Turun Seudun Osuuspankki - nuoren aikuisen valinta

Siirretty Doriast

The Effect of Antiretroviral Combination Treatment on Epstein-Barr Virus (EBV) Genome Load in HIV-Infected Patients

We evaluated the effect of combination anti-retroviral treatment (cART) on the host control of EBV infection in moderately immunosuppressed HIV-1 patients. Twenty HIV-1 infected individuals were followed for five years with repeated measurements of EBV DNA load in peripheral blood lymphocytes in relation to HIV-RNA titers and CD4+ cell counts. Individuals with optimal response, i.e. durable non-detectable HIV-RNA, showed a decline of EBV load to the level of healthy controls. Individuals with non-optimal HIV-1 control did not restore their EBV control. Long-lasting suppression of HIV-replication after early initiation of cART is a prerequisite for re-establishing the immune control of EBV

Dysphonia - Illustrating a Nationwide Initiative to Provide Students with High Quality e-Learning Resources

Dysphonia is one of 16 e-learning projects coordinated and supported by the MedCal committee of the Council for Renewal of Higher Education. The application as such is a multimedia program about voice disorders and comprises a collection of patients suffering from hoarseness, which the user can explore in an interactive manner. The greatest benefits can be reaped by being able to integrate sound (voice) with images, video clips and descriptive text of various pathological conditions. Voice acoustic analysis is also provided. Each diagnosis is explicitly accounted for in classic textbook style. Descriptions of examination techniques, therapeutic sessions, and surgical interventions are included. The material can be accessed in multiple ways and supports explorative learning. The Dysphonia project is the product of a network of collaborators of various expertise supported by a nationwide initiative

Comparison of Machine Learning Techniques for Mortality Prediction in a Prospective Cohort of Older Adults

As global demographics change, ageing is a global phenomenon which is increasingly of interest in our modern and rapidly changing society. Thus, the application of proper prognostic indices in clinical decisions regarding mortality prediction has assumed a significant importance for personalized risk management (i.e., identifying patients who are at high or low risk of death) and to help ensure effective healthcare services to patients. Consequently, prognostic modelling expressed as all‐cause mortality prediction is an important step for effective patient management. Machine learning has the potential to transform prognostic modelling. In this paper, results on the development of machine learning models for all‐cause mortality prediction in a cohort of healthy older adults are reported. The models are based on features covering anthropometric variables, physical and lab examinations, questionnaires, and lifestyles, as well as wearable data collected in free‐living settings, obtained for the “Healthy Ageing Initiative” study conducted on 2291 recruited participants. Several machine learning techniques including feature engineering, feature selection, data augmentation and resampling were investigated for this purpose. A detailed empirical comparison of the impact of the different techniques is presented and discussed. The achieved performances were also compared with a standard epidemiological model. This investigation showed that, for the dataset under consideration, the best results were achieved with Random Under‐ Sampling in conjunction with Random Forest (either with or without probability calibration). However, while including probability calibration slightly reduced the average performance, it increased the model robustness, as indicated by the lower 95% confidence intervals. The analysis showed that machine learning models could provide comparable results to standard epidemiological models while being completely data‐driven and disease‐agnostic, thus demonstrating the opportunity for building machine learning models on health records data for research and clinical practice. However, further testing is required to significantly improve the model performance and its robustness

Vapaa-ajan asuminen Suomessa - Asukas- ja kuntakyselyn tuloksia vapaa-ajan asumisen nykytilasta ja kehittämistarpeista

Vapaa-ajan asunnot ovat merkittävä osa suomalaisten vapaa-aikaa ja suomalaista maaseutua. Meillä on tilastojen mukaan noin 499 000 vapaa-ajan asuntoa mutta niiden määrä on todennäköisesti vieläkin suurempi. Lisäksi yli puolella suomalaisista on käytettävissään vapaa-ajan asunto. Tässä raportissa tarkastellaan suomalaista vapaa-ajan asumista niiden käyttäjien ja kuntien viranhaltijoiden näkökulmasta. Raportti esittelee kahden, vuonna 2012 toteutetun väestöotantaan perustuvan ja vuonna 2014 kuntien kehittämisestä ja maankäytön suunnittelusta vastaaville viranhaltijoille suunnatun, kyselyn tuloksia. Väestökyselyssä selvitettiin vapaa-ajan asuntojen käyttäjien asunnon hankintaa, sijaintia, varustetasoa, käyttöaikoja, paikallisyhteisöön liittyviä taloudellisia ja sosiaalisia suhteita ja elinympäristöjen laadussa havaittuja muutoksia. Kyselyn tulokset mahdollistavat vapaa-ajan asumisen tarkastelun paitsi niiden omistajien myös muiden käyttäjien osalta. Lisäksi kyselyssä on huomioitu se, että merkittävällä osalla suomalaisia on käytössään useampi kuin yksi vapaa-ajan asuntoa. Toisessa kyselyssä kartoitettiin kuntien edustajien näkemyksiä vapaa-ajan asumisen vaikutuksista alueen ympäristöön ja yhteisöön, merkityksestä paikallisessa kehittämisessä ja huomioimisesta osana kuntien maankäytön suunnittelua. Tulokset osoittavat, että vaikka vapaa-ajan asumisen katsotaan erityisesti syrjäalueilla tuovan taloudellisia hyötyjä alueelle, sitä ei pidetä kuntien ensisijaisena kehittämistavoitteena

Second home tourism in Finland - Perceptions of citizens and municipalities on the state and development of second home tourism

Second homes are an important part of Finnish leisure, mobility and rural policy. There are 499,000 second homes in Finland according to the official statistics, but this number is probably underestimated and over half of the Finns actually use the leisure opportunities offered by second homes. This report characterises the phenomenon of second homes in Finland from two perspectives: of their users and of local policy makers. It presents the results of two surveys conducted in years 2012 and 2014 among representative sample of Finnish population, and officials from municipal offices responsible for development and planning issues. The population survey investigated who has access to second homes in Finland, the ways of acquisition of these properties, their location and technical standard, time patterns of use, economic and social relations of second home users with host areas, and their perception of quality of permanent and second home environments and their transformations. This survey enabled to explore practices and opinions not only of the owners of second homes, but also those who use second homes owned by their family or friends. It also did not limit to one second home, as a significant proportion of Finnish population has access to more than one such property. The second survey was sent out to representatives of Finnish municipal governments and aimed to explore their perception of the impacts of second homes on local environment and communities, the role of second homes in local development planning, and policies employed by municipal authorities to manage second homes development. The results show that the municipal authorities in Finland usually perceive second homes as a positive contributor to the local economies, particularly in peripheral locations, but do not treat them as a primary development strategy

Investigation of the analysis of wearable data for cancer-specific mortality prediction in older adults

Cancer is an aggressive disease which imparts a tremendous socio-economic burden on the international community. Early detection is an important aspect in improving survival rates for cancer sufferers; however, very few studies have investigated the possibility of predicting which people have the highest risk to develop this disease, even years before the traditional symptoms first occur. In this paper, a dataset from a longitudinal study which was collected among 2291 70-year olds in Sweden has been analyzed to investigate the possibility for predicting 2-7 year cancer-specific mortality. A tailored ensemble model has been developed to tackle this highly imbalanced dataset. The performance with different feature subsets has been investigated to evaluate the impact that heterogeneous data sources may have on the overall model. While a full-features model shows an Area Under the ROC Curve (AUC-ROC) of 0.882, a feature subset which only includes demographics, self-report health and lifestyle data, and wearable dataset collected in free-living environments presents similar performance (AUC-ROC: 0.857). This analysis confirms the importance of wearable technology for providing unbiased health markers and suggests its possible use in the accurate prediction of 2-7 year cancer-related mortality in older adults

Faktablad – Resultat från integrerad kustfiskövervakning 2023

I det här faktabladet sammanfattas resultaten från sju områden längs den svenska kusten inom programmet integrerad kustfiskövervakning för perioden 2002-2022. Områden är Fjällbacka och Vendelsö i Västerhavet, Torhamn, Hanöbukten och Kvädöfjärden i Egentliga Östersjön, samt Forsmark och Holmöarna i Bottniska viken. Syftet med den integrerade kustfiskövervakningen är att kartlägga fiskbeståndens status samt fiskens hälsotillstånd och miljögiftsbelastning för att upptäcka förändringar som indikerar storskalig påverkan av miljöhot som eutrofiering, miljögifter, klimatförändringar och andra miljöfaktorer. Resultaten från övervakningen visar att miljöförhållandena, kvantifierat som siktdjup, vattentemperatur och salthalt, har varit relativt stabila i alla provfiskeområden. De förändringar som observerats inkluderar en minskning i vattentemperaturen över tid i Holmöarna och Kvädöfjärden och en fördubbling av siktdjupet i Fjällbacka. Undersökningarna av fiskbeståndens status visar att diversiteten i fisksamhället har ökat i Torhamn och Kvädöfjärden, medan den trofiska medelnivån minskat i alla områden utom Torhamn, Vendelsö och Fjällbacka. De fiskarter som ökat i förekomst i provfiskena är ål i Fjällbacka, karpfiskar i Kvädöfjärden och Holmöarna, mesopredatorer i Hanöbukten, sik i Holmöarna, gös i Kvädöfjärden, samt strömming/sill i Forsmark, Torhamn och Hanöbukten. De arter som minskat i fångsterna är stensnultra och skrubbskädda i Fjällbacka och Vendelsö, gös i Forsmark, och gädda i Torhamn. Abborren är en indikatorart i det kustnära fisksamhället i Östersjön och det finns en tendens till minskande provfiskefångster av arten i alla områden i Östersjön, men inga signifikanta trender. Storleken på de stora abborrarna, kvantifierad genom indikatorn L90, har dock inte ändrats under den studerade tidsperioden. Alla områden utom Torhamn har värden för L90 över gränsvärdet vilket indikerar en generell god status. Trots att storleken hos stora abborrar har varit relativt konstant i de undersökta områdena, har dess längd vid ålder generellt ökat i alla provfiskeområden, vilket indikerar snabbare tillväxt hos fisken. Resultaten från undersökningarna av fiskens hälsa visar inga tydliga tecken på förändring i tånglakens reproduktion men förekomst av onormala yngel har observerats i alla provfiskeområden. Under enstaka år överskrids dock det föreslagna gränsvärdet för den naturliga bakgrundsnivån. Även om andra hälsoparametrar hos abborre och tånglake tyder på en negativ påverkan, så finns tecken på att den negativa utvecklingen har planat ut under de senaste åren i alla undersökta områden. Till exempel har den tidigare observerade tidstrenden med minskning i den relativa gonadvikten hos abborrhonor avstannat men den ligger fortfarande cirka 30 procent lägre jämfört med 1980-talet, något som skulle kunna förklaras av fiskens ökade tillväxt men även av flera andra miljöfaktorer samt miljögiftsexponering. Även om den tidigare ökningen i aktiviteten av avgiftningsenzymet EROD hos abborre har avstannat, så ligger den fortfarande på en högre nivå jämfört med 1980-talet. Detta sammantaget med starkt ökade aktiviteter av leverenzymerna glutationreduktas och katalas under senare år indikerar att fisken periodvis är exponerad för organiska miljögifter och ökad oxidativ stress. Dessutom observeras tecken på påverkat immunförsvar och ämnesomsättning. Hälsotillståndet hos skrubbskädda i Hanöbukten, där undersökningarna startat så sent som 2017, visar få förändringar vilket trots den korta tidsperioden kan tyda på stabil hälsa. Halterna av flertalet metaller och organiska miljögifter i abborre, tånglake och sill visar generellt inga tydliga trender under den undersökta tidsperioden. Medan kvicksilverhalterna minskar i tånglake, syns inga trender i abborre. Halterna ligger över EU:s gränsvärde för kvicksilver i toppredatorer med undantag för sill, men under gränsvärdet för skydd av människans hälsa vid konsumtion av fiskeriprodukter. Två metaller vars halter ökar i fisken är koppar i både abborre och tånglake i Kvädöfjärden, och kadmium i tånglake i Kvädöfjärden. Pesticiden hexaklorbensen minskar i sill i Hanöbukten men ökar i abborre i Holmöarna, och för PCB-varianten PCB-153 går halterna ner i abborre i Holmöarna och i tånglake i Kvädöfjärden. För perfluoroktansulfonsyra (PFOS) syns inga trender med undantag för en nedåtgående trend i Hanöbukten. Alla arter ligger under EU:s gränsvärde men för abborre i Kvädöfjärden ligger halterna väldigt nära gränsvärdet. Sammantaget visar resultaten från övervakningen i många fall en, i många fall, icke önskad utveckling av de studerade fisksamhällena. Övergödning, klimatförändring, möjlig påverkan från både kända och okända miljögifter, samt förändringar i den kustnära födoväven med ökande populationer av säl, fiskätande fågel och spigg, är alla i kombination möjliga förklaringar till det observerade tillståndet. Det finns även positiva signaler med ökande fångster av vissa känsliga arter, att den tidigare negativa trenden i fiskens hälsa avstannat, samt att det generellt finns få ökande trender under den undersökta tidsperioden i halterna av de studerade metallerna och organiska miljögifterna. Oroande är dock att de negativa förändringarna som observeras sker i referensområden som kan anses vara relativt opåverkade av direkt mänsklig aktivitet. Att det därtill finns brister i förståelsen för de bakomliggande orsakerna till förändringarna i kustfiskens hälsotillstånd och fisksamhällets sammansättning och funktion, gör det angeläget att kartlägga påverkan på kustfisken från okända och kända miljögifter som inte övervakas i dag i samspel med andra miljöfaktorer som övergödning, klimatförändringar och förändrad födovävsstruktur

Extended Coagulation Profiling in Isolated Traumatic Brain Injury:A CENTER-TBI Analysis

Background: Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profiles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury. Methods: Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confounding factors, patients with strictly isolated TBI (iTBI) (n = 88) were selected and stratified for coagulopathy by routine international normalized ratio (INR): (1) INR &lt; 1.2 and (2) INR ≥ 1.2. An INR &gt; 1.2 has been well adopted over time as a threshold to define trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick’s value, activated partial thromboplastin time, fibrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fibrinolysis-regulating parameters (thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fibrin monomers. Results: Patients with iTBI with INR ≥ 1.2 (n = 16) had a high incidence of progressive intracranial hemorrhage associated with increased mortality and unfavorable outcome compared with patients with INR &lt; 1.2 (n = 72). Activity of coagulation factors V, VIII, IX, and XIII dropped on average by 15–20% between the groups whereas protein C and S levels dropped by 20%. With an elevated INR, thrombin generation decreased, as reflected by lower peak height and endogenous thrombin potential (ETP), whereas the amount of fibrin monomers increased. Plasminogen activity significantly decreased from 89% in patients with INR &lt; 1.2 to 76% in patients with INR ≥ 1.2. Moreover, D-dimer levels significantly increased from a mean of 943 mg/L in patients with INR &lt; 1.2 to 1,301 mg/L in patients with INR ≥ 1.2. Conclusions: This more in-depth analysis beyond routine conventional coagulation assays suggests a counterbalanced regulation of coagulation and fibrinolysis in patients with iTBI with hemostatic abnormalities. We observed distinct patterns involving key pathways of the highly complex and dynamic coagulation system that offer windows of opportunity for further research. Whether the changes observed on factor levels may be relevant and explain the worse outcome or the more severe brain injuries by themselves remains speculative.</p

Rehabilitation and outcomes after complicated vs uncomplicated mild TBI:results from the CENTER-TBI study

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions: Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration: ClinicalTrials.gov NCT02210221.</p