Lasten ja nuorten mielenterveyskuntoutus : Terveydenhuollon ja Kelan yhteistyötä

Suositus on tehty Kelan ja julkisen terveydenhuollon asiantuntijoiden valtakunnallisessa yhteistyössä. Suositus on suunnattu kuntoutusta suunnitteleville ja toteuttaville tahoille. Lapsi tai nuori voi saada Kelan vaativaa lääkinnällistä kuntoutusta, kun • hän ei ole julkisessa laitoshoidossa • hänellä on sairaus tai vamma sekä siihen liittyvä suoritus- ja osallistumisrajoite • suoritus- ja osallistumisrajoite on niin suuri, että hänellä on sen vuoksi huomattavia vaikeuksia arjen toiminnoista suoriutumisessa ja osallistumisessa kotona, opiskelussa, työelämässä tai muissa elämäntilanteissa • rajoite aiheuttaa vähintään vuoden kestävän kuntoutustarpeen • kuntoutus ei liity välittömään sairaanhoitoon • kuntoutuksen tavoitteet eivät ole ainoastaan hoidollisia • kuntoutus on perustellusti tarpeen mahdollistamaan aktiivista ja harkittua arjen toiminnoista suoriutumista ja osallistumista. Suosituksessa ei esitetä yksityiskohtaisesti kuntoutusmenetelmiä eikä vaikuttavuusnäyttöä. Näiltä osin suosituksessa viitataan Käypä hoito -suosituksiin, ajankohtaisiin oppikirjoihin ja tutkimuksiin. Muihin kuin mielenterveyshäiriöiden diagnooseihin, kuten esimerkiksi aistivammaisuuteen tai kehitysvammaisuuteen liittyviä erityistarpeita ei käsitellä tässä suosituksessa. Suosituksessa kuvataan julkisen terveydenhuollon järjestämisvastuu sekä ikäryhmäkohtainen toimintakyvyn arvioinnin ja kuntoutuksen valinnan, käynnistämisen ja seuraamisen prosessi. Suosituksessa kuvataan Kelan järjestämien kuntoutustoimenpiteiden asiakkuuskriteerit vaativan lääkinnällisen kuntoutuksen (luvut 9 ja 10), harkinnanvaraisen kuntoutuksen (luvut 10, 11 ja 12), kuntoutuspsykoterapian (luku 13) sekä ammatillisen kuntoutuksen (luku 14) osalta. Lisäksi suosituksessa esitetään keskeiset lapsen ja nuoren kuntoutusta tukevat etuudet (luvut 15 ja 16) ja se, milloin lapsella tai nuorella voi olla mahdollisuus Kelan maksamaan opiskelun apuvälineeseen (luku 17).nonPeerReviewedVertaisarvioimato

Fabricating Sustainable All-Cellulose Composites

Climate change, waste disposal challenges, and emissions generated by the manufacture of non-renewable materials are driving forces behind the production of more sustainable composite materials. All-cellulose composites (ACCs) originate from renewable biomass, such as trees and other plants, and are considered fully biodegradable. Dissolving cellulose is a common part of manufacturing ACCs, and currently there is a lot of research focused on effective, but also more environmentally friendly cellulose solvents. There are several beneficial properties of ACC materials that make them competitive: light weight, recyclability, low toxicity, good optical, mechanical, and gas barrier properties, and abundance of renewable plant-based raw material. The most prominent ACC applications are currently found in the food packing, medical, technical and vehicle industries. All-cellulose nanocomposites (ACNCs) expand the current research field and can offer a variety of more specific and functional applications. This review provides an overview of the manufacture of sustainable ACCs from lignocellulose, purified cellulose, and cellulosic textiles. There is an introduction of the cellulose dissolution practices of creating ACCs that are currently researched, the structure of cellulose during complete or partial dissolution is discussed, and a brief overview of factors which influence composite properties is presented

All-Cellulose Composite Laminates Made from Wood-Based Textiles: Effects of Process Conditions and the Addition of TEMPO-Oxidized Nanocellulose

All-cellulose composites (ACCs) are manufactured using only cellulose as a raw material. Biobased materials are more sustainable alternatives to the petroleum-based composites that are used in many technical and life-science applications. In this study, an aquatic NaOH-urea solvent system was used to produce sustainable ACCs from wood-based woven textiles with and without the addition of TEMPO-oxidized nanocellulose (at 1 wt.-%). This study investigated the effects of dissolution time, temperature during hot press, and the addition of TEMPO-oxidized nanocellulose on the mechanical and thermal properties of the composites. The results showed a significant change in the tensile properties of the layered textile composite at dissolution times of 30 s and 1 min, while ACC elongation was the highest after 2 and 5 min. Changes in hot press temperature from 70 °C to 150 °C had a significant effect: with an increase in hot press temperature, the tensile strength increased and the elongation at break decreased. Incorporating TEMPO-oxidized nanocellulose into the interface of textile layers before partial dissolution improved tensile strength and, even more markedly, the elongation at break. According to thermal analyses, textile-based ACCs have a higher storage modulus (0.6 GPa) and thermal stabilization than ACCs with nanocellulose additives. This study highlights the important roles of process conditions and raw material characteristics on the structure and properties of ACCs.

Mechanical and Thermal Properties of Wood-Fiber-Based All-Cellulose Composites and Cellulose–Polypropylene Biocomposites

This article explores wood-fiber-based fabrics containing Lyocell yarn in the warp and Spinnova–Lyocell (60%/40%) yarn in the weft, which are used to form unidirectional all-cellulose composites (ACC) through partial dilution in a NaOH–urea solution. The aim is to investigate the role of the yarn orientation in composites, which was conducted by measuring the tensile properties in both the 0° and 90° directions. As a reference, thermoplastic biocomposites were prepared from the same fabrics, with biobased polypropylene (PP) as the matrix. We also compared the mechanical and thermal properties of the ACC and PP biocomposites. The following experiments were carried out: tensile test, TGA, DSC, DMA, water absorption test and SEM. The study found no significant difference in tensile strength regarding the Spinnova–Lyocell orientation between ACC and PP biocomposites, while the composite tensile strength was clearly higher in the warp (Lyocell) direction for both composite variants. Elongation at break doubled in ACC in the Lyocell direction compared with the other samples. Thermal analysis showed that mass reduction started at a lower temperature for ACC, but the thermal stability was higher compared with the PP biocomposites. Maximum thermal degradation temperature was measured as being 352 °C for ACC and 466 °C for neat PP, and the PP biocomposites had two peaks in the same temperature range (340–474 °C) as ACC and neat PP combined. ACCs absorbed 93% of their own dry weight in water in just one hour, whereas the PP biocomposites BC2 and BC4 absorbed only 10% and 6%, respectively. The study highlights the different properties of ACC and PP reference biocomposites that could lead to further development and research of commercial applications for ACC

Associations of cardiorespiratory fitness, body composition, and blood pressure with arterial stiffness in adolescent, young adult, and middle-aged women

Few studies have investigated whether higher cardiorespiratory fitness (CRF) or favourable body composition are related to lower arterial stiffness in women. We therefore investigated the associations of CRF, body fat percentage (BF%), fat free mass index (FFMI), and mean arterial pressure (MAP) with arterial stiffness in 146 women aged 16–58 years. CRF was assessed by a maximal exercise test with respiratory gas analysis either on a cycle ergometer or a treadmill. Aortic pulse wave velocity (PWVao), augmentation index (AIx%), and MAP were assessed by a non-invasive oscillometric device and BF% and FFMI by a bioelectrical impedance or DXA device. CRF was inversely associated with PWVao (β =  − 0.004, 95% CI − 0.005 to − 0.002) and AIx% (β =  − 0.075, 95% CI − 0.102 to − 0.048) and these associations remained similar after adjustment for BF% or MAP, but not after the adjustment for age. FFMI was inversely associated with PWVao (β =  − 0.010, 95% CI − 0.019 to − 0.002) and MAP directly associated with PWVao (β = 0.005, 95% CI 0.003 to 0.006) and AIx% (β = 0.092, 95% CI 0.069 to 0.116) and the associations with PWVao also remained after further adjustments for BF% and age. In conclusion, a higher FFMI and a lower MAP were independently associated with lower arterial stiffness.peerReviewe

Associations of Sex Hormones and Hormonal Status With Arterial Stiffness in a Female Sample From Reproductive Years to Menopause

Objective: Loss of sex hormones has been suggested to underlie menopause-associated increment in cardiovascular risk. We investigated associations of sex hormones with arterial stiffness in 19–58-years-old women. We also studied associations of specific hormonal stages, including natural menstrual cycle, cycle with combined oral contraceptives (COC) and menopausal status with or without hormone therapy (HT), with arterial stiffness. Methods: This study includes repeated measurements of 65 healthy women representing reproductive (n=16 natural, n=10 COC-users) and menopause (n=5 perimenopausal, n=26 postmenopausal, n=8 HT-users) stages. Arterial stiffness outcomes were aortic pulse wave velocity (PWVao) and augmentation index (AIx%) assessed using Arteriograph-device. Generalized estimating equation models were constructed to investigate associations of each hormone (wide age-range models) or hormonal stage (age-group focused models) with arterial stiffness. PWVao models with cross-sectional approach, were adjusted for age, relative fitness, fat mass and mean arterial pressure, while models with longitudinal approach were adjusted for mean arterial pressure. AIx% models used the same approach for adjustments and were also adjusted for heart rate. Results: Negative and positive associations with arterial stiffness variables were observed for estradiol and follicle-stimulating hormone, respectively, until adjustment for confounding effect of age. In naturally menstruating women, AIx% was higher at ovulation (B=3.63, p<0.001) compared to the early follicular phase. In COC-users, PWVao was lower during active (B=-0.33 - -0.57, p<0.05) than inactive pills. In menopausal women, HT-users had higher PWVao (B=1.43, p=0.03) than postmenopausal non-HT-users. Conclusions: When using wide age-range assessments covering reproductive to menopausal lifespan it is difficult to differentiate age- and hormone-mediated associations, because age-mediated influence on arterial stiffness seemed to overrule potential hormone-mediated influences. However, hormonal status associated differentially with arterial stiffness in age-group focused analyses. Thus, the role of sex hormones cannot be excluded. Further research is warranted to resolve potential hormone-mediated mechanisms affecting arterial elasticity.peerReviewe

Associations of resting and peak fat oxidation with sex hormone profile and blood glucose control in middle-aged women

Background and Aims Menopause may reduce fat oxidation. We investigated whether sex hormone profile explains resting fat oxidation (RFO) or peak fat oxidation (PFO) during incremental cycling in middle-aged women. Secondarily, we studied associations of RFO and PFO with glucose regulation. Method and Results We measured RFO and PFO of 42 women (age 52–58 years) with indirect calorimetry. Seven participants were pre- or perimenopausal, 26 were postmenopausal, and nine were postmenopausal hormone therapy users. Serum estradiol (E2), follicle-stimulating hormone, progesterone, and testosterone levels were quantified with immunoassays. Insulin sensitivity (Matsuda index) and glucose tolerance (area under the curve) were determined by glucose tolerance testing. Body composition was assessed with dual-energy X-ray absorptiometry; physical activity with self-report and accelerometry; and diet, with food diaries. Menopausal status or sex hormone levels were not associated with the fat oxidation outcomes. RFO determinants were fat mass (β = 0.44, P = 0.006) and preceding energy intake (β = −0.41, P = 0.019). Cardiorespiratory fitness (β = 0.59, P = 0.002), lean mass (β = 0.49, P = 0.002) and physical activity (self-reported β = 0.37, P = 0.020; accelerometer-measured β = 0.35, P = 0.024) explained PFO. RFO and PFO were not related to insulin sensitivity. Higher RFO was associated with poorer glucose tolerance (β = 0.52, P = 0.002). Conclusion Among studied middle-aged women, sex hormone profile did not explain RFO or PFO, and higher fat oxidation capacity did not indicate better glucose control.peerReviewe