Outcomes after coronary artery bypass grafting and percutaneous coronary intervention in diabetic and non-diabetic patients

AimsTo assess the prognosis of patients with coronary heart disease (CHD) after first myocardial revascularisation procedure in real world practice and to compare the differences in outcomes of coronary artery by-pass grafting (CABG) and percutaneous coronary intervention (PCI) among diabetic and non-diabetic patients.Methods and resultsA database was compiled from the national hospital discharge register to collect data on all cardiac revascularisations performed in Finland in 2000-2015. The outcomes (all-cause deaths, cardiovascular (CV) deaths, major CV events and need for repeat revascularisation) after the first revascularisation were identified from the national registers at 28-day, 1-year and 3-year time points.A total of 139,242 first-time revascularisations (89,493 PCI and 49,749 CABG) were performed during the study period. Of all the revascularized patients, 24% had diabetes, and 76% were non-diabetic patients. At day 28 the risk of fatal outcomes was lower after PCI than after CABG among non-diabetic patients, whereas no difference was seen among diabetic patients. In long-term follow-up the situation was reversed with PCI showing higher risk compared with CABG for most of the outcomes. In particular, at three-year follow-up the risk of all-cause deaths was elevated among diabetic patients (HR 1.30 (95% CI 1.22-1.38) comparing PCI with CABG) more than among non-diabetic patients (HR 1.09 (1.04-1.15)). The same was true for CV deaths (HR 1.29 (1.20-1.38) among diabetic patients, and HR 1.03 (0.98-1.08) among non-diabetic patients).ConclusionAlthough PCI was associated with better 28-day prognosis, CABG seemed to produce better long-term prognosis especially among diabetic patients.</p

Valtatien 2 Torronsuon kohdan alikulku- /ylikulkujärjestelyt, Tammela : Toimenpideselvitys

Työssä laadittavan suunnitelman lähtökohtana on ollut selvittää niin ihmisille kuin eläimillekin turvallinen val-tatien 2 ylitys / alitus Niinimäentien ja Härkätien välisellä alueella. Yhteystarve sekä eritasossa tapahtuva alitus tai ylitys ovat tunnistettu alueella jo pitkään, sillä paikka on esitetty muun muassa maakuntakaavassa, jonka lisäksi Tammelan kunta on tutkinut alikulkuratkaisun mahdollisuutta aiemmin. Tässä suunnitelmassa tutkittiin sekä yli- ja alikulkuratkaisun toteuttamismahdollisuutta

Are coronary event rates declining slower in women than in men – evidence from two population-based myocardial infarction registers in Finland?

<p>Abstract</p> <p>Background</p> <p>Studies have suggested that the prevention and treatment of coronary heart disease may not have been as effective in women as in men. Therefore, we aimed to examine whether the incidence, attack rate and mortality of myocardial infarction (MI) events have declined less in women than in men.</p> <p>Methods</p> <p>Two large population-based MI registers, the FINAMI register and the Finnish Cardiovascular Disease Register (CVDR) were used for comparing the event rates among men and women aged ≥35 years in two time periods, 1994–1996 and 2000–2002.</p> <p>Results</p> <p>In the FINAMI register a total of 5,252 events were recorded in men and 4,898 in women. Corresponding numbers in the CVDR were 78,709 and 70,464. Both FINAMI and CVDR data suggested smaller declines in incidence and attack rate of MI events in women than in men. In CVDR data the decline in mortality was also smaller in women than in men, while in FINAMI data this difference did not reach statistical significance. In the large CVDR data set, negative binomial regression models revealed smaller declines in incidence (p = 0.006), attack rate (p = 0.008) and mortality (p = 0.04) in women than in men aged <55 years. In persons ≥55 years no difference was observed between women and men.</p> <p>Conclusion</p> <p>The incidence and attack rate of MI events have declined less in women aged <55 than in men of similar age. In older persons no significant differences were observed. Further studies are warranted to find out the reasons why the development has been less favourable for young women than for men.</p

Alakoulun 3-4-luokkalaisten seksuaaliterveyden edistäminen : verkkomateriaali terveydenhoitajan työn tueksi

Tämän tuotteellisen opinnäytetyön tarkoituksena oli luoda terveydenhoitajille työkalu 9–10-vuotiaiden seksuaaliterveyden edistämiseen. Tuotimme terveydenhoitajan työn tueksi verkkomateriaalia, josta löytyy helposti ja nopeasti luotettavaa tietoa seksuaaliterveydestä. Opinnäytetyömme on osa Seksuaaliterveyden edistäminen koulu- ja opiskeluterveydenhuollossa ja ammatillisessa koulutuksessa -hanketta, jossa yhteistyötä tekevät Helsingin ja Keravan kaupunkien koulu- ja opiskeluterveydenhuollot ja ehkäisyneuvolat, Terveyden ja hyvinvoinnin laitos, Väestöliitto ja Tyttöjen talo. Projektin tavoitteena on arvioida seksuaaliterveyden edistämisen toteutumista sekä kehittää nuorten seksuaaliterveyden edistämisen osaamista ja työmenetelmiä kunnassa. Ideana oli käsitellä sivustoilla laaja-alaisesti seksuaalikehitystä 9–10-vuotiaiden kehitystaso huomioiden ja luoda siitä selkeä ja monipuolinen tietopaketti, jota voi käyttää sekä ryhmäopetuksessa että yksilöohjauksessakin. Tämän iän keskeiset seksuaalikehitykseen liittyvät asiat ovat murrosiän alkaminen, fyysisen kehityksen kulku, omaan kehoon tutustuminen, yksilön ainutlaatuisuus, hygieniasta huolehtiminen sekä ihastumiset ja rakastumiset. Lisäksi suunnittelimme monikäyttöistä kuvamateriaalia edellä mainituista aiheista. Tavoitteena on, että kuvat olisivat mielenkiintoa herättäviä, selkeitä, tukisivat seksuaaliterveyden opetusta sekä helpottaisivat lapsia uusien asioiden oppimisessa. Opinnäytetyöhömme ei kuulu verkkosivujen käytännön toteuttaminen. Suunnitelmissa on, että Metropolia ammattikorkeakoulun mediatekniikan opiskelijoista koostuva työryhmä toteuttaisi verkkosivut tulevaisuudessa. Hankkeessa on myös mukana useita muita opinnäytetyöryhmiä, jotka tuottavat sisältöä verkkosivuille. Kaikkien näiden ryhmien materiaalit on suunnitelmissa koota yhdeksi laajaksi, toimivaksi kokonaisuudeksi, joka tekee seksuaaliterveyden edistämisestä tuloksellisempaa.The aim of our final project was to improve public health nurses’ sexual health promotion skills for 9–10-years old children. We produced material for a website, which will help public health nurses to find reliable information on sexual health easier and faster. Our final project was part of a Sexual Health Promotion in School Health Care and in Vocational School project. In this project the school and student health care and family planning clinics of the Cities of Helsinki and Kerava collaborated. Also National Institute for Health and Welfare and ”Tyttöjen talo” (in English “Girls House”, own translation) cooperated. The goal of this larger project is to evaluate the implementation of sexual health promotion and to develop the know-how of sexual health promotion. The idea of our final project was to discuss sexual health in a versatile way and to design a website which would be easy to use. The website could be useful in individual patient guidance and in group teaching. The essential topics of the age group 9–10 years old children are physical growth, the beginning of puberty, getting to know one`s own body, individual uniqueness, hygiene and infatuations and love life. In addition, we designed some pictures of the same topics. The aim of the pictures was to arouse interest, support teaching of sexual health and to make it easy for children to absorb new information. Creating the actual website was not part of our final project. In future, a group of Media Technology students of Helsinki Metropolia University of Applied Sciences will do it. In the larger project, there are some other groups too, which create sexual health material for the same website as their final project. Thus, sexual health promotion will become better and more effective

Feasibility of frailty screening among patients with advanced heart failure

Background Frailty is common among patients with advanced heart failure (HF), and screening for frailty to guide care is recommended. Although multiple tools are available to screen for frailty, the feasibility of routinely incorporating frailty screening into daily clinical practice among hospitalised advanced HF patients has not been rigorously tested.Methods This was a prospective, single-centre, quality improvement study. Two brief frailty screening tools were incorporated into palliative care consultations for all patients ≥50 years from August 2021 to October 2022. In the first phase, the Clinical Frailty Scale (CFS) was implemented, followed by the Study of Osteoporotic Fracture (SOF) tool or a modified SOF (mSOF) version in the second phase. The primary outcome was feasibility (%) of performing frailty screenings for this high-risk population.Results A total of 212 patients (mean age 69±10 years, 69% male, 79% white, 30% with ischaemic HF) were referred for palliative care consultation during the study period. Overall, frailty screens were completed in 86% (n=183) of patients. CFS and mSOF reached &gt;80% of adoption, while SOF adoption was 54%. Altogether, 52% of the population screened frail by use of CFS and 52% also by mSOF. All clinicians (n=6) participating in the study reported that frailty screening tools were useful and acceptable, and 83% reported plans for continued utilisation in future clinical practice.Conclusions Frailty screening with CFS or mSOF tools was feasible in hospitalised patients with advanced HF. Tools that require physical assessment were more challenging to implement. These data support the feasibility of incorporating questionnaire-based frailty screening in a busy hospital setting