7 research outputs found

    Ala-asteikäisten lasten liikuntaharrastusten vaikutus koulumenestykseen

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    Tiivistelmä. Lasten liikkumattomuus on usein esillä oleva aihe. Covid 19- pandemian myötä esimerkiksi valtion liikuntaneuvoston huoli on taas suurentunut, sillä ryhmäliikuntaharrastuksia on jouduttu perumaan ja näin ollen oletettavasti vaikuttanut lasten ja nuorten liikuntatottumuksiin hyvinkin huolestuttavasti. Liikunta on lapselle hyvin tärkeä osa arkipäivää, sillä sen avulla edistetään esimerkiksi kognitiivisia toimintoja, oppimista ja motorisia taitoja. Koulupäivän aikaista liikuntaa on tutkittu paljon ja sen on todettu olevan positiivisessa yhteydessä koulumenestyksen kanssa. Samalla on kuitenkin todettu, että koulupäivän jälkeen olevilla liikuntaharrastuksilla on sama positiivinen vaikutus. Tämän kirjallisuuskatsauksen aiheena on tutkia ala-asteikäisten lasten liikuntaharrastuksien vaikutusta heidän koulumenestykseensä. Tarkoituksena on vastata kahteen tutkimuskysymykseen: Miten liikuntaharrastukset vaikuttavat kognitiivisiin taitoihin? Millä tavalla liikunta vaikuttaa koulumenestykseen? Lapselle kognitiiviset taidot eli tiedonkäsittelytaidot ovat hyvin tärkeitä, sillä niiden avulla opitaan uusia asioita. Koululaiselle tärkeitä kognitiivisia taitoja on esimerkiksi tarkkaavaisuus ja toiminnanohjaus. Lapsen oma aktiivisuus on tärkeää kognitiivisten taitojen kehittämisessä, mutta useiden tutkimusten mukaan taitoja pystytään parantamaan liikuntaharrastusten avulla. Kognitiiviset taidot kehittyvät aivojen kehityksen sekä motoristen taitojen kehityksen myötä. On siis tärkeää, että liikunnan avulla kehitetään niin motorisia taitoja kuin aivojen toimintaa. Liikuntaharrastukset näkyvät koulumenestyksessä monella eri tavalla. Tutkimusten mukaan liikunnan harrastaminen on hyvin vahvasti yhteydessä akateemiseen suorituskykyyn ja onkin todennäköisempää, että liikkuva lapsi ja nuori saa parempia kouluarvosanoja kuin liikkumaton. Liikunnan positiiviset vaikutukset näkyvät varsinkin matematiikassa, luonnontieteissä sekä lukutaidossa. Oppiainearvosanojen lisäksi liikunnan on todettu vaikuttavan stressiin, ahdistukseen ja tarkkaavaisuuteen, jotka osaltaan vaikuttavat siihen, että oppilas menestyy koulussa

    Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery

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    This is the peer reviewed version of the following article: , which has been published in final form at https://doi.org/10.1111/codi.14361. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."Colorectal Disease ¬© 2018 The Association of Coloproctology of Great Britain and Ireland Introduction: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0¬†N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging. Results: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as ‚Äėfair‚Äô only (n¬†=¬†429, Kappa 0.25, 0.26 and 0.35 respectively). Conclusion: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials

    Monogenic Early-Onset Lymphoproliferation and Autoimmunity: The Natural History of STAT3 GOF Syndrome.

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    Background In 2014, germline signal transducer and activator of transcription (STAT) 3 gain-of-function (GOF) mutations were first described to cause a novel multisystem disease of early-onset lymphoproliferation and autoimmunity. Objective This pivotal cohort study defines the scope, natural history, treatment, and overall survival of a large global cohort of patients with pathogenic STAT3 GOF variants. Methods We identified 191 patients from 33 countries with 72 unique mutations. Inclusion criteria included symptoms of immune dysregulation and a biochemically confirmed germline heterozygous GOF variant in STAT3. Results Overall survival was 88%, median age at onset of symptoms was 2.3 years, and median age at diagnosis was 12 years. Immune dysregulatory features were present in all patients: lymphoproliferation was the most common manifestation (73%); increased frequencies of double-negative (CD4‚ąíCD8‚ąí) T cells were found in 83% of patients tested. Autoimmune cytopenias were the second most common clinical manifestation (67%), followed by growth delay, enteropathy, skin disease, pulmonary disease, endocrinopathy, arthritis, autoimmune hepatitis, neurologic disease, vasculopathy, renal disease, and malignancy. Infections were reported in 72% of the cohort. A cellular and humoral immunodeficiency was observed in 37% and 51% of patients, respectively. Clinical symptoms dramatically improved in patients treated with JAK inhibitors, while a variety of other immunomodulatory treatment modalities were less efficacious. Thus far, 23 patients have undergone bone marrow transplantation, with a 62% survival rate. Conclusion : STAT3 GOF patients present with a wide array of immune-mediated disease including lymphoproliferation, autoimmune cytopenias, and multisystem autoimmunity. Patient care tends to be siloed, without a clear treatment strategy. Thus, early identification and prompt treatment implementation are lifesaving for STAT3 GOF syndrome. Key word

    The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit.

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    This is the peer reviewed version of the following article: The and E. S. o. C. c. groups (2018). "The impact of conversion on the risk of major complication following laparoscopic colonic surgery: an international, multicentre prospective audit." Colorectal Disease 20(S6): 69-89., which has been published in final form at https://doi.org/10.1111/codi.14371. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.BACKGROUND: Laparoscopy has now been implemented as a standard of care for elective colonic resection around the world. During the adoption period, studies showed that conversion may be detrimental to patients, with poorer outcomes than both laparoscopic completed or planned open surgery. The primary aim of this study was to determine whether laparoscopic conversion was associated with a higher major complication rate than planned open surgery in contemporary, international practice. METHODS: Combined analysis of the European Society of Coloproctology 2017 and 2015 audits. Patients were included if they underwent elective resection of a colonic segment from the caecum to the rectosigmoid junction with primary anastomosis. The primary outcome measure was the 30-day major complication rate, defined as Clavien-Dindo grade III-V. RESULTS: Of 3980 patients, 64% (2561/3980) underwent laparoscopic surgery and a laparoscopic conversion rate of 14% (359/2561). The major complication rate was highest after open surgery (laparoscopic 7.4%, converted 9.7%, open 11.6%, P < 0.001). After case mix adjustment in a multilevel model, only planned open (and not laparoscopic converted) surgery was associated with increased major complications in comparison to laparoscopic surgery (OR 1.64, 1.27-2.11, P < 0.001). CONCLUSIONS: Appropriate laparoscopic conversion should not be considered a treatment failure in modern practice. Conversion does not appear to place patients at increased risk of complications vs planned open surgery, supporting broadening of selection criteria for attempted laparoscopy in elective colonic resection

    Safety of primary anastomosis following emergency left sided colorectal resection: an international, multi-centre prospective audit.