Translation, cross-cultural adaptation and validation of the Finnish Diabetes Risk Score (FINDRISC) for use in Brazilian Portuguese: questionnaire validity study

ABSTRACT BACKGROUND: The Finnish Diabetes Risk Score (FINDRISC) is a questionnaire that was developed by Finnish researchers to track the risk of diabetes. OBJECTIVE: To translate, cross-culturally adapt and validate the FINDRISC for use in Brazilian Portuguese. DESIGN AND SETTING: Questionnaire validity study conducted at a private university. METHODS: The Brazilian version of the FINDRISC was developed through the processes of translation, back-translation, committee review and pre-testing. Test-retest reliability was measured using the intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement (SEM) and minimum detectable change (MDC). Internal consistency was measured using Cronbach's alpha. For construct validity, the total score of the FINDRISC was correlated with the Diabetes Knowledge Scale (DKN-A) and Diabetes Mellitus Risk Questionnaire (QRDM). Ceiling and floor effects were also evaluated in the present study. RESULTS: For construct validity and floor and ceiling effect measurements, a total sample of 107 participants was used. For reliability, a subsample of 51 participants out of the total sample was used. We identified adequate values for reliability (kappa ≥ 0.79 and ICC = 0.98) and internal consistency (Cronbach's alpha = 0.84). Regarding the error inherent in the FINDRISC, we found SEM = 8.02% and MDC = 22.44%. There were significant correlations between the FINDRISC and the QRDM (r = 0.686) and DKN-A (r = -0.216). No ceiling or floor effects were found. CONCLUSION: The Brazilian version of the FINDRISC has adequate psychometric properties that are in accordance with the best international recommendations.

O diálogo aberto e os desafios para sua implementação - análise a partir da revisão da literatura / Open Dialogue and the Challenges for its Implementation - an analysis based on a review of the literature

Resumo O Método Diálogo Aberto foi desenvolvido na Finlândia para atender crises psíquicas graves utilizando diálogo e inclusão da rede social. Este artigo pretende, através de uma revisão da literatura sobre o Método do Diálogo Aberto, identificar seus princípios e contribuições para processos de desisntitucionalização. Método: As bases utilizadas neste artigo de revisão foram: PubMed (365), PsycInfo (134) e Lilacs (nehuma publicação encontrada), além de 2 livros, incluídos por referência cruzada. Foram selecionadas 34 publicações que atendiam ao objetivo proposto. A busca foi realizada em outubro de 2015. Os descritores selecionados foram: open dialogue, crisis, first episode psycosis, schizophrenia, terapy family, need adapted approach. Resultados: Foram encontrados 3 artigos de revisão, 5 estudos teóricos, 21 estudos qualitativos e 5 estudos quantitativos. Destes, 2 foram escritos em italiano, 1 em francês e 31 em inglês. Com relação ao país de origem dos autores temos: Noruega, Estados Unidos, Finlândia, Austrália, Reino Unido, Bélgica, Canadá e Polônia. As produções foram agrupadas para análise em: Concepções e princípios do Diálogo Aberto; Contribuições do diálogo Aberto; Desafios para implementação do Diálogo Aberto em outros países, realidades e contextos.

Abstract The Open Dialogue Method was developed in Finland in order to deal with severe psychotic crises using dialogue and social network inclusion. By means of a review of the literature on the Open Dialogue Method, this article sought to identify the principles and contributions for deinstitutionalization. Method: The PubMed (365), PsycInfo (134), Lilacs (no articles found) databases and 2 books were consulted. Thirty-four publications that fulfilled the requirements of this review were selected. The search was conducted in October 2015. The key words used were: open dialogue, crisis, first psychotic episode, schizophrenia, family therapy, need-adapted approach. Results: There were 3 reviews, 5 theoretical studies, 21 qualitative studies and 5 quantitative studies. Two of them were written in Italian, one in French and thirty-one in English. The authors were from Norway, the United States, Finland, Australia, the United Kingdom, Belgium, Canada and Poland. The publications were grouped for purposes of analysis into the following categories: Open Dialogue concepts and principles; Open Dialogue contributions; Challenges for Open Dialogue implementation in other countries, realities and contexts.

Therapeutic efficacy of Mirena in gynecologic disease

The levonorgestrel-releasing intrauterine system (LNG-IUS) was originally developed as a method of contraception and was first marketed in Finland in 1990. In Korea, the only LNG-IUS approved for non-contraceptive use is Mirena, a T-shaped device with a vertical stem containing a reservoir of 52 mg of levonorgestrel, which releases 20 µg of levonorgestrel per day. The device's strong local effects on the endometrium benefit women with gynecological conditions such as heavy menstrual bleeding, dysmenorrhea, leiomyoma, adenomyosis, and endometriosis. There is also evidence to support its role in endometrial protection during postmenopausal estrogen therapy and in the treatment of endometrial hyperplasia without atypia and, possibly, early endometrial cancer. Because of its effectiveness, safety, and high patient satisfaction, the LNG-IUS will continue to provide important benefits in women's reproductive health.

Prenatal diagnosis of a fetus affected with Finnish type congenital nephrotic syndrome / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a fetus suspected for congenital nephrotic syndrome of Finland (CNF).@*METHODS@#Genomic DNA was extracted from peripheral and umbilical cord blood samples derived from both parents and the fetus. Potential variants were detected by using next-generation sequencing. Suspected variants were confirmed by Sanger sequencing.@*RESULTS@#The fetus was found to carry compound heterozygous variants c.1440+1G>A and c.925G>T of the NPHS1 gene, which were respectively inherited from its mother and father.@*CONCLUSION@#Identification of the compound heterozygous NPHS1 variants has enabled diagnosis of CNF in the fetus and genetic counseling for the affected family.

Workplace Diesel Exhausts and Gasoline Exposure and Risk of Colorectal Cancer in Four Nordic Countries

BACKGROUND: Evidence on associations between occupational diesel exhaust and gasoline exposure and colorectal cancer is limited. We aimed to assess the effect of workplace exposure to diesel exhaust and gasoline on the risk of colorectal cancer. METHODS: This caseecontrol study included 181,709 colon cancer and 109,227 rectal cancer cases diagnosed between 1961 and 2005 in Finland, Iceland, Norway, and Sweden. Cases and controls were identified from the Nordic Occupational Cancer Study cohort and matched for country, birth year, and sex. Diesel exhaust and gasoline exposure values were assigned by country-specific job-exposure matrices. Odds ratios and 95% confidence intervals were calculated by using conditional logistic regression models. The results were adjusted for physical strain at work and occupational exposure to benzene, formaldehyde, ionizing radiation, chlorinated hydrocarbons, chromium, and wood dust. RESULTS: Diesel exhaust exposure was associated with a small increase in the risk of rectal cancer (odds ratio 1/4 1.05, 95% confidence interval 1.02–1.08). Gasoline exposure was not associated with colorectal cancer risk. CONCLUSION: This study showed a small risk increase for rectal cancer after workplace diesel exhaust exposure. However, this finding could be due to chance, given the limitations of the study.

IBD2020 global forum: results of an international patient survey on quality of care

BACKGROUND/AIMS: IBD2020 is a global forum for standards of care in inflammatory bowel disease (IBD). The aim of the IBD2020 survey was to identify and describe variations in quality care of IBD. METHODS: Patients with IBD from Finland, Italy, France, Canada, Germany, UK, Spain and Sweden were surveyed during 2013 to 2014, covering: disease characteristics; impact on life and work; organization and perceived quality of care. RESULTS: Seven thousand five hundred and seven patients participated (median age, 39 years [range, 10–103 years]; 2,354 male [31.4%]), including 4,097 (54.6%) with Crohn’s disease (CD) and 3,410 (45.4%) with ulcerative colitis (UC). Median time from symptom onset to diagnosis was 1 year for both CD (range, 0–47 years) and UC (range, 0–46 years), with no clear evidence of improvement in diagnostic delay over the preceding 24 years. Half of the patients (3,429; 50.0%) rated their care as “excellent” or “very good,” with similar results for CD and UC across countries. Five factors were significantly (P < 0.01) associated with perceived good quality of care: quality of specialist communication; review consultation being long enough; failure to share information; no access to a dietician; speed of advice. CONCLUSIONS: The IBD2020 survey has highlighted areas related to quality of care of IBD from the patients’ perspective, with scope for improvement.

The Big Vitamin D Mistake / 예방의학회지

Since 2006, type 1 diabetes in Finland has plateaued and then decreased after the authorities' decision to fortify dietary milk products with cholecalciferol. The role of vitamin D in innate and adaptive immunity is critical. A statistical error in the estimation of the recommended dietary allowance (RDA) for vitamin D was recently discovered; in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L. Another study confirmed that 6201 IU/d was needed to achieve 75 nmol/L and 9122 IU/d was needed to reach 100 nmol/L. The largest meta-analysis ever conducted of studies published between 1966 and 2013 showed that 25-hydroxyvitamin D levels 1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.

Salud mental en Chile y Finlandia: desafíos y lecciones / Mental health in Chile and Finland: challenges and lessons

This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finland’s experience demonstrates the importance of political will and long-term vision in the construction of mental health policies.

Month and Season of Birth as a Risk Factor for Alzheimer's Disease: A Nationwide Nested Case-control Study / 예방의학회지

OBJECTIVES: Season of birth, an exogenous indicator of early life environment, has been related to higher risk of adverse psychiatric outcomes but the findings for Alzheimer's disease (AD) have been inconsistent. We investigated whether the month or season of birth are associated with AD. METHODS: A nationwide nested case-control study including all community-dwellers with clinically verified AD diagnosed in 2005 to 2012 (n=70 719) and up to four age- sex- and region of residence-matched controls (n=282 862) residing in Finland. Associations between month and season of birth and AD were studied with conditional logistic regression. RESULTS: Month of birth was not associated with AD (p=0.09). No strong associations were observed with season (p=0.13), although in comparison to winter births (December-February) summer births (June-August) were associated with higher odds of AD (odds ratio, 1.03; 95% confidence interval, 1.00 to 1.05). However, the absolute difference in prevalence in winter births was only 0.5% (prevalence of those born in winter were 31.7% and 32.2% for cases and controls, respectively). CONCLUSIONS: Although our findings do not support the hypothesis that season of birth is related to AD/dementia risk, they do not invalidate the developmental origins of health and disease hypothesis in late-life cognition. It is possible that season does not adequately capture the early life circumstances, or that other (postnatal) risk factors such as lifestyle or socioeconomic factors overrule the impact of prenatal and perinatal factors.

Improved biological performance of magnesium by micro-arc oxidation

Magnesium and its alloys have recently been used in the development of lightweight, biodegradable implant materials. However, the corrosion properties of magnesium limit its clinical application. The purpose of this study was to comprehensively evaluate the degradation behavior and biomechanical properties of magnesium materials treated with micro-arc oxidation (MAO), which is a new promising surface treatment for developing corrosion resistance in magnesium, and to provide a theoretical basis for its further optimization and clinical application. The degradation behavior of MAO-treated magnesium was studied systematically by immersion and electrochemical tests, and its biomechanical performance when exposed to simulated body fluids was evaluated by tensile tests. In addition, the cell toxicity of MAO-treated magnesium samples during the corrosion process was evaluated, and its biocompatibility was investigated under in vivo conditions. The results of this study showed that the oxide coating layers could elevate the corrosion potential of magnesium and reduce its degradation rate. In addition, the MAO-coated sample showed no cytotoxicity and more new bone was formed around it during in vivo degradation. MAO treatment could effectively enhance the corrosion resistance of the magnesium specimen and help to keep its original mechanical properties. The MAO-coated magnesium material had good cytocompatibility and biocompatibility. This technique has an advantage for developing novel implant materials and may potentially be used for future clinical applications.

Effects of 5-aza-2′deoxycytidine on RECK gene expression and tumor invasion in salivary adenoid cystic carcinoma

Reversion-inducing cysteine-rich protein with kazal motifs (RECK), a novel tumor suppressor gene that negatively regulates matrix metalloproteinases (MMPs), is expressed in various normal human tissues but downregulated in several types of human tumors. The molecular mechanism for this downregulation and its biological significance in salivary adenoid cystic carcinoma (SACC) are unclear. In the present study, we investigated the effects of a DNA methyltransferase (DNMT) inhibitor, 5-aza-2′deoxycytidine (5-aza-dC), on the methylation status of the RECK gene and tumor invasion in SACC cell lines. Methylation-specific PCR (MSP), Western blot analysis, and quantitative real-time PCR were used to investigate the methylation status of the RECK gene and expression of RECK mRNA and protein in SACC cell lines. The invasive ability of SACC cells was examined by the Transwell migration assay. Promoter methylation was only found in the ACC-M cell line. Treatment of ACC-M cells with 5-aza-dC partially reversed the hypermethylation status of the RECK gene and significantly enhanced the expression of mRNA and protein, and 5-aza-dC significantly suppressed ACC-M cell invasive ability. Our findings showed that 5-aza-dC inhibited cancer cell invasion through the reversal of RECK gene hypermethylation, which might be a promising chemotherapy approach in SACC treatment.

Lesiones focales hepáticas benignas: un hallazgo frecuente a la tomografía computada / Benign focal liver lesions detected by computed tomography: Review of 1,184 examinations

Background: Multidetector computed tomography (MDCT) of the abdomen, with use of contrast medium, is able to detect and differentiate most focal liver lesions. Aim: To determine the prevalence and features of benign focal liver lesions (BFLL) detected by abdominal MDCT. Patients and Methods: We reviewed the reports of contrast abdominal MDCT performed to outpatients between August 2011 and July 2012. Clinical data of examined patients and imaging findings in terms of description of the hepatic parenchyma and the presence of BFLL, were recorded. Results: Data from 1,184 studies were analyzed. Of these, 461 studies (38.4%) reported BFLL. The most prevalent lesions were simple cysts in 290 studies (24%) and hemangiomas in 61 studies (5.1%), granuloma-calcification in 39 (3.2%), focal nodular hyperplasia in 19 (1.6%) and one adenoma. If patients with known causes of liver disease were excluded, the prevalence of BFLL did not change substantially (lesions were found in 396 (37.5%) patients). Compared with livers with signs of damage, normal livers had more cystic lesions (27 and 16.2% respectively, p = 0.014) and hemangiomas (5.3 and 1.1% respectively, p = 0.043). Conclusions: BFLL are very common findings in MDCT studies. Most of these lesions are simple cysts and hemangiomas.

Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase / Análise do protocolo adaptado de steps na reabilitação cardíaca na fase hospitalar

Objective: To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods: This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results: In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion: This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery. .

Objetivo: Analisar o protocolo adaptado de reabilitação cardíaca na fisioterapia durante a fase hospitalar pós-operatória de cirurgia cardíaca em um serviço de alta complexidade, nos aspectos complicações e prevalência de mortalidade e dias de internação. Métodos: Estudo observacional transversal, retrospectivo, analítico. Realizado por meio da investigação de 99 prontuários de pacientes submetidos à cirurgia cardíaca de revascularização do miocárdio, troca de valva cardíaca ou associadas. Foi analisado um programa de step adaptado para reabilitação pós-operatória de cirurgia cardíaca executado pela equipe de Fisioterapia. Resultados: Em média, o paciente permanece dois dias na Unidade de Terapia Intensiva e de três a quatro dias no quarto, ficando, em média, seis dias internado no hospital. O óbito ocorreu em maior percentual no período hospitalar (5,1%) e até dois anos (8,6%) quando comparado ao período de 30 dias pós-alta hospitalar (1,1%). Dentre as complicações no pós-operatório, as hemodinâmicas (63,4%) e respiratórias (42,6%) foram as mais predominantes. De 36% a 42% das complicações ocorreram entre o pós-operatório imediato e o segundo dia pós-operatório. A alta hospitalar teve início a partir do quinto dia pós-operatório. Podemos observar que, com o passar dos dias, os pacientes vão evoluindo na realização dos steps, sendo que o mais utilizado durante a reabilitação na fase I foi o Step 3. Conclusão: Este programa de evolução por steps pode nortear a reabilitação fisioterapêutica nos pacientes no pós-operatório de cirurgia cardíaca na fase hospitalar. .

Evaluation of the predictive indices for candidemia in an adult intensive care unit

INTRODUCTION: To evaluate predictive indices for candidemia in an adult intensive care unit (ICU) and to propose a new index. METHODS: A prospective cohort study was conducted between January 2011 and December 2012. This study was performed in an ICU in a tertiary care hospital at a public university and included 114 patients staying in the adult ICU for at least 48 hours. The association of patient variables with candidemia was analyzed. RESULTS: There were 18 (15.8%) proven cases of candidemia and 96 (84.2%) cases without candidemia. Univariate analysis revealed the following risk factors: parenteral nutrition, severe sepsis, surgical procedure, dialysis, pancreatitis, acute renal failure, and an APACHE II score higher than 20. For the Candida score index, the odds ratio was 8.50 (95% CI, 2.57 to 28.09); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.78, 0.71, 0.33, and 0.94, respectively. With respect to the clinical predictor index, the odds ratio was 9.45 (95%CI, 2.06 to 43.39); the sensitivity, specificity, positive predictive value, and negative predictive value were 0.89, 0.54, 0.27, and 0.96, respectively. The proposed candidemia index cutoff was 8.5; the sensitivity, specificity, positive predictive value, and negative predictive value were 0.77, 0.70, 0.33, and 0.94, respectively. CONCLUSIONS: The Candida score and clinical predictor index excluded candidemia satisfactorily. The effectiveness of the candidemia index was comparable to that of the Candida score. .

Examen de detección de virus papiloma humano en el tamizaje de cáncer cervicouterino en un Servicio de Salud de Santiago, Chile / Human papillomavirus testing in cervical cancer screening at a public health service of Santiago, Chile

Background: Molecular techniques for human papillomavirus (HPV) detection have a good performance as screening tests and could be included in cervical cancer early detection programs. We conducted a population-based trial comparing HPV detection and Papanicolaou as primary screening tests, in a public health service in Santiago, Chile. Aim: To describe the experience of implementing this new molecular test and present the main results of the study. Material and Methods: Women aged 25 to 64 enrolled in three public health centers were invited to participate. In all women, samples were collected for Papanicolaou and HPV DNA testing, and naked-eye visual inspection of the cervix with acetic acid was performed. Women with any positive screening test were referred to the local area hospital for diagnostic confirmation with colposcopy and biopsy of suspicious lesions. Results: Screening results were obtained for 8265 women, of whom 931 (11.3%) were positive to any test. The prevalence of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was 1.1%; nine women had invasive cervical cancer. Sensitivities for the detection of CIN2+ were 22.1% (95% confidence interval (CI) 16.4-29.2) for Papanicolaou and 92.7% (95% CI 84.4-96.8) for HPV testing; specificities were 98.9% (95% CI 98.7-99.0) and 92.0% (95% CI 91.4-92.6) respectively. Conclusion: This experience showed that the implementation of a molecular test for cervical cancer screening is not a major challenge in Chile: it was well accepted by both the health team and the participants, and it may improve the effectiveness of the screening program.

Reduced severity and improved control of self-reported asthma in Finland during 2001-2010

BACKGROUND: Asthma and allergies are common and cause substantial burden in symptoms and suffering, hospitalizations and medication costs. However, despite the high prevalence, asthma burden has already decreased in Finland in 2000s. OBJECTIVE: We carried out an asthma barometer survey in all Finnish pharmacies to study changes in asthma severity and control, and use of health care services from 2001 to 2010. METHODS: Asthma severity, comorbid allergic conditions, and use of medication and health care services were assessed in subjects who purchased asthma or allergy medication from the pharmacies all across the country during one week in 2001 and again in 2010. In 2001, 3,062 patients (mean age, 49 years), and in 2010, 1,114 patients (mean age, 51 years) participated. RESULTS: In 2001 90% and in 2010 73% of the respondents reported physician-diagnosed asthma and were entitled to special reimbursement for their drug costs, i.e., they needed regular maintenance treatment. In 2001, 10% of the asthmatics regarded their disease as severe, compared with 4% in 2010, while the figures for mild asthma were 45% and 62%, respectively (p < 0.001). The proportion of patients needing emergency care during the last year decreased from 34% (2001) to 14% (2010) (p < 0.001) and the need for hospitalizations from 18% to 6% (p < 0.001). Smoking reduced from 24% to 18% among asthmatics ( p = 0.002). In 2010, risk factors for severe asthma were older age, comorbid atopic eczema, and food allergy. CONCLUSION: During ten years, self-reported asthma severity has reduced and disease control improved in Finland.

Reliability Comparison of Rebound Tonometer at the Upright and Supine Position

PURPOSE: Rebound tonometer has been used to measure the intraocular pressure (IOP) in the supine as well as normal upright positions. We investigated the reliability of IOP measurements using the rebound tonometer in the upright and supine positions. METHODS: IOP was measured in 30 patients (60 eyes) with open-angle glaucoma who had no history of ocular surgery and no anterior segment pathology, in both the upright and supine positions using rebound tonometer (IcarePRO; Icare Finland Oy, Finland). The average IOP value after 6 measurements was recorded. We measured IOP repeatedly until 3 reliable values within normal limits of the measurement's variation were obtained. We calculated the intraclass correlation coefficient (ICC), coefficient of variation, and number of repeated measurements necessary to obtain 3 reliable IOP values in each position as measured by one examiner. RESULTS: ICC values for IOP measurements were 0.852 (95% confidence interval [CI], 0.784-0.903; p < 0.001) in the upright position and 0.684 (95% CI, 0.563-0.784; p < 0.027) in the supine position. Coefficient of variation was 8.7 +/- 0.1% in the upright position and 24.0 +/- 0.1% in the supine position. An average of 3.3 times of repeated measurements in the upright position and 6.2 times in the supine position were necessary to obtain 3 reliable IOP values within the normal range of standard deviation. CONCLUSIONS: When measuring IOP using the IcarePRO rebound tonometer, the measurement reliability was different between the upright and supine positions. Reproducibility of IOP measurements was lower in the upright than the supine position.