Frequent pain in older people with and without diabetes - Finnish community based study

Background: The association between pain and diabetes in older people has been largely unexplored. The aim of this survey was to analyze the prevalence and characteristics of pain among Finnish men and women 65 or older with and without diabetes in primary care. Methods: All home-dwelling persons 65 years or older with diabetes (N = 527) and age and gender matched controls (N = 890) were identified from electronic patient records. Frequent pain was regarded as any pain experienced more often than once a week, and it was divided into pain experienced several times a week but not daily and pain experienced daily or continuously. The Numeric Rating Scale (0-10) (NRS) was used to assess the intensity and interference of the pain. Results: The number of subjects who returned the questionnaire was 1084 (76.5%). The prevalence of frequent pain in the preceding week was 50% among women without diabetes and 63% among women with diabetes (adjusted, p = 0.22). In men, the corresponding proportions were 42% without diabetes and 47% with diabetes (adjusted, p = 0.58). In both genders, depressive symptoms and the number of comorbidities were associated with pain experienced more often than once a week and with daily pain. Diabetes was not associated with pain intensity or pain interference in either women or men. Conclusions: Pain in older adults is associated with depressive symptoms and the number of comorbidities more than with diabetes itself.Peer reviewe

On SAT representations of XOR constraints

We study the representation of systems S of linear equations over the two-element field (aka xor- or parity-constraints) via conjunctive normal forms F (boolean clause-sets). First we consider the problem of finding an "arc-consistent" representation ("AC"), meaning that unit-clause propagation will fix all forced assignments for all possible instantiations of the xor-variables. Our main negative result is that there is no polysize AC-representation in general. On the positive side we show that finding such an AC-representation is fixed-parameter tractable (fpt) in the number of equations. Then we turn to a stronger criterion of representation, namely propagation completeness ("PC") --- while AC only covers the variables of S, now all the variables in F (the variables in S plus auxiliary variables) are considered for PC. We show that the standard translation actually yields a PC representation for one equation, but fails so for two equations (in fact arbitrarily badly). We show that with a more intelligent translation we can also easily compute a translation to PC for two equations. We conjecture that computing a representation in PC is fpt in the number of equations.Comment: 39 pages; 2nd v. improved handling of acyclic systems, free-standing proof of the transformation from AC-representations to monotone circuits, improved wording and literature review; 3rd v. updated literature, strengthened treatment of monotonisation, improved discussions; 4th v. update of literature, discussions and formulations, more details and examples; conference v. to appear LATA 201

Social relationships, child poverty, and children's life satisfaction

Child subjective well-being is determined by various personal, social, and contextual factors. Few studies have found reliable differences in the prediction power of these factors; however, the results vary especially when it comes to sociodemographic factors, such as the effect of child’s socioeconomic background on life satisfaction. This paper examines how poverty and social relationships affect the perceived life satisfaction of Finnish schoolchildren. Drawing on survey data of Finnish schoolchildren, from grades 5, 7, and 9 (n = 1793), linear regression was used to test how life satisfaction would be associated with socio-demographic variables, poverty, and child–parent and peer relationships. The results emphasize the complex nature of the determinants of children’s life satisfaction. The greatest unique contribution for change of life satisfaction was made by the time spent with mother (β(p) = 0.189). Overall, the model showed a good fit (R2 19.9). These findings have important implications for family policies and services that promote good parenting and positive parent–child relationships. Furthermore, this study highlights relational well-being as a key determinant of children’s life satisfaction.</p

Early clinical features of new-onset refractory status epilepticus (NORSE) in adults

Peer reviewe

Two middle-aged women with the Finnish variant of muscle-eye-brain disease (MEB)

Muscle-eye-brain disease (MEB) is a recessively inherited rare disease. Sixteen different gene mutations are known, with the most common mutations in the POMGNT1 gene. The disease is now called congenital muscular dystrophy-dystroglycanopathy type A3 (MDDGA3). It manifests itself as muscular dystrophy with eye and brain anomalies and intellectual disability. Previous clinical reports describe young patients. We have been able to follow two patients for almost 40 years. Their clinical picture has remained quite stable since adolescence, appearing as severe intellectual and motor disability, extremely limited communication skills, visual impairment, epilepsy, joint contractures, repeated bowel obstructions, teeth abrasion due to bruxism, an irregular sleep pattern and as a previously unreported feature hypothermic periods manifesting as excessive sleepiness

Work incapacity among family caregivers : a record linkage study

Background Family caregiving-related physical and mental health problems may lead to work incapacity in employed caregivers. The aim of this study was to quantify sickness absences and disability pensions (SADP) among high-intensity family caregivers available to the labour market compared with a control population. Methods The study sample included all individuals in Finland, who had received caregiver's allowance and were available to the labour market in 2012 (n=16 982) and their controls (n=35 371). Information on the number of sickness absence (spells >10 days) and disability pension (SADP) days and related diagnoses according to ICD-10 were obtained from national registers for the years 2012-2017. The analyses were adjusted for age, sex, occupational status, education, income and degree of urbanisation. Results During the follow-up, 40.9% of caregivers and 39.5% of controls had at least one sickness absence spell and 6.1% and 4.7%, respectively, received disability pension. The mean annual number of SADP days was 23.2 (95% CI 22.3 to 24.1) for caregivers and 18.5 (95% CI 18.0 to 19.0) for controls (adjusted incidence rate ratio (IRR)=1.16, 95% CI 1.10 to 1.22). The number of annual SADP days due to mental disorders was higher in caregivers (7.2, 95% CI 6.7 to 7.8) than controls (4.0, 95% CI 3.8 to 4.3; adjusted IRR 1.58, 95% CI 1.42 to 1.75). There were no differences in SADP days due to cancer, neurological, cardiovascular, respiratory, or musculoskeletal diseases, or external causes. Discussion Higher number of SADP days due to mental disorders in caregivers suggests that family caregiving has an adverse effect on work capacity and that caregivers are at increased risk for mental disorders.Peer reviewe

Hard Instances of the Constrained Discrete Logarithm Problem

The discrete logarithm problem (DLP) generalizes to the constrained DLP, where the secret exponent $x$ belongs to a set known to the attacker. The complexity of generic algorithms for solving the constrained DLP depends on the choice of the set. Motivated by cryptographic applications, we study sets with succinct representation for which the constrained DLP is hard. We draw on earlier results due to Erd\"os et al. and Schnorr, develop geometric tools such as generalized Menelaus' theorem for proving lower bounds on the complexity of the constrained DLP, and construct sets with succinct representation with provable non-trivial lower bounds

Natural course of Fabry disease with the p Arg227Ter (pR227*) mutation in Finland: Fast study

BackgroundFabry disease is caused by a deficient or an absent alfa‐galactosidase A activity and is an X‐linked disorder that results in organ damage and a shortened life span, especially in males. The severity of the disease depends on the type of mutation, gender, skewed X‐chromosome inactivation, and other still unknown factors.MethodsIn this article, we describe the natural course of a common classic Fabry disease mutation, p.Arg227Ter or p.R227*, in Finland.ResultsFour males and ten females belonged to two extended families. The mean age was 46 years (SD 18.4). Six patients (43%) had cardiac hypertrophy, three patients (21%) had ischemic stroke, and none had severe kidney dysfunction. Three patients had atrial fibrillation; two patients who had atrial fibrillation also had pacemakers. All males over 30 years of age had at least one of the following manifestations: cardiac hypertrophy, stroke, or proteinuria. In females, the severity of Fabry disease varied from classic multiorgan disease to a condition that mimicked the attenuated cardiac variant. No one was totally asymptomatic without any signs of Fabry disease. Cardiac magnetic resonance imaging was performed on nine of 14 patients was the most sensitive for detecting early cardiac manifestations. Five patients (55%) had late gadolinium enhancement‐positive segments.ConclusionCardiac involvement should be effectively detected in females before considering them asymptomatic mutation carriers.</div

Keinot edistää sää- ja ilmastoriskien hallintaa

ELASTINEN-tutkimushankkeessa selvitettiin sää- ja ilmastoriskien hallinnan tilaa Suomessa ja arvioitiin riskienhallintakeinoja sekä eri toimijoiden roolia. Lisäksi tarkasteltiin, miten riskienhallinnan kustannuksia ja hyötyjä arvioidaan sekä miten riskienhallinta voidaan kääntää liiketoiminnaksi. Yhteiskunnan toimivuuden ja turvallisuuden ylläpitäminen edellyttää aktiivista varautumista sään ääriilmiöihin. Hankkeen tulosten mukaan suomalaiset organisaatiot eivät usein arvioi sää- ja ilmastoriskejä systemaattisesti. Varautumisessa tulee ottaa huomioon, että ilmastonmuutos voi muuttaa sään ääri-ilmiöitä, niiden esiintymistiheyttä ja voimakkuutta. Näin varautuminen sään ääri ilmiöihin on myös osa sopeutumista ilmastonmuutokseen. ELASTINEN-hanke esittää kolme suositusta, joilla sää- ja ilmastoriskien hallintaa voitaisiin parantaa ja sopeutumistyötä tukea: 1) monipuolistetaan tiedon tuottoa ja käyttöä, 2) vahvistetaan yhteistyötä ja kehitetään toimintatapoja sekä 3) kehitetään palveluita ja liiketoimintamahdollisuuksia. Suositusten toteuttamiseksi esitetään toimenpide-ehdotuksia, minkä lisäksi on tunnistettu toimien toteuttajatahoja. Nykyistä monipuolisempi ja helpommin saatavilla oleva tieto parantaisi mahdollisuuksia arvioida ja hallita sää- ja ilmastoriskejä sekä kykyä sopeutua ilmastonmuutoksen vaikutuksiin. Suomessa tulisi myös arvioida säännöllisesti Suomen ulkopuolella tapahtuvia ilmastonmuutoksen vaikutuksia, jotka voivat heijastua Suomeen. Sää- ja ilmastoriskien hallintatoimia tulisi valita ja arvioida myös taloudellisen tehokkuuden näkökulmasta

Translation and cultural adaptation of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale into Arabic for use with patients with diabetes in Libya.

In Libya neuropathic pain is rarely assessed in patients with diabetes. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale is used worldwide to screen for neuropathic pain. There is no Arabic version of LANSS for use in Libya. The aim of this study was to develop an Arabic version of LANSS and to assess its validity and reliability in diabetic patients in Benghazi, Libya. LANSS was translated into Arabic by four bilingual translators and back translated to English by a university academic. Validity and reliability of the Arabic LANSS was assessed on 110 patients attending a Diabetes Centre in Benghazi. Concurrent validity was tested and compared with the Self-completed Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS). Test-retest reliability was conducted 1-2 weeks later. Internal consistency and inter-class correlation (ICC) between LANSS and S-LANSS was also tested. Internal consistency within first completion of the Arabic LANSS was acceptable (Cronbach's alpha = 0.793) and similar to the Arabic S-LANSS (0.796) and the second completion of the Arabic LANSS (0.795). ICC between the Arabic LANSS and the Arabic S-LANSS was 0.999 (p 0.95, p < 0.0001). We concluded that the Arabic version of LANSS pain scale was valid and reliable for use on Libyan diabetic patients. This study provided results suggesting that the S-LANSS could also be used on diabetic patients