Kellokoski Hospital

Turpeinen O [Proofessor Emeritus of Biochemistry, College of Veterinary Medicine, Hämeentie 57, 00550 Helsinki 55, Finland], Karvonen M J, Pekkarinen M, Miettinen M, Elosuo R and Paavilainen E. Dietary prevention of coronary heart disease: the Finnish Mental Hospital Study. International Journal of Epidemiology 1979, 8: 99–118. A controlled intervention trial, with the purpose of testing the hypothesis that the incidence of coronary heart disease (CHD) could be decreased by the use of serum-cholesterol-lowering (SCL) diet, was carried out in 2 mental hospitals near Helsinki in 1959–71. The subjects were hospitalized middle-aged men. One of the hospitals received the SCL diet, i.e. a diet low in saturated fats and cholesterol and relatively high in polyunsaturated fats, while the other served as the control with a normal hospital diet. Six years later the diets were reversed, and the trial was continued another 6 years. The use of the SCL diet was associated with markedly lowered serum-cholesterol-values. The incidence of CHD, as measured by the appearance of certain electrocardiographic patterns and by the occurrence of coronary deaths, was in both hospitals during the SCL-diet periods about half that during the normal-diet periods. An examination of a number of potential confounding variables indicated that the changes in them were small and failed to account for the considerable reduction in the incidence of CHD. It is concluded that the use of the serum-cholesterol-lowering diet exerted a substantial preventive effect on CHD.

BACKGROUND: The standard treatment for septic arthritis in children is antimicrobials for several weeks (initially administered intravenously) and arthrotomy (at least for the hip and shoulder joints). No sufficiently powered study has examined the true need for these treatments. METHODS: In a randomized, multicenter prospective trial in Finland, children aged 3 months to 15 years who had culture-positive septic arthritis were randomized to receive clindamycin or a first-generation cephalosporin for 10 days or 30 days (intravenously for the first 2-4 days). The number of surgical procedures was kept to a minimum. Illness was monitored with preset criteria. Antimicrobial therapy was discontinued when the clinical response was good and the C-reactive protein level decreased to 20 mg/L. The primary end point was full recovery without need for further administration of antimicrobial therapy because of an osteoarticular indication during the 12 months after therapy. RESULTS: Of the total 130 cases, 88% were caused by Staphylococcus aureus, Haemophilus influenzae, or Streptococcus pyogenes; 63 patients were in the short-term treatment group, and 67 were in the long-term treatment group. The median durations of antimicrobial treatment were 10 days and 30 days, respectively. Surgical procedures that were more extensive than percutaneous joint aspiration were performed for 12% of patients, with no preponderance to hip or shoulder arthritis. Two late-onset infections occurred in 1 child in the long-term treatment group; however, all patients recovered without sequelae. CONCLUSIONS: Large doses of well-absorbed antimicrobials for <2 weeks (initially administered intravenously) and only 1 joint aspiration are sufficient for treatment of most cases of childhood septic arthritis, regardless of the infecting pathogen or anatomical site, if the clinical response is good and the C-reactive protein level normalizes shortly after initiation of treatment.

BACKGROUND: Despite the clinical importance of substance-induced psychosis (SIP), few studies have examined the course of this condition after its acute manifestation. OBJECTIVE: To investigate the rate of SIP conversion to a schizophrenia spectrum disorder and the length of follow-up needed to catch the majority of these patients whose diagnoses change. In addition to the conversion rate and pattern, we wanted to look for possible related factors. METHOD: Using the nationwide Finnish Hospital Discharge Register, we followed all patients (N = 18,478) since their first inpatient hospital admission with a diagnosis of SIP (codes 2921 and 2928 in DSM-III-R and codes F10-F19 in ICD-10 with a third digit of 4, 5, or 7) between January 1987 and December 2003 in Finland. Patients (mean age = 43.7 years, standard deviation = 13.5 years) were followed until first occurrence of schizophrenia spectrum disorder, death, or the end of December 2003, whichever took place first. Conversions of discharge diagnoses into schizophrenia spectrum disorders (codes 2951-2959 and 2971 in DSM-III-R and codes F20, F22, and F23 in ICD-10) were recorded at follow-up. RESULTS: Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% (95% CI, 35%-57%) for persons with a diagnosis of cannabis-induced psychosis and 30% (95% CI, 14%-46%) for those with an amphetamine-induced psychosis. Although alcohol-induced psychosis was the most common type of SIP, 8-year cumulative risk for subsequent schizophrenia spectrum diagnosis was only 5.0% (95% CI, 4.6%-5.5%). No differences were detected with regard to gender, except for amphetamine-induced psychosis, which converted into a schizophrenia spectrum disorder significantly more often in men (P = .04). The majority of conversions to a schizophrenia spectrum diagnosis occurred during the first 3 years following the index treatment period, especially for cannabis-induced psychosis. CONCLUSION: Substance-induced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought. The intensity of clinical attention focused on substance-induced psychotic disorders should be increased.

OBJECTIVE: To assess the efficacy of arthroscopic subacromial decompression (ASD) by comparing it with diagnostic arthroscopy, a placebo surgical intervention, and with a non-operative alternative, exercise therapy, in a more pragmatic setting. DESIGN: Multicentre, three group, randomised, double blind, sham controlled trial. SETTING: Orthopaedic departments at three public hospitals in Finland. PARTICIPANTS: 210 patients with symptoms consistent with shoulder impingement syndrome, enrolled from 1 February 2005 with two year follow-up completed by 25 June 2015. INTERVENTIONS: ASD, diagnostic arthroscopy (placebo control), and exercise therapy. MAIN OUTCOME MEASURES: Shoulder pain at rest and on arm activity (visual analogue scale (VAS) from 0 to 100, with 0 denoting no pain), at 24 months. The threshold for minimal clinically important difference was set at 15. RESULTS: In the primary intention to treat analysis (ASD versus diagnostic arthroscopy), no clinically relevant between group differences were seen in the two primary outcomes at 24 months (mean change for ASD 36.0 at rest and 55.4 on activity; for diagnostic arthroscopy 31.4 at rest and 47.5 on activity). The observed mean difference between groups (ASD minus diagnostic arthroscopy) in pain VAS were -4.6 (95% confidence interval -11.3 to 2.1) points (P=0.18) at rest and -9.0 (-18.1 to 0.2) points (P=0.054) on arm activity. No between group differences were seen between the ASD and diagnostic arthroscopy groups in the secondary outcomes or adverse events. In the secondary comparison (ASD versus exercise therapy), statistically significant differences were found in favour of ASD in the two primary outcomes at 24 months in both VAS at rest (-7.5, -14.0 to -1.0, points; P=0.023) and VAS on arm activity (-12.0, -20.9 to -3.2, points; P=0.008), but the mean differences between groups did not exceed the pre-specified minimal clinically important difference. Of note, this ASD versus exercise therapy comparison is not only confounded by lack of blinding but also likely to be biased in favour of ASD owing to the selective removal of patients with likely poor outcome from the ASD group, without comparable exclusions from the exercise therapy group. CONCLUSIONS: In this controlled trial involving patients with a shoulder impingement syndrome, arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy at 24 months. TRIAL REGISTRATION: Clinicaltrials.gov NCT00428870.

PURPOSE: This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. METHODS: The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. RESULTS: Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. PRACTICE IMPLICATIONS: Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development.

BACKGROUND AND AIMS: There have been reports about the increasing number of Achilles tendon ruptures. The most of the reports are based on records in a few hospitals only. We wanted to verify the increasing trend by investigating the epidemiology of Achilles tendon rupture in a very large population. MATERIAL AND METHODS: The retrospective data was collected from 1987 to 1999 in Finnish National Hospital Discharge Register. The study includes 7 375 tendon rupture patients. We recorded their age, gender, home district and the date of admission in a hospital. RESULTS: The incidence of operatively treated Achilles tendon rupture was 11.2/105. The number of the patients was increasing particularly in the old age-groups. The change during the study period was statistically significant (p = 0.015). The females with a tendon rupture were on average 2-3 years older than men (p < 0.01). The urban areas around the capital city had a higher occurrence of tendon ruptures than the rural areas (p < 0.05). CONCLUSION: The number of Achilles tendon ruptures is increasing, but the reasons for this remain unknown. The geographical variations in rupture rate might indicate the role of the urban life-style as a risk factor. One reason for the differences between the men and the women might be the different level of the sport activities, especially ball-games.

The aim of the research was to investigate the effect of the amount and quality of content knowledge on pedagogical content knowledge (PCK). The biological content photosynthesis and plant growth was used as an example. The research sample consisted of 10 primary and 10 secondary (biology) teacher students. Questionnaires, lesson preparation task and an interview were used to collect data. Primary student‐teachers’ were not aware of students’ conceptual difficulties and had problems in choosing the most important content. Neither of the groups had knowledge on suitable experiments and demonstrations, which indicates that PCK should be explicitly taught. The usefulness of PCK and some related constructs in initial teacher training is discussed.

A controlled intervention trial, with the purpose of testing the hypothesis that the incidence of coronary heart disease (CHD) could be decreased by the use of a serum-cholesterol-lowering (SCL) diet, was carried out in two mental hospitals near Helsinki in 1959-71. The subjects were hospitalized middle-aged women. One of the hospitals received the SCL diet, ie a diet low in saturated fats and cholesterol and relatively high in poly-unsaturated fats, while the other served as the control with a normal hospital diet. Six years later the diets were reversed, and the trial was continued another six years. The use of the SCL diet was associated with markedly lowered serum cholesterol values. The incidence of CHD, as measured by the appearance of certain electrocardiographic patterns and by the occurrence of coronary deaths, was in both hospitals during the SCL-diet periods lower than during the normal-diet periods. The differences, however, failed to reach statistical significance. An examination of a number of potential confounding variables indicated that the changes in them were small and failed to account for the reduction in the incidence of CHD. Although the results of this trial do not permit firm conclusions, they support the idea that also among female populations the SCL diet exerts a preventive effect on CHD.

AIM: This paper reports a study of psychiatric inpatient satisfaction with care in one Finnish psychiatric hospital, and explores the factors associated with satisfaction. BACKGROUND: Patient satisfaction is a central indicator for healthcare quality. Previous literature has shown that psychiatric inpatients are quite satisfied with their care in general, but have reported dissatisfaction in the areas of information access and compulsory care. Changes in the structure of Finnish mental health services due to dehospitalization have increased interest in exploring psychiatric patients' treatment experiences and general satisfaction. METHOD: Data were collected in inpatient settings using a self-rating patient satisfaction questionnaire. A total of 316 patients leaving the study units during a 1-year period (May 2000-April 2001) was recruited. The response rate was 61% (n = 313). FINDINGS: In general, patients were quite satisfied with their care. Of seven different satisfaction areas, they were most satisfied with staff-patient relationships, and reported most dissatisfaction in the areas of information, restrictions, compulsory care and ward atmosphere/physical milieu. Younger and female patients were less satisfied with staff-patient relationships than older patients and men. manova (five factors, main effects and two-way interactions in the model) showed that male patients with occasional symptoms or symptoms persisting for less than a month were more satisfied with staff than were women. Further, when symptoms persisted for a month or up to 1 year or more, women were more satisfied with staff than men. CONCLUSION: General patient satisfaction in psychiatric hospital care was good. However, more innovative methods for improvement in the areas of dissatisfaction need to be developed. Special attention should be paid to collaboration with young adults (18-24 years) and female patients with mental health problems of short duration.

This study describes 215 healthcare professionals' experiences of discussing sexuality-related issues with cancer patients at a university hospital in Finland. The results indicate that staff on the cancer ward regard discussions about sexuality as a part of their job. However, discussions on these issues are uncommon: 98% of the respondents said that they talked about these issues with less than 50% of their patients, and only 35% started these discussions on their own initiative. The most important reason for not raising the issue is lack of training. More intensive education on how to open discussions on sensitive areas such as sexuality is needed.

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses' (n = 22) and physicians' (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed that the decision-making process for managing patients' aggressive behaviour contains some in-built ethical dilemmas. They thought that patients' subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients' aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent.

A double-blind, randomized, multi-center, parallel-group study was conducted in Finland to compare the efficacy and safety of risperidone with zuclopenthixol in patients with acute exacerbations of schizophrenia or schizophreniform disorder. Ninety-eight patients were randomly assigned to treatment with risperidone (n = 48) or zuclopenthixol (n = 50), in variable doses, for 6 weeks. The mean daily doses of risperidone and zuclopenthixol at the end of the trial were 8 mg and 38 mg respectively. Efficacy was assessed throughout by the Positive and Negative Syndrome Scale for schizophrenia and Clinical Global Impression. Safety assessments included the Extrapyramidal Symptom Rating Scale, UKU Side-Effect Rating Scale, vital signs, body weight and laboratory screening. The results indicate that risperidone is at least as effective as zuclopenthixol for the treatment of acute schizophrenic episodes, with a trend towards greater improvement in the overall severity of symptoms. The onset of action was significantly shorter with risperidone than with zuclopenthixol. Although the general tolerability of the two drugs was comparable, fewer patients experienced extrapyramidal symptoms with risperidone, so that significantly fewer risperidone-treated patients required antiparkinsonian medication.

Distortion of the sense of reality, actualized in delusions and hallucinations, is the key feature of psychosis but the underlying neuronal correlates remain largely unknown. We studied 11 highly functioning subjects with schizophrenia or schizoaffective disorder while they rated the reality of auditory verbal hallucinations (AVH) during functional magnetic resonance imaging (fMRI). The subjective reality of AVH correlated strongly and specifically with the hallucination-related activation strength of the inferior frontal gyri (IFG), including the Broca's language region. Furthermore, how real the hallucination that subjects experienced was depended on the hallucination-related coupling between the IFG, the ventral striatum, the auditory cortex, the right posterior temporal lobe, and the cingulate cortex. Our findings suggest that the subjective reality of AVH is related to motor mechanisms of speech comprehension, with contributions from sensory and salience-detection-related brain regions as well as circuitries related to self-monitoring and the experience of agency.

Context. The larger number of models of asteroid shapes and their rotational states derived by the lightcurve inversion give us better insight into both the nature of individual objects and the whole asteroid population. With a larger statistical sample we can study the physical properties of asteroid populations, such as main-belt asteroids or individual asteroid families, in more detail. Shape models can also be used in combination with other types of observational data (IR, adaptive optics images, stellar occultations), e.g., to determine sizes and thermal properties.

BACKGROUND: The containment or the prevention of actual violence is the primary justification for the use of restraint and seclusion in psychiatry. The aim of the present study was to determine the grounds for using restraint and seclusion in clinical practice in Finland, and whether these reasons have changed over a 15-year period as a result of legislative changes. METHOD: A structured postal survey concerning the reasons for restraint and seclusion was completed in all the Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998 and 2004. The duration of the episode as well as demographic and clinical information on the restrained and secluded patient were also reported. RESULTS: Agitation/disorientation was the most frequent reason for the use of restraint and seclusion. The duration of the restraint and seclusion episodes was not determined by the reason for using these measures. Some differences in the reasons were found among subgroups of patients. CONCLUSION: Clinical practice deviates from the theoretical and legal grounds established for restraint and seclusion, and is too open to subjective assessment and interpretations.

OBJECTIVE: In clinical practice, a growing need exists for effective nonpharmacological treatments of adult ADHD. The authors present results from a cognitive-behaviorally oriented psychological group rehabilitation for adult ADHD. METHOD: A total of 29 adults with ADHD participated. Rehabilitation consisted of 10 or 11 weekly sessions. Participants were assessed with self-ratings (checklist for ADHD based on the Diagnostic and Statistical Manual of Mental Disorders , Beck Depression Inventory II, Symptom Check List-90 [SCL-90], Brown ADD Scale for Adults [BADDS]), and the ratings of their significant others (BADDS) 3 months prior to treatment, at the beginning of treatment, and at the end of treatment. Also, the Wender Utah Rating Scale questionnaire was completed prior to rehabilitation. RESULTS: Rehabilitation resulted in reduced self-reported symptoms in 16 ADHD-related items of SCL-90, BADDS total score, and BADDS subdomains of activation and affect. CONCLUSION: Results suggest that cognitive-behavioral group rehabilitation can be suitable in treating adult ADHD.

OBJECTIVE: This study evaluated weather educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators' and nurse managers' assessments of novice nurses' professional competence. The purpose was to find competence areas contributing to the acknowledged practice-theory gap. DESIGN: A cross-sectional, comparative design using the Nurse Competence Scale was applied. SUBJECTS: The sample comprised nurse educators (n = 86) and nurse managers (n = 141). METHODS: Descriptive and inferential statistics were used in the data analysis. MAIN OUTCOME MEASURES: Educators assessed novice nurses' competence to a significantly higher level than managers in all competence areas (p < 0.001). The biggest correspondence between educators' and mangers' assessments were in competencies related to immediate patient care, commitment to ethical values, maintaining professional skills and nurses' care of the self. The biggest differences were in competencies related to developmental and evaluation tasks, coaching activities, use of evidence-based knowledge and in activities which required mastering a comprehensive view of care situations. However, differences between educators' and managers' assessments were strongly associated with their age and work experience. Active and improved collaboration should be focused on areas in which the differences between educators' and managers' assessments greatly differ in ensuring novice nurses' fitness for practice.

BACKGROUND: The Symptom Checklist-90 (SCL-90) is a questionnaire that is widely used to measure subjective psychopathology. In this study we investigated the psychometric properties of the SCL-90 among adolescent inpatients and community youth matched on age and gender. METHODS: The final SCL-90 respondents comprised three subsets: 201 inpatients at admission, of whom 152 also completed the instrument at discharge, and 197 controls. The mean age at baseline was 15.0 years (SD 1.2), and 73 % were female. Differential SCL-90 item functioning between the three subsets was assessed with an iterative algorithm, and the presence of multidimensionality was assessed with a number of methods. Confirmatory factor analyses for ordinal items compared three latent factor models: one dimension, nine correlated dimensions, and a one-plus-nine bifactor model. Sensitivity to change was assessed with the bifactor model's general factor scores at admission and discharge. The accuracy of this factor in detecting the need for treatment used, as a gold standard, psychiatric diagnoses based on clinical records and the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) interview. RESULTS: Item measurement properties were largely invariant across subsets under the unidimensional model, with standardized factor scores at admission being 0.04 higher than at discharge and 0.06 higher than those of controls. Determination of the empirical number of factors was inconclusive, reflecting a strong main factor and some multidimensionality. The unidimensional factor model had very good fit, but the bifactor model offered an overall improvement, though subfactors accounted for little item variance. The SCL-90s ability to identify those with and without a psychiatric disorder was good (AUC = 83 %, Glass's Δ = 1.4, Cohen's d = 1.1, diagnostic odds ratio 12.5). Scores were also fairly sensitive to change between admission and discharge (AUC 72 %, Cohen's d = 0.8). CONCLUSIONS: The SCL-90 proved mostly unidimensional and showed sufficient item measurement invariance, and is thus a useful tool for screening overall psychopathology in adolescents. It is also applicable as an outcome measure for adolescent psychiatric patients. SCL-90 revealed significant gender differences in subjective psychopathology among both inpatients and community youth.

BACKGROUND: Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence. METHODS: We included 223 patients from the Helsinki Stroke Aging Memory cohort (n = 486) admitted to Helsinki University Central Hospital with a follow-up of 12 years. We included only patients with first-ever ischaemic stroke who were testable for depression and executive dysfunction. For follow-up, national register data were reviewed for all diagnosis codes of ischaemic stroke, survival data and causes of death. Neuropsychological and neuropsychiatric evaluations for depression and executive functions were performed 12-20 weeks after the index stroke. Univariate analysis was performed using χ(2), Mantel-Haenszel, ANOVA, and Kaplan-Meier log rank analyses. A Cox multivariable model with forced entry was used to adjust for stroke risk factors (age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial disease, hypercholesterolaemia). RESULTS: The mean time to first recurrent stroke was shorter for the depressed patient group (8.15, 95% CI 7.11-9.19 vs. 9.63, 8.89-10.38 years) and even shorter for patients with DES (7.15, 5.55-8.75 vs. 9.75, 9.09-10.41 years) compared to the remaining groups, respectively. The cumulative risk for recurrent ischaemic stroke in the 12-year follow-up was higher for the depression group (log rank p = 0.04) and for the DES group (log rank p = 0.01) compared to the remaining groups, respectively. Cox multivariable analyses revealed that the older age of the patient (1.05; 1.01-1.08/year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and DES (1.95; 1.14-3.33) were all associated with recurrent stroke. CONCLUSIONS: Depression and especially DES are associated with a shorter interval to recurrence of ischaemic stroke but executive dysfunction alone is not associated with a more rapid stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of secondary prevention in patients with ischaemic stroke.

A population sample of 27,000 Finnish women and 30,000 men was studied for the presence of a thoracic vertebral fracture. In both sexes, the prevalence of such fractures increased with age: after 40 years of age in the men and after 55 years of age in the women. The interaction of sex and age was significant, and even when the other determinants were adjusted for. In the women aged 35-44, 55-64, and 75 years or more, the prevalence per 1,000 was respectively 2.4, 5.1, and 29, and in the men in the corresponding age groups 5.2, 15, and 28. A previous history of trauma was a fracture determinant in both sexes. In the men, but not in the women, there was an increased risk of fracture when there was a history of tuberculosis and/or peptic ulcer, and in current smokers. Thus, contrary to observations on extremity fractures, the men had an increased risk of sustaining a thoracic vertebral fracture compared with the women. This may reflect differences in the development of osteoporosis in the axial skeleton versus the appendicular skeleton.