurring 1994-2007. From nationwide registers, we obtained data on prescriptions (1993-2011) and outcomes of interest (1994-2011). Time of initiating post-stroke antidepressants (PSADs) was defined as time of the first filled prescription for antidepressants within the first year from IS. To account for non-random assignment of PSADs, we performed propensity score matching and studied the relationship between PSAD initiation and outcomes using Cox regression models with time-varying coefficients. Results Of all patients (n = 888), 206 (23.2%) initiated PSADs within the first year, of which 203 (98.5%) could be matched to 406 non-initiators. In this matched sample of 609 patients, the median follow-up time was 8.1 (interquartile range [IQR] 5.0-12.6) years and 169 (28.9%) patients had any cardiovascular events, 95 (15.8%) had recurrent ischaemic or haemorrhagic strokes and 106 (17.4%) died. Adjusted for sociodemographics and cardiovascular comorbidities, PSAD initiation was associated with recurrent ischaemic or haemorrhagic stroke 5-10 years after IS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 1.32-7.12). No association emerged between PSAD initiation and other outcomes. Conclusions In young adults, PSAD initiation within the first year after IS was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term. Future studies are needed to verify the results and to further study the nature of this finding. KEY MESSAGES Initiation of post-stroke antidepressants (PSADs) within the first year after ischaemic stroke (IS) was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term. Patients starting antidepressants after IS should be followed up more closely in case of recurrent events. Future studies are needed to verify the results and to further study the nature of this finding.
|
|
| 10. |
- Broman, J., et al.
(författare)
-
Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study
- 2022
-
Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 269, s. 956-965
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Data on post-stroke use of antidepressants in young individuals are scarce. We examined pattern and factors associated with initiating post-stroke antidepressants (PSAD) after ischemic stroke (IS) in young adults. Methods: Helsinki Young Stroke Registry includes patients aged 15–49years with first-ever IS, 1994–2007. Data on prescriptions, hospitalizations and death came from nationwide registers. We defined time of initiating PSAD as time of the first filled prescription for antidepressants within 1year from IS. We assessed factors associated with initiating PSAD with multivariable Cox regression models, allowing for time-varying effects when appropriate. Results: We followed 888 patients, of which 206 (23.2%) initiated PSAD. Higher hazard of starting PSAD within the first 100days appeared among patients with mild versus no limb paresis 2.53 (95% confidence interval 1.48–4.31) and during later follow-up among those with silent infarcts (2.04; 1.27–3.28), prior use of antidepressants (2.09; 1.26–3.46) and moderate versus mild stroke (2.06; 1.18–3.58). The relative difference in the hazard rate for moderate–severe limb paresis persisted both within the first 100days (3.84, 2.12–6.97) and during later follow-up (4.54; 2.51–8.23). The hazard rate was higher throughout the follow-up among smokers (1.48; 1.11–1.97) as well as lower (1.78; 1.25–2.54) and upper white-collar workers (2.00; 1.24–3.23) compared to blue-collar workers. Conclusion: One-fourth of young adults started PSADs within 1year from IS. We identified several specific clinical characteristics associated with PSAD initiation, highlighting their utility in assessing the risk of post-stroke depression during follow-up. © 2021, The Author(s).
|
|
| 11. |
|
|
| 12. |
|
|
| 13. |
|
|
| 14. |
- Heikkilä, P, et al.
(författare)
-
Oral health associated with incident diabetes but not other chronic diseases: A register-based cohort study
- 2022
-
Ingår i: Frontiers in oral health. - : Frontiers Media SA. - 2673-4842. ; 3, s. 956072-
-
Tidskriftsartikel (refereegranskat)abstract
- Oral infectious diseases are common chronic oral diseases characterized by a chronic inflammatory condition. We investigated chronic oral diseases as potential risk factors for systemic chronic diseases, diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis, and Crohn's disease, as well as severe psychotic and other severe mental disorders.MethodsThe cohort comprised 68,273 patients aged ≥ 29 years with at least one dental visit to the Helsinki City Health Services between 2001 and 2002. The cohort was linked to the data on death (Statistics Finland), cancer (Finnish Cancer Registry), and drug reimbursement (Finnish Social Insurance Institution) and followed until death or the end of 2013. The outcomes of interest were the incidences of chronic diseases measured starting with special refund medication, which means Social Insurance Institution partly or fully reimburses medication costs. Outcomes of interest were diabetes mellitus, connective tissue diseases, seropositive rheumatoid arthritis, ulcerative colitis and Crohn's disease, and severe mental disorders.ResultsThe mean follow-up time was 9.8 years. About 25% of the study population had periodontitis, 17% caries, over 70% apical periodontitis, and 9% <24 teeth at the start of follow-up. Diabetes was the only chronic systemic condition associated with oral health variables. Having 24 to 27 teeth was associated with a higher incidence rate ratio (IRR) (1.21, 95% confidence interval 1.09–1.33) compared to having 28 or more teeth; the IRR for having 23 or less was 1.40 (1.22–1.60). Having periodontitis (1.10, 1.01–1.20), caries (1.12, 1.01–1.23), or apical periodontitis (1.16, 1.04–1.30) is also associated with a higher risk of diabetes.ConclusionOur epidemiological 10 years follow-up study suggests that the association exists between chronic oral diseases and diabetes, warranting close collaboration among patient's healthcare professionals.
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
|
|
| 18. |
|
|
| 19. |
|
|
| 20. |
|
|
| 21. |
|
|
| 22. |
- Saloranta, T, et al.
(författare)
-
Use of universally offered family planning services - a cohort study in the city of Vantaa, Helsinki metropolitan area, Finland
- 2022
-
Ingår i: Scandinavian journal of public health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 50:4, s. 454-462
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: Knowledge about the women reached by public family planning services is scarce. The means for provision of these services that are pivotal for women’s health and empowerment varies globally. In Finland, family planning services are offered free of charge, but often separately for different age groups. City of Vantaa offers these services for all female residents without age limit. The aim of this study was to describe the characteristics of the women using public family planning services. Methods: We assessed the sociodemographic and reproductive characteristics of women aged 15–44 using ( n = 11,790) and not using ( n = 42,931) these services in 2013–2014. We obtained adjusted odds ratios (AORs) and 95% confidence intervals (95%CIs) for service use by multivariate logistic regression. Results: Women under 35 years of age had higher odds of service use compared with those over 35 (AORs ranging from 2.79 [95%CI 2.54–3.07] for 15–19 year-olds to 1.81 [95%CI 1.69–1.95] for 30–34 year-olds). Women speaking a foreign native language used services less when aged under 30 and more when aged 35–44 compared with women speaking the national languages. Women with a history of delivery, induced abortion or sexually transmitted infections, or with a lower socioeconomic or educational status were more likely to use the services. Conclusions: Young women in general were more likely to use free-of-charge family planning services. In contrast, young women speaking a foreign native language were underrepresented among service users. It is important to recognise and actively reach underrepresented groups, such as young women with a foreign background, to optimise equal access to family planning services.
|
|
