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Adjustable gastric banding is currently the most common bariatric operation. This study is a retrospective analysis of the Finnish experience with this procedure over the last 10 years. Between March 1993 and June 1999, 123 patients underwent either open (36) or laparoscopic (87) surgery for morbid obesity by the application of an adjustable gastric band. Data on preoperative clinical characteristics and postoperative outcome and weight-loss patterns up to 9 years (mean 55 months) are presented and also evaluated by the Bariatric Analysis and Reporting Outcome System (BAROS). Sex ratio was 31% males / 69% females, mean age 44 years and mean +/- SD preoperative BMI 49 +/- 8 kg/m(2) (range 33.6-85.1). During the evaluation period (March 1993 December 2002), 54% of patients experienced postoperative complications requiring hospital treatment >or= 7 days, and 52% underwent a reoperation. 33% of bands were removed. The most important late complications were esophagitis (30%), obstruction due to slippage / pouch dilatation (21%), incisional hernia (9%) and band erosion (9%). Mean excess weight loss at 1 and 2 year follow-up was 36% and 38%, which later stabilized to 30%. During the evaluation period, there were 10 deaths, 2 of which were 30-day deaths, and the remainder were not associated with the band. According to BAROS, the outcome was regarded as \"very good\" in 3%, \"good\" in 7%, \"fair\" in 40% and \"failure\" in 50%. Our long-term data found that weight reduction is acceptable,but the incidence of late complications and reoperations was high.

Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA. The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA. Seventy-two consecutive overweight patients (body mass index, 28-40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea-hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements. The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 [mean +/- SD]). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08-0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference. VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.

To evaluate whether parameters of obstructive sleep apnoea (OSA) associate with cholesterol metabolism before and after weight reduction, 42 middle-aged overweight subjects with mild OSA were randomised to intensive lifestyle intervention (N=23) or to control group (N=18) with routine lifestyle counselling only. Cholesterol metabolism was evaluated with serum noncholesterol sterol ratios to cholesterol, surrogate markers of cholesterol absorption (cholestanol and plant sterols) and synthesis (cholestenol, desmosterol, and lathosterol) at baseline and after 1-year intervention. At baseline, arterial oxygen saturation (SaO2) was associated with serum campesterol (P<0.05) and inversely with desmosterol ratios (P<0.001) independently of gender, BMI, and homeostasis model assessment index of insulin resistance (HOMA-IR). Apnoea-hypopnoea index (AHI) was not associated with cholesterol metabolism. Weight reduction significantly increased SaO2and serum cholestanol and decreased AHI and serum cholestenol ratios. In the groups combined, the changes in AHI were inversely associated with changes of cholestanol and positively with cholestenol ratios independent of gender and the changes of BMI and HOMA-IR (P<0.05). In conclusion, mild OSA seemed to be associated with cholesterol metabolism independent of BMI and HOMA-IR. Weight reduction increased the markers of cholesterol absorption and decreased those of cholesterol synthesis in the overweight subjects with mild OSA.

Purpose Endothelial dysfunction is one of the early markers of cardiovascular complications in obstructive sleep apnea (OSA). The aim of our study was to evaluate whether overweight patients with mild OSA displayed endothelial dysfunction, and to assess the effect of 1-year lifestyle intervention with an early very low calorie diet in endothelial function. Methods At baseline, the study population consisted of 83 overweight patients with mild OSA and 46 weight-matched non-OSA subjects. OSA patients were further randomized into a 1-year supervised lifestyle intervention group or control group which received routine lifestyle counselling. Endothelial function measured by brachial artery flow-mediated dilatation (FMD), apnea–hypopnea index (AHI), body mass index (BMI), and metabolic parameters were assessed at baseline and 12 months. Results No correlations between endothelial function and mild OSA were detected. However, patients with impaired endothelial function had lower mean saturation and impaired endothelial function correlated significantly with glucose intolerance and dyslipidemia. After the lifestyle intervention and successful weight reduction, AHI, BMI, serum triglycerides and insulin improved significantly; however, no improvement in FMD was detected. Conclusions Mild OSA was not observed to be associated with endothelial dysfunction. Although in mild OSA endothelial function is still preserved, lifestyle intervention with weight reduction did achieve an improvement in other obesity-related risk factors for cardiovascular diseases, thus highlighting the importance of early intervention.

Purpose To examine caregivers' health-related quality of life (HRQoL) and well-being during the first 3 years after their family member's Alzheimer's disease (AD) diagnosis and assessed the relationship between caregivers' HRQoL, well-being, and the severity of AD. Further, to compare of caregivers' HRQoL to general population. Methods Longitudinal design (36 months) after AD diag nosis of 236 caregiver-patient dyads. Linear regression was used to assess age- and gender-adjusted association between repeated measurements of caregivers' HRQoL and the severity of AD. For comparison with general population, the National Health 2011 Health Examination Survey data was utilized. Results Caregivers had significantly lower HRQoL than age- and gender-standardized counterparts. Severity of AD was significantly (p < 0.05) associated with the mobility and depression dimensions of caregiver's HRQoL but not with the total HRQoL index score. Conclusions Caregivers' HRQoL seems to deteriorate earlier than previously noted. The severity of AD has not that great impact on caregiver's HRQoL as assumed.

The adverse effects of air pollutants on the respiratory and cardiovascular systems are unquestionable. However, in recent years, indications of effects beyond these organ systems have become more evident. Traffic-related air pollution has been linked with neurological diseases, exacerbated cognitive dysfunction, and Alzheimer’s disease. However, the exact air pollutant compositions and exposure scenarios leading to these adverse health effects are not known. Although several components of air pollution may be at play, recent experimental studies point to a key role of ultrafine particles (UFPs). While the importance of UFPs has been recognized, almost nothing is known about the smallest fraction of UFPs, and only >23 nm emissions are regulated in the EU. Moreover, the role of the semivolatile fraction of the emissions has been neglected. The Transport-Derived Ultrafines and the Brain Effects (TUBE) project will increase knowledge on harmful ultrafine air pollutants, as well as semivolatile compounds related to adverse health effects. By including all the major current combustion and emission control technologies, the TUBE project aims to provide new information on the adverse health effects of current traffic, as well as information for decision makers to develop more effective emission legislation. Most importantly, the TUBE project will include adverse health effects beyond the respiratory system; TUBE will assess how air pollution affects the brain and how air pollution particles might be removed from the brain. The purpose of this report is to describe the TUBE project, its background, and its goals.

Sand filters have been shown to be an economic and effective solution for wastewater treatment in private households, although the removal of phosphorus (P) may be insufficient. However, P removal can be improved by adding a P-adsorbing material, such as biotite, into the sand filters. The physico-chemical characteristics and the microbial quality of the effluents of family-scale sand filters without adsorbing media (SF), sand filters with a biotite layer (B), and sand filters with a modular filter (MB) were followed for one year. Sand filters with a biotite layer displayed the highest capacity to remove nitrogen (N) and biological oxygen demand BOD7. The efficiency of these filters did not depend on the age of the filter or the season. The P load of the effluent did not differ between sand filters with and without a biotite layer, but the modular sand filter failed to adequately reduce P. The treatment efficiency of sand filters without biotite decreased with increasing age. These private household sand filters can be a good way to treat domestic wastewaters, since these generally comply with the minimum requirements of a Finnish Decree (157/2017). However, enteric viruses (noro- and adenoviruses) were commonly found in the effluents, and the numbers of Escherichia coli were often above 103 colony forming units (CFU) 100 mL−1 (limit for the the EU Bathing Water Directive 2006/7/EC) for good water quality), signifying a risk of microbial contamination of nearby drinking water wells, as well as bathing and irrigation waters.

BackgroundPeople in vulnerable positions, e.g. elderly or disabled people, substance abuser or mental health patients have an increased risk of becoming fire victims. To avoid this risk fire safety knowledge and good practices are needed for professionals working in the field.The social and health policy in Finland prioritise assisted living and home care. At the same time the rescue service act stresses that the responsibility of fire safety is on building owners and service providers. Therefore, care professionals are in a novel situation as they are working at clients home and required to take into consideration diverse environment and self-determination of an individual.The aim of this study was to investigate the fire risk and good practices in assisted living and home care.MethodsThe data is from six group interviews done during 2014–2015. Each group included the whole care service chain: the client and one of his/her relatives, care-giver, service provider and planner representatives and fire safety officer. Each group interviewed represented different type of clients and assisted living facilities and service. Interviews took place in various regions in Finland.ResultsEach agent at the service chain had ambition to improve fire safety. However, the knowledge among professionals what requires to be done and what others belonging to the same service chain are doing was inadequate. Some safety tools were used but oftentimes the user did not understand enough about their function. Overall, most were interested in safety information and to improve the safety, but the will to invest on safety was low.ConclusionsThe care service chain has overall good motivation to improve the safety and fire safety of vulnerable people. However requirements of rescue service act did not materialise in assisted living as well as possible. There is apparent need of knowledge and vocational education material.

BackgroundThe rescue act 2011 in Finland stresses that the responsibility of fire safety is on building owners and service providers. The regulation is justifiable, because people in vulnerable positions, for example elderly and disabled, have an increased risk being fire victims.The aim of this study was to investigate the implementation of rescue service act among service providers in residential, institutional and home care facilities and to monitor changes from 2013 to 2015.MethodsOnline surveys on fire hazard assessment and risk management practices were done in 2013 and 2015. Respondents were managers of residential, institutional and home care facilities for the vulnerable people.Information of the facilities was obtained from the nationwide Register of Institutions in Social Welfare and Health Care. The study sample was systematically selected (every other) and it consisted 1605 organisations.ResultsIn 2013 93% of institutional and 95% residential units had written guidelines to ensure fire safety. In 2015 the proportion has decreased to 84 in institutional and 88% in residential units. At home care written guidelines had less than 50%. The accident prevention guidelines had increased in institutional units from 66% to 74% and in residential units from 66% to 77%. At home care the guidelines had 50%. Safety guidelines in general e.g. crime prevention has also decreased and was now less than 50%, at home care only 22%. Patient and residential safety guidelines were increased only at home care from 55% to 60%.ConclusionsThe organisations have increased their preparedness for fire risk with sprinklers. But at the same time they made less written guidelines to prevent to fire. Fire risk assessment and management practices have improved only in home care. In IR-units the situation seems to be weaker than in 2013. The situation is not acceptable and the reasons should be diagnosed.

BackgroundFire safety in institutional care of vulnerable people in Finland is at a good level. However, in assisted living, residential and home care fatal fires still occur. Risk assessment, as well as knowledge of good procedures is therefore needed. Information of fire safety is included in vocational education of social and health care sector but for formal, non-formal and in-formal education material to improve care practices and identify the fire hazards at clients home is lacking.ObjectiveThe aim of the project was to produce evidence-based educational material about fire safety for social and health care professionals. To produce this material, data gathered by National Institute for Health and Welfare, literature and good practices from social and health care and rescue services were utilised. The project took place 2012–2016 and was sponsored by Fire Protection Fund.ResultsFire safety education material for social and health care professionals, students and planners was first published in 2014. The web-based material includes information about background, legislation, fatal fire cases, principles of risk management and learning from accidents. In addition, there are statistic, special knowledge about fire sensitive fabrics, electrical equipment and chemicals and also good practices to improve fire safety. Additional compact educational package for craft teachers is available. The material can be used also in voluntary work and for example for people taking care of their relatives.ConclusionsWeb-based material is freely available at https://www.thl.fi/fi/tutkimus-ja-asiantuntijatyo/hankkeet-ja-ohjelmat/step-hanke/stepin-koulutusaineisto. The material is available in Finnish and Swedish. English version is under consideration as there is urgent need of fire safety training also for increasing number of foreigners and immigrants in Finland.