Toll‐like receptors 3, 7, and 9 in Juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign tumor affecting adolescent males. The etiology of JNA as well as the causes determining the variable growth patterns of individual tumors remains unknown. Toll‐like receptors (TLRs) are part of the innate immune response to microbes; by recognition of distinct features, they link to induction of pro‐inflammatory signaling pathways. We immunostained TLR 3, 7, and 9 in 27 JNA specimens of patients treated at the Helsinki University Central Hospital, Helsinki, Finland, during the years 1970–2009. Results: TLR 3, 7, and 9 expressions were found in stromal and endothelial cells of JNA, and their expression levels varied from negative to very strong positive. TLR 3 expression was found to have a significant correlation with the clinical stage of JNA. Conclusions: The present results propose a putative role of TLRs in the growth process of JNA.     

The incidence of pelvic fractures and related surgery in the Finnish adult population: a nationwide study of 33,469 patients between 1997 and 2014

Background and purpose — Information on the epidemiological trends of pelvic fractures and fracture surgery in the general population is limited. We therefore determined the incidence of pelvic fractures in the Finnish adult population between 1997 and 2014 and assessed the incidence and trends of fracture surgery.Patients and methods — We used data from the Finnish National Discharge Register (NHDR) to calculate the incidence of pelvic fractures and fracture surgery. All patients 18 years of age or older were included in the study. The NHDR covers the whole Finnish population and gives information on health care services and the surgical procedures performed.Results and interpretation — We found that in Finnish adults the overall incidence of hospitalization for a pelvic fracture increased from 34 to 56/100,000 person-years between 1997 and 2014. This increase was most apparent for the low-energy fragility fractures of the elderly female population. The ageing of the population is likely therefore to partly explain this increase. The annual number and incidence of pelvic fracture surgery also rose between 1997 and 2014, from 118 (number) and 3.0 (incidence) in 1997 to 187 and 4.3 in 2014, respectively. The increasing number and incidence of pelvic fractures in the elderly population will increase the need for social and healthcare services. The main focus should be on fracture prevention.

Pelvic fractures range from minor to major trauma and constitute about 3% to 8% of all fractures treated in hospitals (Court-Brown and Caesar 2006). The incidence of pelvic fractures has varied from 17 to 364/100,000 person-years (Melton et al. 1981, Ragnarsson and Jacobsson 1992, Lüthje et al. 1995, Kannus et al. 2000, Balogh et al. 2007, Andrich et al. 2015, Kannus et al. 2015, Verbeek et al. 2017). This wide range in incidence rates can be explained by different study populations with varying age, and by variations in study designs and follow-up periods. In previous studies, the incidence (n/100,000 person-years) of pelvic fractures was in the United States 37 between 1968 and 1977 (Melton et al. 1981), in Sweden 20 between 1976 and 1985 (Ragnarsson and Jacobsson 1992), in Finland 24 in 1988 (Lüthje et al. 1995), in the Finnish population aged 60 years or older 20 in 1970 and 92 in 1997 (Kannus et al. 2000), in Australia 23 between 2005 and 2006 (Balogh et al. 2007), in the German population aged 60 years or older 22 between 2008 and 2011 (Andrich et al. 2015), in the Finnish population aged 80 years or older 73 in 1971 and 364 in 2013 (Kannus et al. 2015) and in the Netherlands 14 between 2008 and 2012 (Verbeek et al. 2017).In the 80 years and older population, the incidence of low-energy pelvic fractures seems to be increasing (Kannus et al. 2015). Indeed, between 1997 and 2014, the incidence of acetabular fractures, especially low-energy acetabular fractures, rose in Finland (Rinne et al. 2017), whereas the incidence of high-energy acetabular fractures remained at the same level. Notably, since 1997, the incidence of many other fall-related low-energy fractures, such as hip fractures, has decreased in Finland (Korhonen et al. 2013, Kannus et al. 2018).Most pelvic fracture studies concentrate on surgical treatment, even though the majority of these fractures can be treated nonoperatively (Osterhoff et al. 2019, Tornetta et al. 2019). Unstable and dislocated pelvic fractures often need surgery, while stable, non-displaced, or minimally displaced fractures, mostly occurring in elderly people after a simple fall, can usually be treated nonsurgically. At present, however, there is only limited information available regarding the incidence and trends of pelvic fracture surgery in the general population.We assessed the incidence of pelvic fractures in the Finnish adult population between 1997 and 2014 and the incidence and trends of pelvic fracture surgery.     

The economic burden of preventable adverse drug reactions: a systematic review of observational studies

Introduction: Adverse drug reactions (ADRs) are an important cause of morbidity and mortality worldwide. They are associated with healthcare costs due to hospital admissions or prolonged length of stay, as well as additional interventions. The aim of this study was to conduct a systematic review of observational studies to evaluate the economic impact of preventable ADRs.

Areas covered: Published observational research investigating the cost of preventable ADRs in Western countries (limited to the USA and European countries).

Expert opinion: Several reviews have been carried out in the field of the ADR epidemiology but fewer reviews have investigated the economic impact of ADRs, and at the time of writing, none has focused on preventable ADRs. The reason why future research should focus on the costs of preventable ADRs is that both the costs and the negative clinical outcomes are preventable, and as such, are a key point of public health policy action. Nevertheless, the present review highlights an important and sobering limitation of published research on the cost of preventable ADRs, of which the major limitation is the heterogeneity in methods and in reporting which limit what can be known through the summarizing work of a systematic review.     

Income change after cruciate ligament injury — A population-based study

ObjectivesTo investigate the association between choice of treatment and patients' income after cruciate ligament (CL) injury and assess the effect of different covariates such as sex, age, comorbidities and type of work.MethodsThis entire-population cohort study in Sweden included working patients with a diagnosed CL injury between 2002 and 2005, identified in The National Swedish Patient Register (n = 13,662). The exposure was the treatment choice (operative or non-operative treatment). The main outcome measure was average yearly income five years after CL diagnosis, adjusted for the following covariates: sex, age, comorbidities, type of work, region, calendar year, education and income.ResultsRelative to non-operative treatment, operative treatment was associated with greater average yearly incomes (nine to 15%) after injury among patients between 20 and 50 years, patients with partial university education, patients living in large cities and patients with one comorbidity, despite no overall significant association in the national cohort. Delayed operative treatment (> 1 year) had no significant association with income change, whereas early operative treatment (< 1 year) was associated with higher average yearly incomes (11 to 16%) among females, patients between 20 and 50 years, patients living in large cities and patients with one comorbidity.ConclusionsIn a broad sense, treatment choice was not associated with changes in income five years after CL injuries among patients in the workforce, however earlier operative treatment was associated with higher average incomes among patients with ages between 20 and 50, females, living in large cities, with one comorbidity and with a high level of education.     

A radiological study of degenerative vascular changes in the external carotid region and carotid bifurcation

In a series of 79 autopsies performed on subjects aged from 18 to 95 years occlusions in the external carotid, maxillary and inferior alveolar arteries were rare: only two cases were found in the maxillary and one in the inferior alveolar arteries. Tortuosity of the arteries increased with age, being most extensive in the external carotid and least in the inferior alveolar artery. Variations in the diameter of the maxillary artery occurred in 11 persons (14%), the incidence increasing with age. The youngest person showing such changes was aged 55 years. The average diameter of the arterial lumen of the inferior alveolar artery decreased with advancing age. This narrowing of the lumen also correlated with the loss of teeth. Calcified atherosclerotic plaques in the carotid bifurcation were present in 59% of the cases studied. In persons aged over 60 years a correlation was found between the carotid calcifications and coronary artery disease.     

Children's dental healthcare quality using several outcome measures

The aim of this study was to measure the quality of children's dental healthcare from the oral health records of 10-year-olds and from the numbers of children in risk groups. The focus was on dental healthcare and markers of dental records. A representative sample of women expecting their first child was selected in southwestern Finland. Children's dental health, dmft/DMFT = 0, was recorded in 45% of cases with a mean DMFT index of 0.5, and dmft/DMFT > or = 5 in 15%) of the children. Late-appearing caries (caries-free at the age of 5 years but caries-existing thereafter) was present in 31% (258/828) of the children. The focus on restorative dental healthcare was appropriate. The use of sweets was documented in 23% of cases and tooth-brushing in 28%. A total of 26% of the children had gingivitis in every segment. The study illustrates that only one of the targets has bees fully reached.     

Changes in Dental Health and Dental Health Habits from 3 to 5 Years of Age

Objectives : This study sought to determine how dental health and dental health habits change from 3 to 5 years of age and to consider whether preventive dental health care helped in preventing or halting caries in children. Methods : The study included 67 maternity health care clinics, 72 well-baby clinics, and 69 dental health care clinics. Of the 1,292 newborn children, 1,003 (90.8%) were included in this study. Results : Preventive dental health care contributed to dental caries being halted in only 13.2 percent of those children who had enamel caries at 3 years of age. The dmft index did not increase in 22.6 percent of those children who had dentinal caries at 3 years of age. For all others, the disease became more severe. Toothbrushing habits of 3-year-old children were very consistent over the two years studied. Children were at a risk for caries when their mothers had nine years of basic education, when they already had plaque and caries at 3 years of age, and when the frequency of eating sweets increased the most during the two-year study period. Conclusion : Among 3-year-old children, plaque is an indicator of caries risk and therefore should be a key element in health education. Those children who already have evidence of caries at 3 years of age should be the target of preventive dental services because of their increased risk.     

Reactions and Attitudes to Postpartal Mental Symptoms in a Rural Community

We examined the reactions of population, social and health care professionals and local politicians in the context of a narrative case of a newborn and her mother evincing postpartal mental symptoms. The results of this postal questionnaire study indicated that in assessing the urgent need for support, a significant positive association prevailed in the resident cohort with female gender, age over 50 years or being a parent. Professionals and politicians estimated that appropriate care and access to care would be obtained in the maternity and child health clinic in the local health centre. Residents would contact relatives rather than social and health care professionals. A future challenge is to promote the knowledge and sensitivity of the general population in recognizing mental symptoms in mothers with small children. Adequate information is also called for regarding local services and means of access to care.