Hurdles for adopting mobile learning devices at the outset of clinical courses.

BACKGROUND: Mobile devices provide medical students with easy access to medical information and educational resources. Since 2013, we have followed the study use of iPads among medical students. In 2016, we observed a notable drop in the mobile device usage in the first cohort of medical students entering their clinical courses. METHODS: The aim of the study was to identify the hurdles for adopting mobile devices at the beginning of the clinical courses. We examined how students evaluated their own and the clinical teachers' ability to use the iPad, how the study assignments fit into digital learning, and how students used the mobile device with patients. The data were collected with online surveys among three consecutive student cohorts and the distributions of closed-ended questions analyzed. RESULTS: Response rates ranged from 67.5 to 90.8%. Students evaluated their own ability to use the iPad as good or excellent and teachers' skills as relatively poor and wanted more digitally tailored assignments. They reported negative attitudes towards mobile device use in the clinical setting and were hesitant to use them in patient contact. Teachers seldom communicated suitable quality medical applications to students. CONCLUSIONS: Clinical teachers need support and training to implement a learning environment and assignments appropriate for mobile devices. Both students and teachers were concerned about using these devices with patients. To achieve the full potential of digitalisation in clinical courses, their use should be developed collectively with students.

Termination of pregnancy and sterilisation in women with childhood-onset type 1 diabetes.

AIMS/HYPOTHESIS: The aim of this study was to explore the association between type 1 diabetes and reproductive health indicators in women, focusing on termination of pregnancy and sterilisation. METHODS: We conducted a registry-based cohort study involving 2281 women with childhood-onset type 1 diabetes, matched for age and birthplace with women without diabetes: two control participants for each woman with diabetes. We compared the frequencies of termination of pregnancy and sterilisation over a 25 year period between women with type 1 diabetes and women without, and estimated standardised incidence ratios (SIRs). Smoothed age and period effects in the incidence of termination of pregnancy or sterilisation were tested statistically. RESULTS: There were more terminations of pregnancy (SIR 1.67; 95% CI 1.51, 1.86) and sterilisations (SIR 1.69; 95% CI 1.56, 1.83) in women with diabetes than in control women. During recent years, sterilisations in women with diabetes have decreased and the difference compared with control women has vanished. The indications for both procedures showed a statistically highly significant difference: maternal medical indications were almost absent (< 1%) in procedures among control women, but comprised 23.6% of terminations of pregnancy and 22.9% of sterilisations in women with diabetes. CONCLUSIONS/INTERPRETATION: The indications for termination of pregnancy and sterilisation are different in women with diabetes compared with other women. Pregnancies in women with type 1 diabetes are still terminated more often than in women without diabetes, but the difference in sterilisation rates has disappeared during recent years.

Tolerance of uncertainty and fears of making mistakes among fifth-year medical students.

BACKGROUND AND OBJECTIVES: Tolerance of uncertainty is an important skill among general practitioners (GPs). Our aim was to study fifth-year medical students' feelings related to facing uncertainty and fears of making mistakes in medical decisions. Further, we studied the associations of intolerance of uncertainty with demographic factors, the students' fears of making mistakes, and their views of a GP's work prior to their ultimate course in general practice. METHODS: A questionnaire-based survey was carried out among the fifth-year medical students prior to their main course in general practice at the University of Helsinki. The questionnaire included demographic variables and inquired about their views of their own tolerance of uncertainty, fear of making mistakes, and of a GP's work overall. RESULTS: During the years 2008--2010, 307/359 medical students (mean age 25.7 years, 64% females) responded. Of the respondents, 22% felt they had difficulty tolerating uncertainty when making medical decisions. Females reported that they tolerated uncertainty poorly more often (27%) than did males (11%). Those tolerating uncertainty more poorly were more often afraid of making mistakes (100% versus 86%). This group more often considered a GP's work too difficult and challenging than did others. CONCLUSIONS: Poor self-reported tolerance of uncertainty among medical students is associated with considering a GP's work too challenging.

Menopause in women with type 1 diabetes.

OBJECTIVE: Our objective was to study age at menopause and the factors associated with it in a large population-based group of Finnish women with childhood-onset type 1 diabetes. METHODS: We contacted a sample of 978 women with type 1 diabetes and mailed them a questionnaire on their gynecological and reproductive histories, diabetes and its management, other diseases, and lifestyle factors. The questionnaire survey was repeated 3 years later among those 641 who responded in the first round and were eligible to take part. Both cross-sectional and retrospective epidemiological cohort study designs were applied to study factors associated with the occurrence of menopause. RESULTS: The median age at cessation of menstruation observed in women with type 1 diabetes was 52.5 years, not lower than that of the general Finnish population (median, 51 y). Women with end-stage renal disease (prevalence ratio, 2.22; 95% CI, 1.22-4.02; P = 0.009) or proliferative retinopathy (prevalence ratio, 1.89; 95% CI, 1.11-3.21; P = 0.02) were more likely than others to have entered menopause by the time of the study. Both associations remained statistically significant after age adjustment. CONCLUSIONS: Age at menopause in women with type 1 diabetes is not lower than that in the general population in Finland. The only statistically significant factors independently associated with earlier menopause in our study were microvascular complications, that is, end-stage renal disease and proliferative retinopathy.

Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study.

BACKGROUND: Finland has the highest incidence of type 1 diabetes worldwide, reaching 40 per 100,000 people per year in the 1990s. Our aim was to assess the temporal trend in type 1 diabetes incidence since 2000 in Finnish children aged younger than 15 years and to predict the number of cases of type 1 diabetes in the future. METHODS: Children with newly diagnosed type 1 diabetes in Finland who were listed on the National Public Health Institute diabetes register, Central Drug Register, and Hospital Discharge Register in 1980-2005 were included in a cohort study. We excluded patients with type 2 diabetes and diabetes occurring secondary to other conditions, such as steroid use, Down's syndrome, and congenital malformations of pancreas. FINDINGS: 10,737 children-5816 boys and 4921 girls-were diagnosed with type 1 diabetes before 15 years of age during 1980-2005. The average age-standardised incidence was 42.9 per 100,000 per year (95% CI 42.6-44.3) during this period, increasing from 31.4 per 100,000 per year in 1980 to 64.2 per 100,000 per year in 2005. The age-specific rates per 100,000 per year were 31.0, 50.5, and 50.6 at ages 0-4 years, 5-9 years, and 10-14-years, respectively. We noted a significant non-linear component to the time trend (p<0.0003). In children aged 0-4 years, the increase was largest, at 4.7% more affected every year. The overall boy-to-girl ratio of incidence was 1.1; at the age of 13 years, it was 1.7 (1.4-2.0). The predicted cumulative number of new cases with type 1 diabetes before 15 years of age between 2006 and 2020 was about 10 800. INTERPRETATION: The incidence of type 1 diabetes in Finnish children is increasing even faster than before. The number of new cases diagnosed at or before 14 years of age will double in the next 15 years and the age of onset will be younger (0-4 years).

The increasing prevalence of metabolic syndrome among Finnish men and women over a decade.

OBJECTIVE: Our objective was to assess a 10-yr change in the prevalence of the metabolic syndrome defined by the National Cholesterol Education Program (NCEP) and the International Diabetes Federation (IDF) among Finnish men and women. DESIGN AND SUBJECTS: Two cross-sectional population surveys were performed in Finland in 1992 and 2002. A total of 3495 participants aged 45-64 yr were included in the analysis. RESULTS: In both years the metabolic syndrome was more common among men than women. In men the prevalence of the metabolic syndrome tended to increase slightly between 1992 and 2002, from 48.8-52.6% (P=0.139) based on the NCEP definition, and from 51.4-55.6% based on the IDF definition (P=0.102). In women the prevalence of the metabolic syndrome increased significantly from 32.2-39.1% based on the NCEP definition (P=0.003), and from 38.0-45.3% based on the IDF definition (P=0.002). In both sexes the prevalence of high blood pressure decreased, but the abnormalities in glucose metabolism increased between 1992 and 2002. The prevalence of central obesity increased in women between 1992 and 2002. CONCLUSIONS: In Finland the prevalence of the metabolic syndrome, based both on the NCEP and IDF definitions, is higher in men than women. However, the increase in the prevalence of the metabolic syndrome, from 1992-2002, was significant only among women.

Epidemiology of postmenopausal hypertension.

Hypertension is more common in younger men than women but this trend is inverted at approximately 60 years of age--thereafter hypertension is more common in women. Menopause's contribution to this phenomenon is complex. Oestrogen deficiency after menopause precipitates a number of factors and these have established the 'menopausal metabolic syndrome' as a concept in postmenopausal women. However, studies have indicated that changes in the prevalence of hypertension, and overall cardiovascular risk profiles in postmenopausal women, might be due to ageing and not oestrogen deficiency. Undoubtedly, there is a strong multicolinearity between the two phenomena. Furthermore, hormone replacement therapy (HRT) may reduce age-induced blood pressure increases, thus decreasing cardiovascular risks. However, recent results have questioned HRT's role in cardiovascular disease (CVD) prevention in postmenopausal women and trials have unequivocally shown that CVD risk in postmenopausal women with hypertension can be effectively reduced by common antihypertensive drugs.