Impact of a digital web-based asthma platform, a real-life study.

BACKGROUND: Digital health technology (DHT) is a growing area in the treatment of chronic diseases. Study results on DHT's effect on asthma control have been mixed, but benefits have been seen for adherence, self-management, symptoms, and quality of life. The aim was to evaluate the impact of an interactive web-based asthma treatment platform on asthma exacerbations and health care visits. METHODS: In this real-life study, we retrospectively collected data on adult patients registered on a web-based interactive asthma treatment platform between December 2018 and May 2021. Patients who activated their accounts were active users, and patients who did not were inactive users and considered as controls. We compared the number of exacerbations, total number of exacerbation events defined as the sum of oral corticosteroid (OCS) and antimicrobial courses, emergency room visits, hospitalizations, and asthma-related health care visits before and one year after the registration on the platform. Statistical tests used included the t-test, Pearson's chi-square test and Poisson regression models. RESULTS: Of 147 patients registered on the platform, 106 activated their accounts and 41 did not. The active users had significantly fewer total number of exacerbation events (2.56 per person years, relative decline 0.78, 95% CI 0.6 to 1.0) and asthma-related health care visits (2.38 per person years, relative decline 0.84, 95% CI 0.74 to 0.96) than before registration to the platform, whereas the reductions in health care visits and the total number of exacerbation events were not significant in the inactive users. CONCLUSIONS: An interactive web-based asthma platform can reduce asthma-related health care visits and exacerbations when used actively.

Temporal Trends Over Two Decades in the Use of Anticholinergic Drugs Among Older Community-Dwelling People in Helsinki, Finland.

BACKGROUND: Knowledge of the adverse effects of drugs with anticholinergic properties (DAPs) has increased in recent decades. However, research on the temporal trends of the clinical use of DAPs is still sparse. OBJECTIVES: The aim of this study was to investigate the temporal trends of DAP use over two decades in the older community-dwelling population and to explore the medication classes contributing to the use of DAPs. METHODS: The study involved random samples of ≥ 75-year-old community-dwelling Helsinki citizens in 1999, 2009, and 2019 from the Helsinki Ageing Study. A postal questionnaire inquired about their health, functioning, and medications. The medications were categorized as DAPs according to Duran's list. In addition, we grouped DAPs into various medication groups. RESULTS: The prevalence and burden of DAPs on Duran's list showed a decreasing trend over the years. In 1999 the prevalence was 20% and the burden 0.35, in 2009 they were 22% and 0.35, respectively, and in 2019 they were 16% and 0.23, respectively. There were no differences in how the 75- and 80-year-olds used DAPs compared with those aged 85 years and older. The proportion of typical antipsychotics, benzodiazepines, hypnotics, urinary antispasmodics, and asthma/chronic obstructive pulmonary disease medications decreased, whereas the proportion of atypical antipsychotics, antidepressants, strong opioids, and antihistamines increased. In particular the use of mirtazapine increased-to 3.9% in 2019. In 2019 the three most prevalent groups of DAPs were antidepressants (7.4%), opioids (2.7%), and antihistamines (2.4%). CONCLUSIONS: The decrease in the use of DAPs on Duran's list is a welcome change. Although the use of old, strong DAPs has decreased, new DAPs have simultaneously emerged. Physicians need continuous education in prescribing DAPs and more recent information on the use and effects of DAPs is needed in order to decrease their exposure among the rapidly growing older population.

Decreasing muscle performance associated with increasing disease activity in patients with rheumatoid arthritis.

OBJECTIVES: Increasing evidence suggests that inflammation has a detrimental effect on muscle strength. Our objective was to analyse the association between muscle performance and different disease activity levels in patients with rheumatoid arthritis (RA). METHOD: A total of 199 consecutive outpatients were subject to cross-sectional assessment. Measurements of grip strength, endurance of the upper and lower limbs and trunk strength were combined as a muscle performance composite score (MPCS), using a standardised method. The disease activity for 28 joints (DAS28), radiographs of small joints (Larsen score), rheumatoid factor, body mass index (BMI), comorbidities and anti-rheumatic drugs were verified. Patients' questionnaires included sociodemographic information, pain level, global disease activity, the Beck Depression Inventory, the mental and physical component scores of Short Form-36 and physical activity level. RESULTS: Of the 199 patients, 36%, 17% and 47% patients had remission, low/moderate and high DAS28, respectively. The patients in remission had significantly shorter disease duration, better parameters in terms of pain, physician's assessment, Larsen, Beck or physical component score of Short Form-36, and they were more physically active than other patients. After adjustments for age, sex, RA duration, radiographs and BMI, the decreasing MPCS associated linearly with the increasing DAS28 activity levels (linearity, P <0.001). CONCLUSION: Poorer MPCS is clearly associated with higher disease activity in patients with RA. Muscle performance is a modifiable risk factor. The findings suggest evaluating muscle performance in clinical practice as a part of patient care.

Body size modifies the relationship between maternal serum 25-hydroxyvitamin D concentrations and gestational diabetes in high-risk women.

Obesity increases the risk of low 25-hydroxyvitamin D (25(OH)D) concentrations and gestational diabetes (GDM). We explored whether the association between GDM and change in 25(OH)D concentrations measured in the first (7-18 wk) and second (20-27 wk) trimesters of pregnancy is dependent on maternal BMI. The study was a prospective study of 219 women with BMI of ≥30 kg/m2, a history of GDM, or both. The participants were stratified by first-trimester BMI: BMI of <25.0, 25.0-29.9, 30.0-34.9, and ≥35 kg/m2. In the BMI group ≥35 kg/m2, those who did not develop GDM during the follow-up showed higher increase in serum 25(OH)D concentrations compared with women who developed GDM (43.2 vs. 11.5%; P < 0.001). No associations between 25(OH)D concentrations and GDM were observed in other BMI groups. These findings give an important aspect of the role of maternal body size in the association between vitamin D and GDM in high-risk women.

Short- and long-term outcome following laparoscopic versus open resection for carcinoma of the rectum in the multimodal setting.

BACKGROUND: Laparoscopic resection for rectal cancer has remained controversial because of the lack of level 1 evidence regarding oncologic safety and long-term survival. OBJECTIVES: The aim of this study was to assess the impact of laparoscopic versus open resection for rectal cancer on clinical and oncologic outcome in the multimodal setting. DESIGN: This is a review of prospectively gathered data from a single-institution rectal cancer database. SETTINGS: This study was conducted in the Central Hospital of Central Finland. PATIENTS: From January 1999 to December 2006, 191 selected patients were included. INTERVENTIONS: One hundred patients underwent laparoscopic resection, and 91 patients, also suitable for laparoscopic surgery, underwent open major rectal resection in the multimodal setting. MAIN OUTCOME MEASURES: The main measures of outcome were early recovery and short- and long-term morbidity; local recurrence and survival were secondary outcomes. LIMITATIONS: This is not a randomized study. RESULTS: The study groups were balanced for baseline characteristics. Conversion rate to open surgery was 22%. Laparoscopic surgery resulted in significantly less bleeding (175 mL vs 500 mL, p < 0.001), 1 day earlier recovery of normal diet (3 days vs 4 days, p = 0.001), and shorter postoperative hospital stay (7 days vs 9 days, p < 0.001). Postoperative 30-day mortality (1% vs 3%), morbidity (31% vs 43%), readmission (11% vs 15%), and reoperation (6% vs 9%) rates were similar in the 2 groups, but significantly fewer patients in the laparoscopic group had long-term complications (19% vs 36%, p = 0.033). The 5-year disease-free survival (78% vs 80%, p = 0.74) and local recurrence (5% vs 6%, p = 0.66) rates were similar in the laparoscopic and open group for those 175 patients treated for cure. CONCLUSION: Laparoscopic surgery resulted in faster postoperative recovery and fewer long-term complications than open surgery without apparently compromising the long-term oncologic outcome. Our results indicate that laparoscopic rectal resection is an acceptable alternative to open surgery in selected patients with rectal cancer.

Core muscle activation during dynamic upper limb exercises in women.

Although several everyday functions and sporting activities demand controlled use of the abdominal and back muscles while working with the upper limbs, the activity of core muscles during dynamic upper limb exercises in the standing position has not been studied extensively. The purpose of this cross-sectional study was to examine abdominal and back muscle activity during dynamic upper limb exercises while standing and to evaluate whether dynamic exercises are appropriate for strengthening muscles. The activation of the rectus abdominis, obliquus externus abdominis, longissimus, and multifidus muscles during dynamic bilateral or unilateral shoulder exercises with or without fixation of the pelvis was measured in 20 healthy women using surface electromyography. Trunk muscle activation during isometric maximum contraction was used as a comparative reference. With bilateral shoulder extension and unilateral shoulder horizontal adduction, abdominal muscle activity was >60% of activity during reference exercises. With unilateral shoulder horizontal abduction and shoulder extension exercises, back muscle activity was >60% of the activity level reference exercise. Muscle activation levels were 35-64% lower during shoulder horizontal adduction and abduction without fixation compared with exercises with fixation. The results indicate that upper limb exercises performed in the standing position are effective for activating core muscles. Bilateral and unilateral shoulder extension and unilateral shoulder horizontal abduction and adduction with the pelvis fixed elicited the greatest activity of the core muscles.

Comparison of active, manual, and instrumental straight leg raise in measuring hamstring extensibility.

The active manual straight leg raise (ASLR) and passive manual straight leg raise (MSLR) tests are commonly used in clinical settings to assess hamstring tightness. However, to our knowledge, the validity and sensitivity of these tests have not been compared with the instrumental straight leg raise (ISLR). The aim of the present study was to assess the intrarater reproducibility of the ISLR and compare the sensitivity of the ASLR, MSLR, and ISLR to change. Twelve men with hamstring tightness underwent the ASLR, MSLR, and ISLR tests at baseline and after a 4-week home-based right leg stretching program with the left leg serving as a control. The ISLR measurements were repeated consecutively at baseline to assess reproducibility. The intraclass correlation coefficient for the ISLR was 0.94, and the coefficient of reproducibility was 6. Significant differences in the range of motion emerged between all testing methods (p < 0.05). In the stretched legs, the mean +/- SD increases were 17 +/- 5 degrees for ISLR, 10 +/- 8 degrees for ASLR, and 6 +/- 5 degrees for MSLR, whereas the control legs showed a significant mean change only for ASLR (5 +/- 4 degrees ). The mean standard response with the ASLR and MSLR tests did not differentiate between the treated and control legs, but it was almost 10-fold higher in the treated leg than the control leg for the ISLR, clearly differentiating between them. The ISLR had good reproducibility and sensitivity to changes, whereas ASLR and MSLR showed a poor ability to detect changes. Thus, the ISLR test is recommended for use in research evaluating the effectiveness of stretching.

Gender difference among smoking, adiponectin, and high-sensitivity C-reactive protein.

BACKGROUND: Subclinical inflammation is a novel risk factor of cardiovascular diseases and type 2 diabetes. An inverse association between plasma adiponectin and insulin resistance has been previously shown. Elevated levels of high-sensitivity C-reactive protein (hs-CRP) predict future cardiovascular events. Smoking has been proven to connect with inflammatory markers. There is also evidence of a difference between genders in pro-inflammation. This study aimed to examine the connections among adiponectin, hs-CRP, and smoking and to determine possible gender differences in these associations. METHODS: Included were 365 men and 476 women; all were nondiabetic and middle-aged. Daily smoking subjects were considered to be smokers. Adiponectin and hs-CRP were analyzed. Data were collected in 1997-1998, and cytokines were analyzed in 2003. RESULTS: Thirty-five percent of the men and 22% of the women were smokers. In women, the adiponectin level was significantly lower in smokers (6.94+/-3.27 microg/ml) compared to nonsmokers (8.27+/-4.72 microg/ml, p=0.0017). This association remained significant after adjustment for age and BMI (p=0.0061). The hs-CRP level was significantly higher in smoking men (1.59+/-1.71 pg/ml) compared to nonsmoking men (1.17+/-1.41 pg/ml, p=0.018). This result remained after adjustment for age and BMI (p=0.0056). When smokers were compared to nonsmokers, there was no difference in adiponectin among men or in hs-CRP among women. CONCLUSIONS: In the nondiabetic population, smoking associates differently with subclinical inflammation between genders, with a decreased adiponectin level in women and with an increased hs-CRP level in men.

Changes in pain and physical function during waiting time and 3 months after knee joint arthroplasty.

OBJECTIVE: To determine changes in physical and social function during a prolonged preoperative waiting period and at 3 months after total knee arthroplasty. SUBJECTS: Forty-three patients were evaluated on the day that surgery was decided, the day before surgery, and 3 months afterwards. METHODS: Knee pain and function were assessed using a visual analogue scale and a functional assessment system. Isometric knee flexion extension strength and mobility were measured. RESULTS: Knee pain and muscle strength remained unchanged during the mean waiting time of 10 (standard deviation 8) months. On the affected side, knee extension strength was 19% weaker than on the contralateral side and did not change pre-operatively. Post-operatively, knee pain decreased by 50%. Knee extension strength decreased by 26% and flexion strength by 12% compared with the initial assessments. Knee extension strength of the operated side was 42% lower than on the non-operated side. Knee flexion mobility was decreased by 8%, while the initially detected knee extension deficit of 10 degrees (SD 7) remained unchanged. The functional assessment system did not detect any changes in function. CONCLUSION: Waiting time did not affect knee pain or isometric knee extension/flexion strength. Three months post-operatively, knee pain had decreased significantly, but the strength of the operated knee was significantly lower than the pre-operative level.

Outcome after temporary physeal stapling for knee valgus deformity in children with JIA.

INTRODUCTION: Majority of children with secondary knee valgus deformity due to juvenile idiopathic arthritis (JIA) are affected by the polyarthritic disease subtype. Progressive rheumatoid knee destruction in patients with JIA and valgus deformity may necessitate total knee replacement (TKR) at a young age. Temporary physeal arrest is a safe and effective method for correction of knee valgus malalignment prior to closure of the epiphyseal growth plates even during active arthritis. RESULTS: Most of the angular correction achieved in the stapled knees (n = 103) in the present cohort remained the same through the long-term follow-up though in some patients the deformity did recur. The advantages of angular correction prior to possible future TKR include easier soft tissue balancing, diminished bony deformity and less deranged collateral ligaments reducing the need for expensive custom and constrained implants. CONCLUSION: However, the effect of the correction on postponing the early need for TKR is limited.

Effect of isometric upper-extremity exercises on the activation of core stabilizing muscles.

OBJECTIVE: To evaluate whether isometric exercises for the upper extremities could sufficiently activate core stabilizing muscles to increase muscle strength. DESIGN: Cross-sectional study. SETTING: Department of physical medicine and rehabilitation at a Finnish hospital. PARTICIPANTS: Healthy adult women (N=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak isometric strength of the back and abdominal muscles was measured and relative loading in 5 test exercises was evaluated by surface electromyography. RESULTS: The rectus abdominis and obliquus externus abdominis were activated to the greatest degree in a bilateral shoulder extension exercise and the average surface electromyographic activity was 114% and 101% compared with the amplitude elicited during the maximal isometric trunk flexion exercise. Horizontal shoulder extension elicited the greatest activation of the longissimus and multifidus muscles. In this exercise, the activity levels of the left side multifidus and longissimus muscles were 84% and 69%, respectively, compared with the level of activity elicited during trunk extension. CONCLUSIONS: Of all the exercises studied, bilaterally performed isometric shoulder extension and unilaterally performed horizontal shoulder extension elicited the greatest levels of activation of the trunk musculature. Thus, it can be assumed that these exercises elicit sufficient levels of contraction of the trunk muscles for the development of their endurance and strength characteristics in rehabilitation.

Effects of twelve-month strength training subsequent to twelve-month stretching exercise in treatment of chronic neck pain.

Previously, in a randomized study, we showed that women with chronic neck pain were able to perform intensive training for neck and shoulder muscles and that the increase in strength was accompanied by a reduction in pain and disability. The changes were significantly greater in the training groups compared with controls. The aim of the present study was to evaluate whether the controls would achieve similar results. Thus, 59 women in the control group initiated high-intensity strength training. Maximal isometric neck strength increased by 44% in both flexion and rotation and 27% in extension at the 2-year follow-up. Statistically and also clinically significant decreases in neck pain and disability indices occurred. Stretching and aerobic exercising during the first follow-up year produced only minor changes in both subjective and functional measures. Adding progressive strength training for the second year led to a significant improvement in neck strength and also to a considerable decrease in the pain and disability scores. Thus, to achieve effective rehabilitation in cases of chronic neck pain, a combination of strength training and stretching exercises are recommended.

Effects of neck muscle training in women with chronic neck pain: one-year follow-up study.

Exercises are commonly recommended for chronic neck pain, but evidence-based guidelines do not explain what types of exercise. The aim of this randomized study was to evaluate the rate of change in neck strength following high- and low-intensity neck muscle training and their effects on pain and disability. One hundred eighty women with chronic neck pain were randomized into a high-intensity strength training group (STG), local muscle endurance training group (ETG), or control group (CG). The neck training consisted of isometric exercises in the STG and dynamic exercises in the ETG. Both groups performed dynamic exercises for the upper extremities. Strength tests, neck pain, and disability indices were evaluated at the baseline, at the follow-ups after 2 and 6 months in the training groups, and after 12 months in all groups. In both groups the greatest gains in neck strength, as well as decrease in neck pain and disability, were achieved during the first 2 months. However, the improvements continued up to 12 months. The STG achieved the greatest strength gains at all follow-ups. The CG showed only minor changes, and significant differences were found in favor of the training groups in all measures. The change in neck pain and disability indices correlated with the isometric neck strength (r = -0.22 [-0.36 to - 0.08] to -0.36 [-0.49 to -0.23]). Neck and shoulder muscle training was shown to be an effective therapy for chronic neck pain, resulting in early improvement in both the strength tests and subjective measures. The results can be maintained and even improved with long-term training.

Survival and complications are similar after Swanson and Sutter implant replacement of metacarpophalangeal joints in patients with rheumatoid arthritis.

We compared the survival, fracture, and deformation rates of Swanson and Sutter implants in a prospective series of 53 patients with rheumatoid arthritis (RA). Fifty-eight hands were operated on with 215 silastic implants. The Swanson group comprised 25 hands and 89 implants, and the Sutter group 33 and 126, respectively. Follow up was 58 (37-80) months. During a period of 48 months the survival of Swanson and Sutter prostheses did not differ significantly: 92% (95% CI 84% to 96%) and 97% (95% CI 92% to 99%), respectively. The fracture rate was high in both groups: 26 (34%) in the Swanson and 25 (26%) in the Sutter group. There was no significant difference between the groups in definite fracture rates of implants. The Sutter prosthesis appears to be at least as durable an implant in rheumatoid patients' metacarpophalangeal arthroplasty as the Swanson.

The non-use of hearing aids in people aged 75 years and over in the city of Kuopio in Finland.

Hearing loss is one of the most prevalent chronic conditions affecting the health of the aged. It is typically medically non-treatable, and hearing aid (HA) use remains the treatment of choice. However, only 15-30% of older adults with hearing impairment possess an HA. Many of them never use it. The purpose of our study was to investigate the use of provided HAs and reasons for the non-use of HAs. This population-based survey was set in the city of Kuopio in eastern Finland. A total of 601 people aged 75 years or older participated in this study. A geriatrician and a trained nurse examined the subjects. Their functional and cognitive capacity was evaluated. A questionnaire about participants' socioeconomic characteristics and the use of HAs were included in the study protocol. The subjects who had an HA were assigned to three groups on the basis of HA use: full-time users, part-time users and non-users. Inquiries were made about the subjective reasons for the non-use of HAs. An HA had been prescribed earlier to 16.6% of the study group. Fourteen percent of the females and 23% of the males had been provided with an HA. The HA owners were older than persons who had not been provided with an HA. Twenty-five percent of the HA owners were non-users, and 55% were full-time users. A decline in cognitive or functional capacity and low income explained the non-use of HAs. The most common subjective reasons for the non-use of HAs were that the use did not help at all (10/24), the HA was broken (4/24) or it was too complicated to use (5/24). The non-use of HAs is still common among the aged. Elderly people who have been provided with an HA and who have a cognitive or functional decline are at risk to be a non-user of an HA. Therefore, they need special attention in counseling.

Etanercept does not essentially increase the total costs of the treatment of refractory juvenile idiopathic arthritis.

OBJECTIVE: To assess the costs of adding etanercept to the prevailing drug therapy for a one-year period in a group of 31 children with juvenile idiopathic arthritis (JIA) whose disease was refractory to conventional disease modifying antirheumatic drugs. METHODS: The changes in total costs were retrospectively collected from medical records and by interviewing parents 6 months before the initiation of etanercept treatment and during a 12-month followup divided into 3-month periods. RESULTS: Direct median costs increased during the first 3 months after the introduction of etanercept, but decreased later during the followup. The estimated median direct costs per patient increased by 4200 US dollars per year, and the indirect costs were reduced by 50%, i.e., 1700 US dollars . The estimated median total cost per patient was increased by about 2700 US dollars per year (10%). CONCLUSION: After combining etanercept with the prevailing treatment, the total costs of refractory JIA calculated per year were only slightly higher than those of traditional therapy. This finding must be evaluated in light of the reduced inflammatory activity of the joint disease and the probable reduction of lifetime pain and disability produced by the disease.

Reoperation rate after elbow synovectomy in rheumatoid arthritis.

The purpose of this study was to evaluate the reoperation rate of elbow synovectomy in patients with rheumatoid arthritis. A total of 103 synovectomies were performed in 88 patients (61 women) with rheumatoid factor-positive rheumatoid arthritis with a mean follow-up of 5.2 years (range, 1-8 years). The survival rate after elbow synovectomy (free from reoperation) was 77% (95% confidence interval, 66%-85%) at 5 years. Eight resynovectomies and fourteen total elbow replacements were performed during the follow-up. No significant improvement in range of motion was detected after synovectomy, but pain relief and patient satisfaction were favorable. Elbows were classified preoperatively (before primary synovectomy) with the Larsen system. All resynovectomies were performed for elbows of grade 0-2 destruction. A significant difference was found between early (Larsen grade 0-2) and late (Larsen grade 3) synovectomies in relation to elbow replacement (P =.002) during the follow-up. Late synovectomy yielded more temporary pain relief with a high rate of elbow arthroplasties.

Functional impairment in spondyloarthropathy and fibromyalgia.

OBJECTIVE: To compare the functional ability of patients with spondyloarthropathy (SpA) and fibromyalgia (FM) using the Bath Ankylosing Spondylitis Functional Index (BASFI), the Dougados Functional Index (DFI), and and the Health Assessment Questionnaire for Spondyloarthropathy (HAQ-S), to establish whether these indicators can differentiate between these patient groups, and to ascertain how well the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) functions in patients with FM. METHODS: Twenty-four patients with SpA and 70 with FM, all female, filled in 4 self-administered questionnaires: BASFI, DFI, HAQ-S, and the BASDAI; results were compared between the 2 groups. RESULTS: The decline in functional ability was similar in patients with SpA and FM when assessed by BASFI, but slightly greater in the SpA group when assessed by DFI and HAQ-S. BASDAI was significantly (p = 0.018) greater in the FM group. CONCLUSION: An almost similar functional decline was observed in both SpA and FM patients when measured by the indices developed for patients with AS and SpA. The specificity of BASDAI in measuring disease activity in SpA was poor, as disease activity in FM was rated higher than in SpA.