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1.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(10): 1022-1024, 2019 Oct 10.
Artigo em Chinês | MEDLINE | ID: mdl-31598951

RESUMO

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.


Assuntos
Síndrome Nefrótica/congênito , Síndrome Nefrótica/diagnóstico , Feminino , Feto , Finlândia , Heterozigoto , Humanos , Proteínas de Membrana/genética , Gravidez , Diagnóstico Pré-Natal
2.
Cent Eur J Public Health ; 27(3): 182-187, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31580551

RESUMO

OBJECTIVES: Although manufactured cigarettes remain the most popular tobacco product worldwide, the use of other products, including little cigar and cigarillo, has been rising in recent years; however, there is a paucity of data on the correlates of current and ever use of cigarillos in Europe. The aim of this study was to explore the extent and determinants of cigarillo use, as well as to describe the cost and affordability of cigarillos across the EU, in light of the current regulatory framework at a European level. METHODS: We performed a secondary analysis of data collected across 28 European Union (EU) Member States through wave 87.1 of the Eurobarometer survey, conducted in March 2017 (N = 27,901). A multilevel logistic regression model was fitted to assess the association of current and ever cigarillo use with the above socio-demographic factors. We also analysed Euromonitor International data on cigarillo prices in 2017 from 24 EU Member States. RESULTS: Across the EU, 0.46% (95% CI: 0.33-0.63) of those aged ≥ 15 years reported at least weekly current use of cigarillos in 2017, which corresponds to 1,966,516 (95% CI: 1,426,554-2,709,563) people. Finland recorded the highest prevalence (20.51%) of ever cigarillo use in Europe while Ireland had the lowest (1.15%). Male sex, living in urban area and being over 55 years old compared to 15-24 year olds were associated with greater odds of ever cigarillo use. Median cigarillo prices varied widely, ranging from 3.60 Euros in Portugal to 20.40 Euros in Bulgaria per 20 sticks. CONCLUSIONS: The use of cigarillos in Europe is associated with several socio-demographic factors such as gender, age and living area. Policy makers of EU countries, especially now under the regulatory framework of the EU Tobacco Products Directive, should work together to enforce more restrictive rules for cigarillos.


Assuntos
Fumar , Produtos do Tabaco , Bulgária , Europa (Continente) , Finlândia , Humanos , Masculino , Prevalência
3.
BMJ ; 367: l5678, 2019 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619384

RESUMO

OBJECTIVE: To determine if postnatal transfer or birth in a non-tertiary hospital is associated with adverse outcomes. DESIGN: Observational cohort study with propensity score matching. SETTING: National health service neonatal care in England; population data held in the National Neonatal Research Database. PARTICIPANTS: Extremely preterm infants born at less than 28 gestational weeks between 2008 and 2015 (n=17 577) grouped based on birth hospital and transfer within 48 hours of birth: upward transfer (non-tertiary to tertiary hospital, n=2158), non-tertiary care (born in non-tertiary hospital; not transferred, n=2668), and controls (born in tertiary hospital; not transferred, n=10 866). Infants were matched on propensity scores and predefined background variables to form subgroups with near identical distributions of confounders. Infants transferred between tertiary hospitals (horizontal transfer) were separately matched to controls in a 1:5 ratio. MAIN OUTCOME MEASURES: Death, severe brain injury, and survival without severe brain injury. RESULTS: 2181 infants, 727 from each group (upward transfer, non-tertiary care, and control) were well matched. Compared with controls, infants in the upward transfer group had no significant difference in the odds of death before discharge (odds ratio 1.22, 95% confidence interval 0.92 to 1.61) but significantly higher odds of severe brain injury (2.32, 1.78 to 3.06; number needed to treat (NNT) 8) and significantly lower odds of survival without severe brain injury (0.60, 0.47 to 0.76; NNT 9). Compared with controls, infants in the non-tertiary care group had significantly higher odds of death (1.34, 1.02 to 1.77; NNT 20) but no significant difference in the odds of severe brain injury (0.95, 0.70 to 1.30) or survival without severe brain injury (0.82, 0.64 to 1.05). Compared with infants in the upward transfer group, infants in the non-tertiary care group had no significant difference in death before discharge (1.10, 0.84 to 1.44) but significantly lower odds of severe brain injury (0.41, 0.31 to 0.53; NNT 8) and significantly higher odds of survival without severe brain injury (1.37, 1.09 to 1.73; NNT 14). No significant differences were found in outcomes between the horizontal transfer group (n=305) and controls (n=1525). CONCLUSIONS: In extremely preterm infants, birth in a non-tertiary hospital and transfer within 48 hours are associated with poor outcomes when compared with birth in a tertiary setting. We recommend perinatal services promote pathways that facilitate delivery of extremely preterm infants in tertiary hospitals in preference to postnatal transfer.


Assuntos
Lesões Encefálicas , Salas de Parto , Doenças do Prematuro , Transferência de Pacientes , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/etiologia , Lesões Encefálicas/mortalidade , Salas de Parto/classificação , Salas de Parto/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Lactente Extremamente Prematuro , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/etiologia , Doenças do Prematuro/mortalidade , Masculino , Transferência de Pacientes/métodos , Transferência de Pacientes/estatística & dados numéricos , Gravidez , Resultado da Gravidez/epidemiologia , Pontuação de Propensão , Análise de Sobrevida , Centros de Atenção Terciária/estatística & dados numéricos
4.
Int J Prosthodont ; 32(5): 402-410, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486810

RESUMO

PURPOSE: To evaluate the challenges of the direct filling technique, the use of dental chairside CAD/CAM milling, the use of 3D printing, and the attitudes toward 3D printing-based applications for restorative treatments among Finnish dentists. MATERIALS AND METHODS: An electronic questionnaire was sent to 3,777 Finnish dentists. Background information, challenges linked to the direct filling technique, use of dental chairside CAD/CAM milling, use of 3D printing, and attitudes toward 3D printing-based applications in restorative dentistry were asked in the questionnaire with multiple-choice questions. The number of replies was 760, and the response rate was 20.1%. RESULTS: Poor survival rates and moisture sensitivity were the main reported challenges associated with the direct filling technique. Use of chairside CAD/CAM milling was reported by 271 (35.7%) respondents. Use of 3D printing technique was reported by 54 (7.1%) respondents. Most respondents answered that they would consider using 3D printing for manufacturing tooth fillings in the future. CONCLUSION: If dental chairside CAD/CAM technology can provide a solution for manufacturing long-lasting indirect restorations with good esthetic properties and an effective cost-benefit ratio, the wider use of chairside CAD/CAM systems might be indicated, especially in the public sector. New 3D printing-based applications used for restorative treatments are attracting interest among Finnish dentists, but also indicate a need for further development of 3D printing techniques for cost-effective restorative treatment.


Assuntos
Planejamento de Prótese Dentária , Estética Dentária , Atitude , Projeto Auxiliado por Computador , Odontólogos , Finlândia , Humanos , Impressão Tridimensional
5.
Sci Total Environ ; 692: 1070-1085, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31539939

RESUMO

The aim of this work is (i) to review the recent studies on weather and climate change in Finnish Sápmi and to present the literature review findings alongside our survey on the observations made by local reindeer herders on the same phenomena, and, further, (ii) to review the impacts of climate change on the ecosystem services (ES) in Finnish Sápmi. The focus of the study is on the impacts of climate change on those habitat, provisioning and cultural ecosystem services which are interconnected with the Saami way of life as Indigenous people and thus support the continuity of their culture. In the holistic world view of Arctic Indigenous peoples, material culture and non-material culture are not separated, and there is no boundary between nature and culture. However, cultural and spiritual meanings of ecosystems, species and landscapes are rarely taken into account in scientific research on ecosystems services. Our review indicates that mostly negative impacts of climate warming on ecosystems and traditional livelihoods are to be expected in Sápmi. The most profound negative impacts will be on palsa mire and fell ecosystems, in particular snowbeds, snow patches and mountain birch forests. Consequently, changes in ecosystems may erode cultural meanings, stories, memories and traditional knowledge attached to them and affect the nature-based traditional livelihoods. In a situation where our rapidly changing climate is affecting the foundations of the nature-based cultures, the present review can provide a knowledge base for developing adaptation actions and strategies for local communities and Indigenous peoples to cope with changes caused by climate change and other drivers.


Assuntos
Mudança Climática , Ecossistema , Monitoramento Ambiental , Finlândia
6.
Ambio ; 48(11): 1350-1361, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473976

RESUMO

This paper applies the concept of cultural ecosystem services (CES) to reveal the diverse benefits the Baltic Sea provides to human well-being. The study identifies and defines relevant CES for marine and coastal environments and applies them in a survey with 4800 respondents from Germany, Finland and Latvia. The relative importance of various CES was determined by asking respondents to allocate 100 points between CES related to recreation, landscape, inspiration, learning and education, spiritual experiences and belonging, historically and culturally important places and the existence of habitats. The results reveal significant differences in the importance of various CES across countries, users and nonusers of the Baltic Sea, as well as respondents with different human-nature relationships. The results emphasize the importance of considering recreation, landscapes and habitats in conservation policies, while acknowledging that all CES are perceived as important by some population groups.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Países Bálticos , Finlândia , Alemanha , Humanos , Letônia , Oceanos e Mares
7.
Oecologia ; 191(3): 601-608, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31522244

RESUMO

The functional composition of plant communities is a critical modulator of climate change impacts on ecosystems, but it is not a simple function of regional climate. In the Arctic tundra, where climate change is proceeding the most rapidly, communities have not shifted their trait composition as predicted by spatial temperature-trait relationships. Important causal pathways are thus missing from models of trait composition change. Here, we study causes of plant community functional variation in an oroarctic tundra landscape in Kilpisjärvi, Finland. We consider the community-weighted means of plant vegetative height, as well as two traits related to the leaf economic spectrum. Specifically, we model their responses to locally measured summer air temperature, snow conditions, and soil resource levels. For each of the traits, we also quantify the importance of intraspecific trait variation (ITV) for between-community functional differences and trait-environment matching. Our study shows that in a tundra landscape (1) snow is the most influential abiotic variable affecting functional composition, (2) vegetation height is under weak local environmental control, whereas leaf economics is under strong local environmental control, (3) the relative magnitude of ITV differs between traits, and (4) ITV is not very consequential for community-level trait-environment relationships. Our analyses highlight the importance of winter conditions for community functional composition in seasonal areas. We show that winter climate change can either amplify or counter the effects summer warming, depending on the trait.


Assuntos
Ecossistema , Neve , Finlândia , Plantas , Tundra
8.
Nurs Educ Perspect ; 40(5): 283-290, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436691

RESUMO

AIM: This exploratory, qualitative study was conducted to compare nursing tasks/roles in Ecuador, Finland, Ghana, Navajo Nation, Russia, Taiwan, and Tonga. BACKGROUND: The definition of nurse varies internationally, with little description of the specific tasks nurses perform. To better know the profession, nurses must understand what their counterparts do in different parts of the world. METHOD: Students and faculty traveled to seven nations to conduct an observational study. Students observed nurses (n = 71) over a period of three weeks using a checklist of basic tasks/skills, advanced skills, critical thinking, communication, public health, and professionalism. RESULTS: Similarities in nursing tasks/roles were found, with a few stark differences between countries. Autonomy of practice and communication styles varied; all nurses were found to be effective patient advocates. CONCLUSION: Sufficient nursing personnel, resources, patient load, and technology affect nursing tasks/roles.


Assuntos
Comparação Transcultural , Papel do Profissional de Enfermagem , Estudantes de Enfermagem/psicologia , Equador , Finlândia , Gana , Humanos , Pesquisa Qualitativa , Federação Russa , Taiwan , Tonga , Estados Unidos
9.
Nurs Educ Perspect ; 40(5): 300-302, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31436694

RESUMO

The purpose of this study was to explore nursing students' perceptions of global health experiences from an international partnership. Nursing organizations have identified global health care as core knowledge. To address global health care competencies and culture awareness, activities were designed by nursing faculty in Finland and the United States. A mixed-method questionnaire was given to 111 students. Data suggest contact with international nursing peers and learning activities increased understanding of health issues in another culture and increased student self-confidence and communication. Developing a partnership between nursing schools can result in positive global health learning experiences for students.


Assuntos
Educação em Enfermagem/organização & administração , Intercâmbio Educacional Internacional , Satisfação Pessoal , Estudantes de Enfermagem/psicologia , Finlândia , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Estados Unidos
10.
Waste Manag ; 97: 97-104, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31447032

RESUMO

For enhancing food waste weighing measurements we established a platform (Restaurant Forum RF) for different kinds of food service businesses. Our aim was to explore food waste data, but also to develop a monitoring system by increasing our knowledge about the relevant processes and possible internal barriers. We studied food waste generation and origin in the outlets and how to avoid overproduction of food and buffet line waste. During 2016-2017, a number of outlets (n = 51) conducted food waste measurements over a period of two weeks. The businesses that participated included schools, day-care centres and work place and student canteens, which present sectors that mainly serve a lunch buffet. According to our results, 17.5% of all prepared food ended up as waste, which can be further divided into kitchen waste (2.2%), serving waste (11.3%) and customer leftovers (3.9%). On average, 449 g of food was prepared per portion and 78 g of this ended up as waste. We also studied the mechanisms of waste generation, best practices for decreasing food waste, how staff experienced weighing measurements and how measurement systems can be utilized in food service business management.


Assuntos
Serviços de Alimentação , Finlândia , Humanos , Almoço , Restaurantes , Instituições Acadêmicas , Estudantes
11.
Stud Health Technol Inform ; 264: 1253-1257, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438126

RESUMO

The training and competence of healthcare professionals are key factors in adopting new eHealth services. The scope of eHealth is broadening from information systems to eHealth services such as patient portals supporting self-management, which create a need for new competencies. In this study, we evaluated clinical leaders' eHealth competencies and training needs in two public healthcare organizations in Finland. The target organizations' goal was to increase the number of patients' eHealth services and clinical leaders were seen as critical in this change. Data were collected through an online survey of 98 clinical leaders working in two healthcare organizations. The results imply that managing change and planning implementation are challenging to clinical leaders. They need more information about eHealth services, their possibilities, and benefits in order to support their subordinates and patients. The clinical leaders seem to be in a critical role in supporting healthcare professionals and avoiding resistance to change.


Assuntos
Portais do Paciente , Autogestão , Telemedicina , Finlândia , Pessoal de Saúde , Humanos
12.
BMC Public Health ; 19(1): 1011, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357984

RESUMO

BACKGROUND: Previous research has shown that certain living arrangements, such as living alone, are associated with worse health at older ages. We assessed the association between living arrangements and hospital care use among middle-aged and older adults, and investigated to what extent observed and unobserved individual characteristics explain this association. METHODS: Longitudinal Finnish registry data for men and women aged 50-89 years were used for the period 1987-2007. The relationship between living arrangements (based on whether an individual lived with a partner, other adults or alone, and whether they lived with minor/adult children) and heavy hospital care use (i.e., having been in hospital for 8 or more days in a year) was studied. First, we applied logistic regression models and linear probability models controlling for observed time-invariant factors (socioeconomic status measured by education, labour force status, and household income; and marital status), and then individual linear probability models with fixed-effects to further account for unobserved time-invariant individual characteristics in the measurement period. Analyses were done separately for 10 year age-groups. RESULTS: In the logistic regression models, men and women who lived alone had higher crude odds of heavy hospital care use than those living only with their partner. These odds ratios were highest for men and women in the youngest age category (50-59 years, 1.72 and 1.36 respectively) and decreased with age. Adjusting for observed time-invariant socioeconomic status attenuated these odds by 14-40%, but adjusting for marital status did not affect the results. Lower odds were observed among adults aged 50-59 years who lived with their partner and (minor or adult) children. But odds were higher for individuals aged 60-79 years who co-resided with their adult children, regardless of whether they lived with a partner. Adjusting for observed time-invariant factors generally did not change these results. After further adjusting for unobserved time-invariant individual characteristics in the individual fixed-effects models, most of these associations largely attenuated or disappeared, particularly for ages 80-89 years. CONCLUSIONS: The association between living arrangements and higher use of hospital care at middle and older ages is largely explained by socioeconomic disadvantage and unobserved time-invariant individual characteristics.


Assuntos
Hospitalização/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Finlândia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores Socioeconômicos
13.
Nord J Psychiatry ; 73(6): 340-348, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259640

RESUMO

Purpose: This study examined a developmental model that links affect-regulation difficulties in childhood with three dimensions of alexithymia in adolescence (difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking) and substance use and depression in adulthood, while accounting for cumulative contextual risk in childhood, and testing potential gender moderation. Methods: Multiple group path analyses were conducted using data from the Northern Finland Birth Cohort 1986 (N = 6963). Analyses used data collected during prenatal/birth, childhood, adolescence, and young adulthood periods. Results: Our examination of early precursors for alexithymia indicated that the associations of affect-regulation problems in childhood with alexithymia were stronger for girls, potentially putting girls with affect-regulation difficulties in childhood at higher risk for developing alexithymia in adolescence. The associations of cumulative contextual risk in childhood with alexithymia, substance use disorder, and depression diagnosis in adulthood were significant for both girls and boys. Our findings in regard to substance use and depression disorders revealed that alexithymia in adolescence predicted depression diagnosis in adulthood, particularly due to a contribution from the alexithymia domain of 'difficulties identifying feelings.' However, none of the alexithymia domains was directly associated with substance use disorder in adulthood. Conclusions: Our study contributes to research that links alexithymia with difficulties in affect regulation and cumulative contextual risk in childhood, yielding findings that may be relevant for preventive interventions.


Assuntos
Sintomas Afetivos/complicações , Depressão/complicações , Transtorno Depressivo/complicações , Psicologia do Adolescente , Transtornos Relacionados ao Uso de Substâncias/complicações , Adolescente , Adulto , Criança , Estudos de Coortes , Emoções , Feminino , Finlândia , Humanos , Masculino , Gravidez , Adulto Jovem
14.
Nord J Psychiatry ; 73(6): 357-364, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31271336

RESUMO

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.


Assuntos
Transtornos Mentais/mortalidade , Adolescente , Adulto , Alcoolismo/mortalidade , Alcoolismo/psicologia , Causas de Morte , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Autodestrutivo/mortalidade , Comportamento Autodestrutivo/psicologia , Fatores Socioeconômicos , Suicídio/estatística & dados numéricos , Adulto Jovem
15.
J Environ Manage ; 247: 580-587, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31260924

RESUMO

A displacement factor (DF) may be used to describe the efficiency of using wood-based products or fuels instead of fossil-based ones to reduce net greenhouse gas (GHG) emissions. However, the DFs of individual products and their production volumes could not be used alone to evaluate the climate impacts of forest utilization. For this reason, in this study we have developed a methodology to assess a required displacement factor (RDF) for all wood products and bioenergy manufactured and harvested in a certain country in order to achieve zero CO2 equivalent emissions from increased forest utilization over time in comparison with a selected baseline harvesting scenario. Input data for calculations were produced with the simulation model, Monsu, capable of predicting the carbon stocks of forests and wood-based products. We tested the calculations in Finnish conditions in a 100-year time horizon and estimated the current average DF of manufactured wood-based products and fuels in Finland for the interpretation of RDF results. The results showed that if domestic wood harvesting will be increased by 17-33% compared to the basic scenario, the RDF will be 2.0 to 2.4 tC tC-1 for increased wood use in 2017-2116. However, the estimated average DF of manufactured wood-based products and fuels currently in Finland was less than 1.1 tC tC-1. The results indicate strongly that the increased harvesting intensity from the current situation would represent a challenge for the Finnish forest-based bioeconomy from the viewpoint of climate change mitigation. For this reason, there is an immediate need to improve reliability and applicability of the RDF approach by repeating corresponding calculations in different circumstances and by improving estimations of DFs on country levels.


Assuntos
Gases de Efeito Estufa , Finlândia , Florestas , Efeito Estufa , Reprodutibilidade dos Testes , Madeira
16.
Health Qual Life Outcomes ; 17(1): 117, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286982

RESUMO

BACKGROUND: Type 2 diabetes (T2D) causes significant health and economic burden. In addition to comorbidities there are also coexisting diseases linked to obesity, lifestyle and T2D. The aim of this study was to examine the effect of T2D and T2D-coexisting diseases on health-related quality of life (HRQoL) in the Finnish population and whether it is T2D or the coexisting diseases that have the largest impact on HRQoL. METHODS: The study was based on a national cross-sectional population survey (n = 5305). Respondents' HRQoL was measured using the EQ-5D-5 L instrument. Our study included diabetic respondents treated with non-insulin medications (NI-T2D) with or without insulin and non-diabetic respondents, whereas diabetic respondents not taking any anti-diabetic medications or treated with insulin alone were excluded. A crosswalk algorithm was used to convert EQ-5D-5 L index scores into EQ-5D-3 L index scores as a sensitivity analysis. A two-part model was used to examine the association between T2D and coexisting diseases and HRQoL. RESULTS: The unadjusted mean (SD) EQ-5D-5 L index scores for non-diabetics (n = 4856) was 0.90 (0.13) and 0.85 (0.16) for respondents with NI-T2D (n = 449). With adjustment for demographic factors, the difference in EQ-5D-5 L index scores was 0.036 (95% CI 0.023-0.050). After adjusting for the number of coexisting diseases, the EQ-5D-5 L index scores among respondents with NI-T2D and three or more coexisting diseases were lower when compared to all non-diabetics but not when compared to non-diabetics with similar number of coexisting diseases. The number of T2D-coexisting diseases had a larger effect on EQ-5D-5 L index scores in younger age groups (20 and 40 years old). CONCLUSIONS: Lower EQ-5D-5 L index score is associated with NI-T2D when compared to non-diabetic respondents. When compared to non-diabetics, the disutility associated with NI-T2D increases as more coexisting diseases appear. The disutility effect of coexisting diseases was equally large in non-diabetics and respondents with NI-T2D. Thus, public health interventions targeting the prevention of both T2D and its coexisting diseases have potential to have significant benefits also in terms of HRQoL.


Assuntos
Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Feminino , Finlândia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Insulinas , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
17.
Genet Sel Evol ; 51(1): 35, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262246

RESUMO

BACKGROUND: The Finnhorse was established as a breed more than 110 years ago by combining local Finnish landraces. Since its foundation, the breed has experienced both strong directional selection, especially for size and colour, and severe population bottlenecks that are connected with its initial foundation and subsequent changes in agricultural and forestry practices. Here, we used sequences of the mitochondrial control region and genomic single nucleotide polymorphisms (SNPs) to estimate the genetic diversity and differentiation of the four Finnhorse breeding sections: trotters, pony-sized horses, draught horses and riding horses. Furthermore, we estimated inbreeding and effective population sizes over time to infer the history of this breed. RESULTS: We found a high level of mitochondrial genetic variation and identified 16 of the 18 haplogroups described in present-day horses. Interestingly, one of these detected haplogroups was previously reported only in the Przewalski's horse. Female effective population sizes were in the thousands, but declines were evident at the times when the breed and its breeding sections were founded. By contrast, nuclear variation and effective population sizes were small (approximately 50). Nevertheless, inbreeding in Finnhorses was lower than in many other horse breeds. Based on nuclear SNP data, genetic differentiation among the four breeding sections was strongest between the draught horses and the three other sections (FST = 0.007-0.018), whereas based on mitochondrial DNA data, it was strongest between the trotters and the pony-sized and riding horses (ΦST = 0.054-0.068). CONCLUSIONS: The existence of a Przewalski's horse haplogroup in the Finnhorse provides new insights into the domestication of the horse, and this finding supports previous suggestions of a close relationship between the Finnhorse and eastern primitive breeds. The high level of mitochondrial DNA variation in the Finnhorse supports its domestication from a large number of mares but also reflects that its founding depended on many local landraces. Although inbreeding in Finnhorses was lower than in many other horse breeds, the small nuclear effective population sizes of each of its breeding sections can be considered as a warning sign, which warrants changes in breeding practices.


Assuntos
Variação Genética , Cavalos/genética , Animais , Cruzamento , DNA Mitocondrial , Feminino , Finlândia , Endogamia , Masculino , Polimorfismo de Nucleotídeo Único , Densidade Demográfica , Especificidade da Espécie
18.
Stud Health Technol Inform ; 262: 304-307, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31349328

RESUMO

A digital service pathway for managing chronic headache has been designed in tertiary care in Finland. The digital tool facilitates self-management by providing exercises, information and messaging opportunities for patients. However, the largest potential benefits are in primaryand occupational care. Thus, the purpose of this study was to explore the needs and requirements of primary and occupational care actors for better understanding of the context in the transfer of the service. The study was performed as a single embedded case study. The qualitative data was collected through semi-structured interviews with 16 informants from different organizations and analyzed with Gioia-methodology. This study gathers important empirical knowledge about the meaning of context and transferring digital health interventions from one context to another from clinician and management perspective. Nine key contextual differences were identified and six main expectations emerged.


Assuntos
Cefaleia , Informática Médica , Atenção Primária à Saúde , Autogestão , Terapia por Exercício , Finlândia , Cefaleia/terapia , Humanos , Manejo da Dor , Pesquisa Qualitativa
20.
Lakartidningen ; 1162019 May 07.
Artigo em Sueco | MEDLINE | ID: mdl-31192434

RESUMO

The proposal for a new Swedish 6-year undergraduate medical education entails that the Master of Science in Medicine provides the basis for the licence to practice. During 2017-2018, the Finnish National Education Evaluation Center (FINEEC) conducted a nationwide evaluation of their 6-year medical education. Experiences from their evaluation may be useful in the development of the new Swedish undergraduate education. The outcome important to consider in Sweden is defining common core competencies for all newly graduated doctors, a framework for "Swedish Doctor". A curriculum mapping tool to ensure constructive alignment and an organization to oversee how the curriculum is implemented is essential. Further, the universities have to ensure that all students get training in essential clinical skills and that those skills are assessed. Development of the national collaboration similar to that of Finland is encouraged.


Assuntos
Competência Clínica/normas , Educação de Graduação em Medicina/organização & administração , Currículo , Finlândia , Humanos , Licenciamento em Medicina , Avaliação de Programas e Projetos de Saúde , Suécia
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