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2.
Clin Exp Nephrol ; 26(2): 162-169, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34581898

RESUMO

BACKGROUND: The management of congenital nephrotic syndrome of the Finnish type (CNF) is challenging. It is difficult to withdraw intravenous albumin infusions, resulting in long-term hospitalization. In addition, fatal hypotension after bilateral nephrectomy has been reported. In our center, we have performed unilateral nephrectomy during early infancy. METHODS: Infants diagnosed with CNF between 2011 and 2020 in our institution were enrolled. We examined the clinical course before and after unilateral nephrectomy and evaluated the effectiveness of this strategy. RESULTS: Seven patients (all showing NPHS1 mutations) were enrolled. All required daily intravenous albumin infusion via central venous catheter (CVC). Unilateral nephrectomy was performed at a median of 76 days of age (59-208 days). Surgical complications did not occur in any of patients. The mean albumin dose was decreased after unilateral nephrectomy (2.0 vs 0.4 g/kg/day; p = 0.02). Intravenous albumin infusion could be withdrawn at a median of 17 days, the CVC removed at a median of 21 days, and they discharged at a median of 82 days after unilateral nephrectomy. Although bacterial infections were noted seven times before unilateral nephrectomy, only one episode occurred after surgery. Four patients initiated peritoneal dialysis at two to three years of age and all of them underwent kidney transplantation thereafter. CONCLUSIONS: Unilateral nephrectomy during early infancy may be an effective treatment allowing for withdrawal from albumin infusion, prevention of complications, withdrawal from CVCs and shortening hospital stay for patients with CNF.


Assuntos
Transplante de Rim , Síndrome Nefrótica , Diálise Peritoneal , Finlândia , Humanos , Lactente , Nefrectomia/efeitos adversos , Síndrome Nefrótica/diagnóstico
3.
J Epidemiol Community Health ; 76(12): 1019-1026, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36356969

RESUMO

AIM: The aim of this study was to explore whether active participation in a longitudinal birth cohort study is associated with study participants' health behaviour and well-being. METHODS: The subjects of this study were part of the Northern Finland Birth Cohort 1966. The follow-up data were collected through clinical examinations and questionnaires when the cohort members were 1, 14, 31 and 46 years old. In this study, cohort participation activity was divided into three categories: active, semiactive and least active. RESULTS: The total number of study participants who participated in the 46-year follow-up on both the survey and clinical trials was 6392, of which 66.5% (n=4268) participated actively in the cohort study. A total of 67.6% were female (p<0.001). Of the participants, 23.7% (n=1519) were semiactive and 9.5% (n=605) were the least active. Women who participated least actively experienced statistically significantly more depressive symptoms and poorer health, were more dissatisfied with their lives and had more addiction problems. In men, there was not a statistically significant association between participation activity and these well-being variables other than addiction problems and mental health. CONCLUSIONS: The findings indicate that participation activity is associated with better self-reported health and well-being, especially among women. With this knowledge, people can be encouraged to participate in longitudinal health research and, at the same time, may improve their own health and quality of life.


Assuntos
Coorte de Nascimento , Qualidade de Vida , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Estudos de Coortes , Autorrelato , Finlândia/epidemiologia , Inquéritos e Questionários
4.
Eur J Obstet Gynecol Reprod Biol ; 279: 112-117, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36332538

RESUMO

OBJECTIVES: Physicians and midwives meet patients with sexual health issues regularly; however, they may have limited sexual medicine education. The study's aim was to evaluate the self-reported competence of medical and midwifery students to bring up sexual health issues with their patients and to assess the barriers that hinder these discussions. The need for additional education was also evaluated. STUDY DESIGN: A web-based questionnaire was sent to the last-year medical and midwifery students graduating between December 2018 and May 2019 in Finland. In total, 233 medical students and 131 midwifery students participated in the study. Three fields were evaluated: the self-reported competence in discussing sexual health issues and treating patients with these issues, the barriers to bringing up sexual problems, and the need for education in sexual medicine. RESULTS: The students self-reported better competence in discussing sexual health issues than in treating patients' sexual problems. For the medical students, the most important barriers hindering bringing up sexual health issues were lack of i) time (89.2 %), ii) experience with sexual medicine (88.1 %), and iii) knowledge (82.1 %). For the midwifery students, the most important barriers were i) lack of experience with sexual medicine (73.3 %), ii) fear of failing to respond to patients' sexual health issues (64.9 %), and iii) lack of knowledge (62.5 %). A higher percentage of the midwifery students (96.2 %) reported an interest in sexual medicine education compared to the medical students (55.4 %) (OR 13.89, 95 % CI 5.32-35.71, P <.001). Majority (76.5 %) of the medical students and almost half (45.0 %) of the midwifery students reported receiving too little sexual medicine education (OR 7.30, 95 % CI 4.00-13.33, P <.001). CONCLUSIONS: Both student groups reported several barriers hindering bringing up sexual health issues with their patients and expressed a need for more education, particularly the medical students.


Assuntos
Tocologia , Saúde Sexual , Estudantes de Medicina , Estudantes de Enfermagem , Gravidez , Humanos , Feminino , Tocologia/educação , Finlândia , Competência Clínica
5.
Artigo em Inglês | MEDLINE | ID: mdl-36361128

RESUMO

This article examines older physical education (PE) teachers' wellbeing over the course of their career in Finland. The study highlights challenges to physical and mental functioning as well as how teachers respond to these challenges. The six interviewees were over 55-year-old PE teachers, whose career had lasted for more than 30 years. Qualitative methods were used in the collection, transcription and analysis of the research data. The qualitative analysis consisted of a series of interpretations that visualised the world described by the interviewees. All the research participants had physical problems that affected their teaching and make teachers consider a potential career change. To be able to teach, teachers adapted their ways of working according to the challenges brought by age and injuries. The research participants found that the challenges caused by musculoskeletal problems and ageing were an inevitable part of the profession. They emphasised the positive sides of the work: the profession permits varied workdays. In addition, the teachers noted that their work provides them with opportunities to remain physically fit. Teaching health education is a means to lighten the workload of older teachers. PE teachers enjoy their profession and are dedicated to it, despite all the challenges. The interviewed participants clearly experienced work engagement. Our development proposal for teacher education is that future PE teachers be informed about the risks involved in the profession. Such activity helps young teachers reflect proactively on the measures taken to maintain their functioning during their career and on perspectives related to the ways of working.


Assuntos
Educação Física e Treinamento , Capacitação de Professores , Humanos , Pessoa de Meia-Idade , Carga de Trabalho , Finlândia , Professores Escolares
6.
BMC Infect Dis ; 22(1): 816, 2022 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-36335289

RESUMO

BACKGROUND: The elderly are highly vulnerable to severe COVID-19. Waning immunity and emergence of Omicron have caused concerns about reduced effectiveness of COVID-19 vaccines. The objective was to estimate vaccine effectiveness (VE) against severe COVID-19 among the elderly. METHODS: This nationwide, register-based cohort analysis included all residents aged 70 years and over in Finland. The follow-up started on December 27, 2020, and ended on March 31, 2022. The outcomes of interest were COVID-19-related hospitalization and intensive care unit (ICU) admission timely associated with SARS-CoV-2 infection. VE was estimated as one minus the hazard ratio comparing the vaccinated and unvaccinated and taking into account time since vaccination. Omicron-specific VE was evaluated as the effectiveness observed since January 1, 2022. RESULTS: The cohort included 896,220 individuals. Comirnaty (BioNTech/Pfizer) VE against COVID-19-related hospitalization was 93% (95% CI 89-95%) and 85% (95% CI 82-87%) 14-90 and 91-180 days after the second dose; VE increased to 95% (95% CI 94-96%) 14-60 days after the third dose. VE of other homologous and heterologous three dose series was similar. Protection against severe COVID-19 requiring ICU treatment was even better. Since January 1, 2022, Comirnaty VE was 98% (95% CI 92-99%) and 92% (95% CI 87-95%) 14-90 and 91-180 days after the second and 98% (95% CI 95-99%) 14-60 days after the third dose. CONCLUSIONS: VE against severe COVID-19 is high among the elderly. It waned slightly after two doses, but a third restored the protection. VE against severe COVID-19 remained high even after the emergence of Omicron.


Assuntos
COVID-19 , Idoso , Humanos , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19 , Finlândia/epidemiologia , Eficácia de Vacinas , SARS-CoV-2
7.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36347821

RESUMO

PURPOSE: The purpose of this study was to elucidate facilitators and barriers to health system resilience and resilient responses at local and regional levels during the first year of the COVID-19 pandemic in Finland. DESIGN/METHODOLOGY/APPROACH: The authors utilized a qualitative research approach and conducted semi-structured interviews (n = 32) with study participants representing five different regions in Finland. Study participants were recruited using purposive and snowball sampling. All study participants had been in management and civil servant positions during the first year of the pandemic, representing municipalities, municipalities' social and healthcare services, hospital districts and regional state administrative agencies. All interviews were completed remotely from April to December 2021 and the recordings transcribed verbatim. The authors coded the transcripts in ATLAS.ti 9.1 using directed content analysis. FINDINGS: The findings highlighted a wide range of localized responses to the pandemic in Finland. Facilitators to health system resilience included active networks of cooperation, crisis anticipation, transitioning into crisis leadership mode, learning how to incorporate new modes of operation, as well as relying on the competencies and motivation of health workforce. The authors found several barriers to health system resilience, including fragmented organization and management particularly in settings where integrated health care systems were not in place, insufficient preparedness to a prolonged crisis, lack of reliable information regarding COVID-19, not having plans in place for crisis communication, pandemic fatigue, and outflux of health workforce to other positions with better compensation and working conditions. ORIGINALITY/VALUE: Factors affecting health system resilience are often studied at the aggregate level of a nation. This study offers insights into what resilient responses look like from the perspective of local and regional actors in a decentralized health system. The results highlight that local capacities and context matter greatly for resilience. The authors call for more nuanced analyses on health systems and health system resilience at the sub-national level.


Assuntos
COVID-19 , Humanos , COVID-19/epidemiologia , Pandemias , Finlândia , Pesquisa Qualitativa , Mão de Obra em Saúde
8.
Acta Orthop ; 93: 859-865, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36440602

RESUMO

BACKGROUND AND PURPOSE:  Smoking weakens bone health and increases the risk of fractures. We investigated the incidence of fractures in smoking, fertile-aged women and compared it with that of non-smoking, fertile-aged women using data from nationwide registers. PATIENTS AND METHODS:  We conducted a retrospective register-based nationwide cohort study from 1998 to 2018. We identified all women smoking during pregnancy from the Medical Birth Register and compared these with non-smokers. We gathered fractures for both groups from the Care Register for Health Care. Pregnancies with missing smoking or socioeconomic status were excluded. A Cox regression model was used to analyze adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for fractures during the 5-year follow-up starting from delivery. The model was adjusted for the age of the mother at the time of delivery and socioeconomic status. RESULTS:  The smoking group included 110,675 pregnancies and the non-smoking group 628,085 pregnancies. The overall fracture rate was higher in smokers after 1-year follow-up (aHR 1.7, CI 1.5-2.0) and 5-year follow-up (aHR 1.7, CI 1.6-1.8). After 5-year follow-up, the fracture rates for polytraumas (aHR 2.3, CI 1.4-3.7), inpatient admitted fractures (aHR 2.0, CI 1.7-2.4), and non-admitted fractures (aHR 1.8, CI 1.7-1.9) were all higher among smoking women. CONCLUSION: Smoking in fertile-aged women was associated with a higher risk of fractures during the 1-year and 5-year follow-up after giving birth, also after adjusting for age and socioeconomic status. Whether the increased fracture risk is caused by direct effects of smoking on bone health or riskier behavior remains uncertain.


Assuntos
Fraturas Ósseas , Fumar , Gravidez , Feminino , Humanos , Idoso , Estudos de Coortes , Estudos Retrospectivos , Finlândia/epidemiologia , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Risco , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia
10.
Sci Rep ; 12(1): 20335, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36434073

RESUMO

Empirical evidence, primarily based on hospital-based or voluntary samples, suggests that current smokers have a lower risk of COVID-19 infection than never smokers. In this study, we used nationally representative data to examine the association between tobacco use and the risk of having a confirmed COVID-19 case. We explored several forms of tobacco use, contributing to separate the role of nicotine from smoking. We used data from 44,199 participants from three pooled national health surveys in Finland (FinSote 2018-2020). The primary outcome was a confirmed COVID-19 case. We examined current smoking, moist smokeless tobacco (snus), e-cigarettes with and without nicotine and nicotine replacement therapy products. Current daily smokers had a relative risk of 1.12 of a confirmed COVID-19 case (95% CI 0.65; 1.94) in fully adjusted models compared with never smokers. Current snus use was associated with a 68% higher risk of a confirmed COVID-19 case (RR 1.68, 95% CI 1.02; 2.75) than never users. We did not find conclusive evidence of associations between e-cigarettes with and without nicotine and nicotine replacement therapy products and the risk of confirmed COVID-19 cases. Our findings suggest that nicotine might not have a protective role in the risk of COVID-19 as previously hypothesized.


Assuntos
COVID-19 , Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Humanos , Finlândia/epidemiologia , Nicotina , Dispositivos para o Abandono do Uso de Tabaco , COVID-19/epidemiologia , Uso de Tabaco/efeitos adversos , Uso de Tabaco/epidemiologia
11.
BMC Public Health ; 22(1): 2188, 2022 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-36434562

RESUMO

BACKGROUND: Regardless of competitive athletes' body image pressures, only few studies have focused on adolescent sport participants' body image and the findings are inconclusive. Furthermore, the role of competitive goals in sports on adolescents' body size perception has not been studied. We examined the factors associated with adolescents' competitive goals in sports and body size perception, and the associations between adolescents' competitive goals in sports and body size perception. METHODS: The cross-sectional study consisted of 475 goal-oriented sports club participants and 936 reference youths (aged 14-16 years). The study questionnaire included multiple choice items on health behaviours, motives to exercise, competitive goals in sports and body size perception. The multinomial logistic regression analysis was used to investigate the associations. RESULTS: Adolescents with competitive goals in sports perceived their body size as about the right size more frequently than reference youths (68% vs 47%, p < 0.001 in girls; 74% vs 61%, p < 0.001 in boys). More than one-fourth of girls with competitive goals in sports perceived themselves as overweight, although only 7% of them were overweight. Adolescents with appearance/weight motives to exercise and poor perceived physical fitness had higher odds of perceived fatness. Additionally, BMI was positively associated with perceived fatness and negatively with perceived thinness. Having competitive goals in sports was not independently associated with perceived fatness or perceived thinness. CONCLUSIONS: Adolescents' BMI, appearance/weight motives to exercise, and perceived physical fitness were more strongly associated with body size perception than their competitive goals in sports. However, perceived fatness among girls with competitive goals in sports should be considered in organized sports.


Assuntos
Esportes Juvenis , Masculino , Feminino , Adolescente , Humanos , Estudos Transversais , Percepção de Tamanho , Sobrepeso , Magreza , Finlândia , Objetivos , Tamanho Corporal
12.
PLoS One ; 17(11): e0276550, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36331970

RESUMO

Substantial empirical evidence suggests that individuals who belong to sexual and gender minorities experience more anxiety and depression than heterosexual and cisgender people. Many previous studies have not, however, used population-based samples. There is also a shortage of evidence about certain sexual and gender minorities (e.g., nonbinary individuals). We examined differences in levels of anxiety and depression within sexual and gender minorities, as well as compared to the heterosexual and cisgender majority in a population-based Finnish sample (N = 8,589). We also explored if individuals who belong to both a gender and a sexual minority (double minority) reported higher rates of anxiety and depression than individuals who hold either a gender or a sexual minority status (single minority). Individuals who belonged to either a sexual or a gender minority overall experienced significantly higher rates of anxiety and depression than cisgender and heterosexual individuals. Among the different sexual and gender minorities, bisexual, emerging identity, and nonbinary individuals reported the highest rates of anxiety and depression. We found no differences in anxiety and depression between single minority and double minority individuals. Our results suggest that even though Finland is a country with an inclusive social climate, sexual and gender minorities are, nevertheless, disproportionately affected by mental health issues. The present study gives further support to the claim that individuals holding a sexual or gender minority status experience higher levels of depression and anxiety compared to cisgender and heterosexual individuals and pinpoints the need to acknowledge these issues both in the context of health care and in the society at large.


Assuntos
Saúde Mental , Minorias Sexuais e de Gênero , Humanos , Feminino , Masculino , Finlândia/epidemiologia , Depressão/epidemiologia , Depressão/psicologia , Comportamento Sexual/psicologia , Ansiedade/epidemiologia , Ansiedade/psicologia , Identidade de Gênero
13.
J Environ Manage ; 324: 116374, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-36352726

RESUMO

A collective understanding of economic impacts and in particular of monetary costs of biological invasions is lacking for the Nordic region. This paper synthesizes findings from the literature on costs of invasions in the Nordic countries together with expert elicitation. The analysis of cost data has been made possible through the InvaCost database, a globally open repository of monetary costs that allows for the use of temporal, spatial, and taxonomic descriptors facilitating a better understanding of how costs are distributed. The total reported costs of invasive species across the Nordic countries were estimated at $8.35 billion (in 2017 US$ values) with damage costs significantly outweighing management costs. Norway incurred the highest costs ($3.23 billion), followed by Denmark ($2.20 billion), Sweden ($1.45 billion), Finland ($1.11 billion) and Iceland ($25.45 million). Costs from invasions in the Nordics appear to be largely underestimated. We conclude by highlighting such knowledge gaps, including gaps in policies and regulation stemming from expert judgment as well as avenues for an improved understanding of invasion costs and needs for future research.


Assuntos
Países Escandinavos e Nórdicos , Noruega , Islândia , Finlândia , Suécia
14.
BMC Endocr Disord ; 22(1): 284, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401251

RESUMO

PURPOSE: To investigate whether exposure to systemic antibiotics influences the risk of developing type 2 diabetes and overweight/obesity. METHODS: The study sample comprised 2209 (110 with incident diabetes) participants from the population-based Cardiovascular Risk in Young Finns Study (YFS) aged 24-39 years in 2001. The exposure was national linked register data on purchased antibiotic courses between 1993 and 2001. Clinical examinations including BMI were conducted in 2001, 2007 and 2011. Participants with prevalent diabetes in 2001 were excluded. Data on type 2 diabetes was also obtained from two national registers until 2017. Data from four population-based National FINRISK studies were used for replication (N = 24,674, 1866 with incident diabetes). RESULTS: Prior antibiotic exposure (> 5 versus 0-1 antibiotic courses) was associated with subsequent type 2 diabetes in both YFS (OR 2.29; 95%CI 1.33-3.96) and FINRISK (HR 1.73; 95%CI 1.51-1.99). An increased risk for type 2 diabetes was observed in YFS (OR 1.043; 95%CI 1.013-1.074) and FINRISK (HR 1.022; 95%CI 1.016-1.029) per course. Exposure to antibiotics increased the risk of overweight/obesity (BMI > 25 kg/m2) after a 10-year follow-up in YFS (OR 1.043; 95%CI 1.019-1.068) and in FINRISK (OR 1.023; 95%CI 1.018-1.029) at baseline per antibiotic course. Adjustments for confounders from early life in YFS and at baseline in FINRISK, including BMI, socioeconomic status, smoking, insulin, blood pressure, and physical activity, did not appreciably alter the findings. CONCLUSION: Our results show that exposure to antibiotics was associated with increased risk for future type 2 diabetes and overweight/obesity and support judicious antibiotic prescribing.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Sobrepeso/complicações , Sobrepeso/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Antibacterianos/efeitos adversos , Finlândia/epidemiologia , Fatores de Risco , Obesidade/complicações , Obesidade/epidemiologia , Fatores de Risco de Doenças Cardíacas
15.
BMC Emerg Med ; 22(1): 178, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36368934

RESUMO

BACKGROUND: The work environment in prehospital emergency medical care setting is dynamic and complex and includes many stressors. However, little is known about the perceived human factors from the perspective of paramedics. In this study, we investigated, from the perspective of paramedics, what are the human factors, and how are they linked to prehospital emergency medical care? METHODS: Data were collected through semi-structured interviews (n = 15) with Finnish paramedics. The material was analyzed using inductive content analysis. RESULTS: Three main categories of human factors were identified. The first main category consisted of factors related to work which were divided into two generic categories: "Challenging organizational work environment" and "Changing external work environment." The second main category comprised factors related to paramedics themselves and were divided into three generic categories: "Issues linked to personality," "Personal experiences", and "Factors resulting from personal features." The third main category described that paramedics have difficulties in understanding and describing human factors. CONCLUSION: This study revealed numerous factors that can affect paramedics' work in the EMS setting. Increased knowledge about human factors in the EMS setting provides organizations with the opportunity to develop procedures that can support paramedics' cognitive and physical work. Human factors in different situations can be addressed to improve occupational and patient safety.


Assuntos
Serviços Médicos de Emergência , Auxiliares de Emergência , Humanos , Pessoal Técnico de Saúde/psicologia , Pesquisa Qualitativa , Serviços Médicos de Emergência/métodos , Segurança do Paciente , Finlândia , Auxiliares de Emergência/psicologia
16.
BMJ Open ; 12(9): e067123, 2022 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-36378622

RESUMO

INTRODUCTION: Gliomas are the most common primary tumour of the central nervous system (CNS), with an estimated annual incidence of 6.6 per 100 000 individuals in the USA and around 14 deaths per day from brain tumours in the UK. The genomic and biological landscape of brain tumours has been increasingly defined and, since 2016, the WHO classification of tumours of the CNS incorporates molecular data, along with morphology, to define tumour subtypes more accurately. The Tessa Jowell BRAIN MATRIX Platform (TJBM) study aims to create a transformative clinical research infrastructure that leverages UK National Health Service resources to support research that is patient centric and attractive to both academic and commercial investors. METHODS AND ANALYSIS: The TJBM study is a programme of work with the principal purpose to improve the knowledge of glioma and treatment for patients with glioma. The programme includes a platform study and subsequent interventional clinical trials (as separate protocols). The platform study described here is the backbone data-repository of disease, treatment and outcome data from clinical, imaging and pathology data being collected in patients with glioma from secondary care hospitals. The primary outcome measure of the platform is time from biopsy to integrated histological-molecular diagnosis using whole-genome sequencing and epigenomic classification. Secondary outcome measures include those that are process centred, patient centred and framework based. Target recruitment for the study is 1000 patients with interim analyses at 100 and 500 patients. ETHICS AND DISSEMINATION: The study will be performed in accordance with the recommendations guiding physicians in biomedical research involving human subjects, adopted by the 18th World Medical Association General Assembly, Helsinki, Finland and stated in the respective participating countries' laws governing human research, and Good Clinical Practice. The protocol was initially approved on 18 February 2020 by West Midlands - Edgbaston Research Ethics Committee; the current protocol (v3.0) was approved on 15 June 2022. Participants will be required to provide written informed consent. A meeting will be held after the end of the study to allow discussion of the main results among the collaborators prior to publication. The results of this study will be disseminated through national and international presentations and peer-reviewed publications. Manuscripts will be prepared by the Study Management Group and authorship will be determined by mutual agreement. TRIAL REGISTRATION NUMBER: NCT04274283, 18-Feb-2020; ISRCTN14218060, 03-Feb-2020.


Assuntos
Neoplasias Encefálicas , Glioma , Humanos , Medicina Estatal , Consentimento Livre e Esclarecido , Glioma/genética , Glioma/terapia , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/terapia , Finlândia
17.
BMJ Case Rep ; 15(11)2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36379630

RESUMO

Familial amyloidosis of the Finnish type (FAF) is a rare multisystemic disorder caused by mutations in the gelsolin gene. The clinical presentation is typically characterised by a triad of ophthalmic, neurological and dermatological findings. FAF has been reported in several countries, primarily in Finland and recently in Portugal. We report the first genetically confirmed cases of FAF from two unrelated families in our neuromuscular outpatient clinic. Gelsolin gene sequencing revealed the heterozygous gelsolin mutation (c.640G>A). The clinical features and the neurophysiological studies of two index patients and their relatives are presented. Obtaining an early diagnosis can be challenging, but FAF should be considered in the differential diagnosis of progressive bilateral facial neuropathy, even if there is no known Finnish ancestor.


Assuntos
Amiloidose Familiar , Gelsolina , Humanos , Gelsolina/genética , Finlândia , Amiloidose Familiar/diagnóstico , Amiloidose Familiar/genética , Mutação , Portugal
18.
BMC Prim Care ; 23(1): 278, 2022 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352358

RESUMO

AIMS: Type 2 diabetes (T2D) is a progressive disease often associated with comorbidities that complicate the management of T2D and affect the achievement of treatment targets. However, adherence to guidelines and individualized treatments can potentially improve treatment outcomes. This study assessed the association between different glucose lowering and lipid lowering medication lines and the achievement of treatment targets with different comorbidities among a T2D cohort in North Karelia, Finland (2011-12 to 2015-16). METHODS: The data on all diagnosed T2D patients (n = 10,190) in North Karelia were collated retrospectively from regional electronic health records (EHRs). Analyses were performed considering the age, sex, and comorbidities such as cardiovascular diseases (CVD) and any mental disorders (AMD). We analyzed the trends in using glucose lowering and lipid lowering medications and the effect of changes in medication on the achievement of treatment targets among different patient groups. RESULTS: Metformin was the most common treatment in all patient groups. The use of only metformin declined and the use of metformin and/or other non-insulin medications increased during the follow-up. A Combination of insulin and non-insulin medication was mostly used by T2D patients with both cardiovascular diseases and mental disorders (T2D + CVD + AMD), and the use of insulin increased among this group in follow-up. Achievement of the glucose treatment target deteriorated even after the intensification of medication among all patient groups during the follow-up. A considerably higher number of patients with T2D + AMD and T2D + CVD + AMD did not use lipid lowering medication when compared to the T2D + CVD patients both at baseline and follow-up. However, the achievement of the LDL treatment target improved during the follow-up. CONCLUSION: Achievement of the glucose target deteriorated even after the intensification of treatment, and especially among patients with multiple diseases. Many T2D patients with AMD and CVD remained without lipid lowering medication, which needs further attention.


Assuntos
Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Metformina , Humanos , Diabetes Mellitus Tipo 2/complicações , Estudos Retrospectivos , Doenças Cardiovasculares/tratamento farmacológico , Glicemia , Finlândia/epidemiologia , Metformina/uso terapêutico , Estudos de Coortes , Lipídeos/uso terapêutico
19.
PLoS One ; 17(11): e0274953, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36355795

RESUMO

Most European hunter-gatherers slowly assimilated into farming communities during the Neolithic period. In the north these groups persisted far longer. In this paper, we present evidence from what may be one of the most recent non-agricultural sites in the region, where a marine hunter-gatherer lifestyle may have continued until as late as the 15th-16th centuries AD. The isotope composition of incremental dental analysis suggests a significant, long-term dependence on seals. This indicates that vestiges of this means of subsistence might have been present in Europe for much longer than previously thought.


Assuntos
Agricultura , Cemitérios , Finlândia , Agricultura/história , Fazendas , Europa (Continente)
20.
Artigo em Inglês | MEDLINE | ID: mdl-36429888

RESUMO

This paper describes the development of an objective curriculum- and performance-based health literacy (HL) measurement instrument to assess Finnish 9th graders' learning outcomes in the school subject termed Health Education (HE). There were four phases: (i) construction of the theoretical framework for the measurement, (ii) item generation, (iii) the field test (n = 252), and (iv) item analysis and item selection for the main study, in which 3652 ninth grade pupils (aged 15-16) participated. Initially, 303 HL test items were formulated, of which 107 were tested in two different field test versions. Both versions exhibited high reliability as measured by Cronbach's alpha coefficient. The main study contained 55 items. Testing and item analysis enabled the development of a comprehensive competence- and curriculum-based HL measurement instrument for school-aged children. Measurement of HL in schools provides information for national policies, and for developing HE as a school subject.


Assuntos
Letramento em Saúde , Criança , Humanos , Finlândia , Reprodutibilidade dos Testes , Currículo , Instituições Acadêmicas
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