Duodecim; laaketieteellinen aikakauskirja最新文献

In the HUUTI consortium research project, the illicit use of drugs and consequences thereof among Finnish people were studied, also seeking possible new pharmacological therapies for dependency problems. The epidemiological part included 4,817 persons, who attended the services for drug users at Helsinki Deaconess Institute between 1997 and 2008. The majority were below 35 years of age. The average level of education was low and the proportion of employed was small. On the average, 3.5 different substances were being used, of which buprenorphine and amphetamine were the most common primary drugs, cannabis being the most common secondary drug. An almost tenfold mortality was observed in the follow-up comparison with the reverence population.

Positive trends achieved in health in Finland are not equally reflected mental health, hence mental health promotion deserves a central position. Mental health promotion refers to strengthening of psychological resources, and has been linked to increased well-being and life satisfaction. Health care has an important role in supporting a solid foundation of mental health and in preventing intergenerational transmission of problems. Mental health promotion requires strong involvement of non-health sectors. There are means for strengthening mental health skills also on the individual level. The gap between existing evidence on effectiveness and cost-effectiveness of mental health promotion and the lack of large scale implementation needs to addressed by future health and social policies.

While the overall number of driving under the influence (DUI) cases has reduced, the proportion of drivers under the influence of medications or illicit drugs has increased. In studies based on Finnish register data sets, the factors involved in DUI have been examined with the conclusion that drunk driving may be an indication of multiple health or social problems. According to several measures, DUI offenders who had used medications, especially benzodiazepines, were ill and disadvantaged. Doctors play a central role in reducing the number of DUI cases, e.g. by treating substance abuse problems and by monitoring the use of drugs which affect the central nervous system. It is possible that a DUI offender has accumulated a number of different problems at the same time, which is why the treatment of DUI offenders should pay attention to a comprehensive mapping of the situation and the use of multidisciplinary cooperation.

Recent technological development has enabled fast and cost-effective simultaneous analyses of several gene variants or sequence of even the whole genome. For medical practitioners this has created challenges although genomic information may be clinically useful in new applications such as finding out individual risk for diseases influenced by as many as 50,000 variable DNA regions or in detecting pharmacogenetic risks prior to prescribing a medicine. New digital tools have paved the way for utilization of genomic data via easy access and clear clinical interpretation for both doctor and patient. In this review we describe some of these tools and applications for clinical use.

Individualized medicine, based on a detailed mapping of the patient's disease mechanisms, is becoming an essential part of treatment for an increasing number of diseases. In the past few years, the possibility to determine the abnormal genome and transcriptome of diseased cells at a reasonable cost has been the major advance. The vast amount of data accumulated from one patient will set requirements for data extraction tools, in order to have the essential information affecting the treatment of the patient information quickly and reliably at the disposal of attending physicians. A computerized decision support system connected to the information systems of the hospital is an integral part of individualized treatment. Although the application of genomic and other profiling information is challenging, individualization of medication provides great promises more effective and safer treatment.

Of the 14,000 hernias operated annually in Finland, approximately 5 to 6% are treated as emergencies usually due to incarceration. Compared with elective hernia operations, emergency operations carry an increased risk of complications and death, especially in elderly patients and those with comorbidities. The risk of hernia recurrence is higher after an emergency procedure. In an emergency situation, a solution resulting in the best immediate and long-term outcome should be selected for each patient. Sometimes it is best to treat only the acute incarceration, whereas in some cases a hernia repair with good and lasting outcome can be safely performed already during the acute situation. Besides the nature of the hernia itself, the decisions are affected by the general condition and underlying disease of the patient, as well as the surgeon's experience. Emergency hernia surgery requires experience, as suboptimal solutions will complicate any repair operations that may be required later.

Learning of a serious illness is unique news. Nothing certain can be known about how it will affect the hearer's outlook on the future before a conception is established about the hearer's expectations and how he/she has understood the issue. For example, a person who has been expecting muscle tension to be an explanation for back pain but hearing that a cancer metastasis is the underlying cause, will inevitably be in shock. The healthcare system is not able to influence everything, but is usually given one possibility to make a good first impression when telling about a serious diagnosis. Various lists of issues to be taken into account have been devised to help this. They do not, however, replace effective interaction, which is a matter of skill but can also be practiced. It is possible to anticipate the reactions of the hearers, as long as they remember that feelings are feelings and facts are facts.

Psoriasis is a chronic, immune-mediated, inflammatory disorder of the skin and joints. Moderate-to-server cases are associated with an independent risk of comorbidity (cardiovascular diseases and diabetes) even after adjusting for risk factors, known to be more prevalent in psoriatics compared to normal population. The systemic underlying inflammation, analogous to that observed in rheumatoid arthritis, calls for a long-term effective treatment. Screening and treatment of cardiovascular risk factors is highly recommended. The biologic drug arsenal has new additions. Long term treatment data from clinical study extensions and independent registries are reviewed.

DRESS (drug reaction with eosinophilia and systemic symptoms) is a rare, severe multiorgan adverse drug reaction. Antiepileptic age's and antibiotics are the most frequently reported causative agents. Compared with other drug reactions, DRESS demonstrates a long latency period thus complicating recognition and diagnosis. DRESS is defined as presence of fever, skin eruption, hematologic abnormalities and systemic involvement, especially liver injury. Withdrawal of the culprit drug, commencement of systemic corticosteroid and supportive care are the mainstay of treatment. The majority of patients recover completely after drug withdrawal and appropriate therapy. Some patients suffer from chronic sequelae or even death.

Progesterone regulates several female reproductive functions. Progesterone and synthetic progestins derived from it have long been utilized in gynecology. The effects of these steroids in target cells are mediated via progesterone receptors, Progesterone receptors are also the target of action of selective progesterone receptor modulators. Of the molecules of this newer group of drugs, two are presently in clinical use. Mifepristone is used in nonsurgical abortion, in softening of the cervix before surgical abortion, and in the induction of labor in cases of intrauterine death. The indications of ulipristal acetate are postcoital contraception and treatment of uterine myomas and the resulting symptoms.