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Biomedical subjects

T Kangas

Publications and source records attributed to T Kangas.

At least 19 recordsLinked to original sources
PubMed2000

Degree of lung maturity determines the direction of the interleukin-1- induced effect on the expression of surfactant proteins.

Intra-amniotic interleukin (IL)-1 increases surfactant components in immature fetal lung, whereas high IL-1 after birth is associated with surfactant dysfunction. Our aim was to investigate whether the fetal age influences the responsiveness of surfactant proteins (SPs) to IL-1. Rabbit lung explants from fetuses at 19, 22, 27, and 30 d of gestation and 1-d-old newborns were cultured in serum-free medium in the presence of recombinant human (rh) IL-1alpha or vehicle. The influence of IL-1alpha on SP-A, -B, and -C messenger RNA (mRNA) content was dependent on the conceptional age. In very immature lung on Day 19, rhIL-1alpha (570 ng/ml for 20 h) increased SP-A, -B, and -C mRNA by 860+/-15%, 314+/-108%, and 64+/-17%, respectively. The increase in SP-A mRNA was evident within 4 to 6 h. IL-1alpha increased the SP-A concentration in alveolar epithelial cells and in the culture medium within 20 h. In contrast, at 27 to 30 d of gestation and in newborns, IL-1alpha decreased SP-C, -B, and -A mRNA by means of 64 to 67%, 48 to 59%, and 12 to 15%, respectively. SP-B protein decreased by 45 to 60%. The decrease in mRNA became evident within 8 to 12 h and was dependent on IL-1 concentration. On Day 27, IL-1alpha accelerated the degradation of SP-B mRNA in the presence of actinomycin D. IL-1 did not increase the degradation rate of SP-A mRNA unless both actinomycin D and cycloheximide were added to the explants. The present findings may explain some of the contrasting associations between inflammatory cytokines and lung diseases during the perinatal period. The determinants of the direction of the IL-1 effect on the expression of SPs remain to be identified.

Amniotic Fluid↗
PubMed2000

Nationwide survey of comorbidity, use, and costs of all medications in Finnish diabetic individuals.

OBJECTIVE: To investigate comorbidity and overall use and costs of medication for all Finnish individuals with diabetes treated with drugs compared with sex- and age-matched control subjects. RESEARCH DESIGN AND METHODS: According to a cross-sectional population study using national registries, 116,224 individuals purchased antidiabetic medications in Finland in 1995. The same number of nondiabetic individuals matched for sex, age, and area of residence were chosen as control subjects. Age at onset of diabetes was used as a criterion for distinguishing between type 1 and type 2 diabetes. The criterion could be applied in 74% of cases. A total of 16,955 individuals were defined as having type 1 diabetes, and 68,517 were defined as having type 2 diabetes. Comorbidity was determined by linkage with a national register including all individuals entitled to special reimbursement for drug treatment for a range of chronic diseases. Data on use and costs of all medications prescribed were obtained from drug purchase records. RESULTS: Cardiovascular diseases and uremia were, as expected, the chronic diseases most closely associated with diabetes. Use of almost all kinds of medication was significantly greater in individuals with type 1 and type 2 diabetes than in control subjects. The greatest differences were observed in relation to cardiovascular drugs and antibiotics. Unexpectedly low use of antiasthmatics was observed in individuals with both types of diabetes, low use of neuroleptics was observed in type 1 diabetic individuals, and low use of hormone replacement therapy was observed in women with type 2 diabetes. Total costs of medications for individuals with diabetes were 3.5 times greater than those for nondiabetic control subjects. The higher costs were mostly attributable to insulin therapy for individuals with type 1 diabetes. The higher costs for individuals with type 2 diabetes were related to the cost of medications other than antidiabetic medication. The possible selection bias in omitting diabetic individuals treated with diet only and individuals in whom diabetes type could not be determined must be considered in interpreting the results. CONCLUSIONS: Greater use by and costs of medications for individuals with diabetes than for nondiabetic individuals is related not only to antidiabetic treatment but also to all other kinds of medications. Although drug treatment and the prevalence of several chronic conditions were overall greater in individuals with diabetes versus other individuals, some exceptions merit further study

Chronic Disease↗
PubMed1999

Glycemic control in patients with diabetes in Finland.

OBJECTIVE: To evaluate the quality of diabetes care at a national level in Finland, using level of glycemia as a determinant of success in treatment. RESEARCH DESIGN AND METHODS: Physicians and diabetes nurses in 76 randomly selected clinics (59 primary care units and 17 hospitals) evenly covering the whole of Finland were asked to fill in a questionnaire asking for data based on the 1993 medical records of a random sample of 50 diabetic patients from each center (total n = 3,800). HbAlc was used as an index of glycemic control. RESULTS: Information on 3,195 (84%) diabetic patients was received. HbAlc was measured in 67% of the patients in 1993. The mean HbAlc in the whole population was 8.6 +/- 1.9% (normal range 4-6%). Some 25% of patients had HbAlc < or = 7.3%, while 25% had HbAlc > or = 9.7%. The mean HbAlc was 8.8 +/- 1.9% in type 1 and 8.5 +/- 1.9% in type 2 diabetic patients. There was no sex difference in the HbAlc level in type 1 diabetic patients. However, male type 2 diabetic patients had better glycemic control than female patients (8.3 +/- 1.9 vs. 8.8 +/- 1.9%, P < 0.0001). The sex difference was independent of the type of therapy. The mean level of glycemic control was lowest among individuals with the shortest duration of diabetes. After 7-9 years after the diagnosis, there was no change in the mean level of glycemia. CONCLUSIONS: Average glycemic control is poor in a majority of the diabetic patients in Finland. Better treatment strategies and methods should be used to improve glycemic control and to reduce long-term complications.

Adult↗
PubMed1996

Influence of morbidity and health care structure on hospitalization among adult diabetic patients.

The aim of the study was to investigate the influence of outpatient care, overall hospital bed provision and the prevalence of diabetes on the hospital use by adult diabetic patients. Population based data were collected in Finland from a 3-year period. Hospital admissions, inpatient days, and mean length of stay due to diabetes were derived from the Hospital Discharge Register. Estimates of diabetes prevalence were derived from the Central Drug Register. Primary outpatient site, annual number of physician visits, and age at onset among diabetic patients were assessed by questionnaire. The unit of analysis was hospital district (n = 21) and all analyses refer to the 15-64 years age group. Linear regression models were used to explain discharge rates and inpatient days in the district. Large variations between hospital districts were observed in diabetes prevalence, discharge rates due to diabetes, and mean length of stay among diabetic patients. Prevalence of diabetes and overall supply of hospital beds in the district were not related to hospital use. Univariate analyses showed that the larger the proportion of diabetic patients primarily using a private practitioner, the lower the hospital use. In districts where early onset of diabetes was more common, the average number of inpatient days was significantly lower than in other districts. In stepwise regression analyses, early onset of diabetes was the only variable that entered the models. In the full model, 24.6% of the variance in inpatient days and 16.1% of the variance in discharge rates were explained. In conclusion, factors related to health care structure, provision of hospital beds or morbidity explain little of the regional variation in hospital use. The observed variations in hospital use probably depend mainly on local treatment policies and differences in clinical decision-making.

Adolescent↗
PubMed1996

Health behaviour, social integration, perceived health and dysfunction. A comparison between patients with type I and II diabetes and controls.

This survey compared diabetic patients (n = 953) and population controls (n = 2366) in terms of socioeconomic and occupational factors, family life, leisure activity, health habits, perceived social support and quality of life. The differences between type I and type II diabetic patients and controls were examined by proportions adjusted for age. Type II diabetic men had a lower educational level and were more often retired, unemployed or unmarried than controls. Type II diabetics were also less likely to have fewer healthy behaviour patterns than controls. Type I diabetics assessed their social support as inadequate slightly more often than controls, though no major differences in perceived availability of social support were detected between study groups. Both diabetic groups reported a lower health-related quality of life than healthy controls. Thus a chronic illness such as diabetes seems to tax the individual's personal resources, leading to lower quality of life.

Activities of Daily Living↗
PubMed1996

Structure and costs of health care of diabetic patients in Finland.

OBJECTIVE: The aim of the present study was to examine both the structure, including modes of drug treatment, ambulatory care, and hospital inpatient care, and the costs of health care for drug-treated diabetic patients in Finland. RESEARCH DESIGN AND METHODS: The modes of drug treatment and ambulatory care were studied with the help of a questionnaire given to all diabetic patients obtaining their medication through pharmacies in Finland during a 7-week period in 1989. The questionnaire sought information on drug treatment, site of health care, and frequency of visits to physicians. Hospital inpatient care was evaluated by linking the patient data from the Hospital Discharge Register and the Central Drug Register. The direct costs of health care were calculated by using relevant average costs. RESULTS: A total of 30,266 questionnaires were returned, representing > 70% of all drug-treated diabetic patients receiving medication in the period studied. Of the diabetic patients, 63% were treated by oral medication only, 31% by insulin only, and 6% by a combination of insulin and oral agents. Of the patients in whom diabetes was diagnosed at > or = 30 years of age, 75% were treated at health centers, whereas > 60% of those in whom diabetes was diagnosed at < 30 years of age were treated at outpatient clinics. The mean annual frequency of visits was 4.0 for patients receiving insulin treatment and 3.3 for patients receiving treatment with oral medications. The diabetic patients used 1.5 million hospital inpatient days per year, which was 13% of the total inpatient days in Finland. Of the inpatient days, 20% were for diabetes as the principal cause, 52% for diabetes-related diseases, and 28% for causes unrelated to diabetes. The direct costs of the health care of drug-treated diabetic patients in 1989 were 5.8% of the total costs of health care in Finland and were three times higher than the average costs of care for nondiabetic individuals. The direct costs were divided into inpatient care (81%), medication (9%), ambulatory care (8%), and self-care equipment (2%). CONCLUSIONS: Hospital inpatient care is the major contributor to the excess of health care expenditures for diabetic patients.

Ambulatory Care↗
PubMed1994

Hospital use among diabetic patients and the general population.

OBJECTIVE: This register-based linkage study compared hospital use among diabetic and nondiabetic populations. The study focused on overall use, use by disease categories, and inpatient care caused by complications. RESEARCH DESIGN AND METHODS: The patient data were derived from the Hospital Discharge Register and the Central Drug Register in Finland. All drug-treated diabetic patients and discharges of patients in a 3-year period were included in the study. Hospital use was measured by inpatient days, mean length of stay, and discharge rate. RESULTS: Among diabetic patients were eligible for drug reimbursement, 14.2% had at least one hospital stay because of diabetes in a year, while 50.7% had at least one hospital stay for any cause. Only 12.4% of the nondiabetic population was hospitalized annually. Patients with diabetes as the principal diagnosis consumed about 3% of all inpatient days; patients who had diabetes either as the principal or as a subsidiary diagnosis used 8.3%; and people who were eligible for antidiabetic drug reimbursement used 13.3% of total inpatient days. Among diabetic children, the risk for hospitalization was 6.5 times higher than among nondiabetic children. With advancing age, causes other than diabetes increasingly dominated hospitalization among diabetic patients. Inpatient days because of cardiovascular diseases were 1.6-18 times more common among diabetic patients than among nondiabetic patients, depending on gender and age-group. Diabetic patients used many more hospital inpatient days than did the nondiabetic population for a number of other disease categories that are usually not related to diabetes. CONCLUSIONS: Hospital use among diabetic patients is substantially greater than that among the nondiabetic population, mainly because of cardiovascular and microvascular complications, but also because of diseases unrelated to diabetes.

Adolescent↗
PubMed1989

Seasonal variation in the photosynthetic capacity of a willow (Salix cv. Aquatica gigantea) canopy. 2 Comparison of the structure and function of chloroplasts at different levels in the canopy.

Development of leaf chloroplast ultrastructure at five levels in a willow (Salix cv. Aquatica gigantea) canopy was followed during one growing season in the field. Changes in chloroplast ultrastructure were compared with the rate of CO(2) uptake of the same leaves. The highest rates of CO(2) uptake were recorded in young leaves exposed to full available sunlight. In these leaves, the area of the grana stacks was less than 20% of the total chloroplast area and the degree of thylakoid stacking was less than 1.5. The chloroplasts of these leaves contained large amounts of starch and small amounts of plastoglobuli. As the canopy grew and the leaves in the lower parts of the canopy became shaded, the structure of the chloroplast thylakoids gradually changed. In leaves at the two lowest levels of the canopy, the degree of stacking at the end of the growing season was close to 2 and correspondingly the rate of CO(2) uptake was low. The areas of grana stacks and plastoglobuli in these chloroplasts increased and were about 30 and 10% of the chloroplast area, respectively, by the end of the growing season. The increase in the degree of thylakoid stacking was caused by increased biosynthesis of grana lamellae, which in general were thinner than the lamellae of young leaves. The length of the stroma lamellae did not change with leaf age. Morphometric measurements showed that the structure of the chloroplasts in leaves 160 cm above ground was dynamic and responsive to environmental conditions so that photosynthetic capacity remained high for 7 weeks despite an increase in leaf shading.

Journal Article↗
PubMed1988

Non-invasive characterisation of angiopathy in the diabetic foot.

A comparison between 19 consecutive insulin dependent diabetic patients with a history of or current foot ulcers, gangrene or infection, with 14 arteriosclerotic patients with advanced lower limb ischaemia was performed using measurements of ankle and great toe systolic blood pressure, forefoot skin perfusion pressure and pulse volume assessment. Although clinical examination was usually sufficient to distinguish different types of diabetic foot, the vascular laboratory often gave additional information about the vascular component of the diabetic foot. In this study, great toe systolic pressure appeared to be the best indicator of the degree of macroangiopathy. The role of microangiopathy in the development of diabetic foot remains uncertain. The major factor responsible for diabetic foot in addition to neuropathy seems to be macroangiopathy which is not different from that of arteriosclerotic occlusive disease.

Adult↗
PubMed1980

Premedication for outpatient adenoidectomy: comparison between ketamine and pethidine.

A comparison of intramuscular ketamine and pethidine as premedicants was carried out in a series of 32 children under two years of age who were given thiopentone-N2O-O2-succinyl choline anesthesia for elective outpatient adenoidectomy. Fourteen (87.5%) of the 16 children premedicated with ketamine (3 mg./kg.) were calm or asleep when brought into the operating room as compared to 4 (25.0%) of the 16 children (p less than 0.001) premedicated with pethidine (1 mg/kg.). Immediate recovery was similar in the groups premedicated with ketamine and pethidine. These two small groups of children did not differ significantly in their emotional state during recovery room observation, nor during the 48 postoperative hours at home, either. It is suggested that ketamine administered intramuscularly is a suitable agent for outpatient premedication of small children because of its rapid action, excellent sedative and analgesic properties and low incidence of side-effects.

Adenoidectomy↗
PubMed1980

Isobaric 0.5% bupivacaine in spinal anaesthesia.

A study of 240 consecutive patients who were given spinal anaesthesia with isobaric 0.5% bupivacaine is presented. 215 patients had various orthopaedic operations; 89 patients underwent a total hip-prosthesis operation. Mean age was 62 years (22-88). Duration of surgery was 79 +/- 35 min (mean +/- SD) and analgesia always outlasted the surgery. The follow-up time in the recovery room was 416 +/- 139 min (170-570 min) and 31% of patients needed no analgesics during this time. No serious complications were observed. The incidence of hypotension was exceptionally high (30%) possibly due to the fact that no fluid preloading was used but it was easily controlled by etilefrine and atropine.

Adult↗