Comprehensive self-tracking of blood glucose and lifestyle with a mobile application in the management of gestational diabetes : a study protocol for a randomised controlled trial (eMOM GDM study)

IntroductionGestational diabetes (GDM) causes various adverse short-term and long-term consequences for the mother and child, and its incidence is increasing globally. So far, the most promising digital health interventions for GDM management have involved healthcare professionals to provide guidance and feedback. The principal aim of this study is to evaluate the effects of comprehensive and real-time self-tracking with eMOM GDM mobile application (app) on glucose levels in women with GDM, and more broadly, on different other maternal and neonatal outcomes.Methods and analysisThis randomised controlled trial is carried out in Helsinki metropolitan area. We randomise 200 pregnant women with GDM into the intervention and the control group at gestational week (GW) 24-28 (baseline, BL). The intervention group receives standard antenatal care and the eMOM GDM app, while the control group will receive only standard care. Participants in the intervention group use the eMOM GDM app with continuous glucose metre (CGM) and activity bracelet for 1 week every month until delivery and an electronic 3-day food record every month until delivery. The follow-up visit after intervention takes place 3 months post partum for both groups. Data are collected by laboratory blood tests, clinical measurements, capillary glucose measures, wearable sensors, air displacement plethysmography and digital questionnaires. The primary outcome is fasting plasma glucose change from BL to GW 35-37. Secondary outcomes include, for example, self-tracked capillary fasting and postprandial glucose measures, change in gestational weight gain, change in nutrition quality, change in physical activity, medication use due to GDM, birth weight and fat percentage of the child.Ethics and disseminationThe study has been approved by Ethics Committee of the Helsinki and Uusimaa Hospital District. The results will be presented in peer-reviewed journals and at conferences.Peer reviewe

Tampereen yliopistollisessa keskussairaalassa vuosina 1980-1988 hoidetut kantaluun murtumat.

Syventävä työ ei kirjastoss

Tampereen yliopistollisessa keskussairaalassa vuosina 1980-1988 hoidetut kantaluun murtumat.

Syventävä työ ei kirjastoss

Uusi biokaasun tankkausasema ja sen logistiikka

Opinnäytetyössä tutkittiin biokaasun tankkausaseman sijoittamista Jyväskylään sekä siihen liittyvää logistiikkaa. Työ on osa Jyväskylän ammattikorkeakoulun hanketta, jossa muutetaan 60 tonnin kuorma-autoja käyttämään dieselin lisäksi biokaasua. Näiden kuor-ma-autojen päästöluokitus on välillä Euro 3 – 6. Taustalla on Euroopan Unionin ilmasto- ja energiapolitiikka, jonka tavoitteena on nostaa uusiutuvien energialähteiden osuutta liikenteessä. Suomen tavoitteena on, että kaikista energialähteistä uusiutuvien osuus olisi 20 % vuoteen 2020 mennessä. Teoreettisessa osassa tarkastellaan metaanikaasujen ominaisuuksia, ympäristövaikutuksia sekä niiden tuotantoa ja hankintaa. Lisäksi tarkastellaan metaanikaasuautoilun tilaa Suomessa sekä muissa Pohjoismaissa. Teoriapohjassa esitellään myös biokaasun tankkausaseman perustamisen edellytykset ja mahdollisia edistämiskeinoja. Tutkimusaineisto perustuu muihin alan tutkimuksiin. Tuloksista selvisi, että Jyväskylän seudulla on kasvava biokaasuautoilukanta, ja myös yritysten taholta on kiinnostusta biokaasuautoiluun siirtymiseen. Jyväskylässä on tarve biokaasun tankkausasemalle, mutta tämän sijoittaminen edellyttäisi ehdottomasti sidosryhmien mukaan liittymistä. Tarvittava biokaasu olisi mahdollista tuoda tankkausasemalle maantiekuljetuksin muista kohteista. Jyväskylän seudun tuotantolaitosten tuotantomäärät ovat riittävät, joten niille olisi mahdollista rakentaa jalostuslaitos. Tässä tapauksessa biokaasu voitaisiin esimerkiksi kuljettaa tankkausasemalle putkistoa pitkin. Biokaasun käyttö on merkittävä keino vähentää kasvihuonekaasu- ja liikennepäästöjä, ja sen käytön edistämiseen tarvitaan valtiolta tukitoimia, helpotuksia sekä muutoksia lainsäädäntöön.The thesis studies the placing of a biogas filling station and it’s logistics. The thesis is a part of a project, which turns 60-ton trucks with emission rating of Euro 3 – 6 into using bio gas in addition to diesel. This project is led by JAMK University of Applied Sciences. The project is based on the European Union’s climate and energy policy, which aims to increase the amount of renewable energy sources in transport. Finland’s goal is to achieve 20 % share by the year 2020. In the theoretical part the focus is on the attributes and climate impacts of methane gas as well as production, purchasing and methane gas motoring in Finland and the other Nordic countries. The theoretical part also introduces the preconditions for founding a biogas filling station and possible ways to promoting it. The research data is based on other studies in the field. The results indicate that the amount of biogas-operated motoring is increasing. Also com-panies seem to be interested in switching into biogas-operated motoring. There is a de-mand for a biogas filling station in Jyväskylä, but this would require the companies taking part in this process. It is possible to transport the biogas needed to the filling station by road transport from other destinations. The amount of biogas production in Jyväskylä is sufficient, so it would be possible to build a processing facility for the factories in Jyväskylä. In this case for example, biogas could be transported to the filling station via a pipeline. Using biogas is a significant way to reduce greenhouse and transport emissions. To increase the use of biogas, support from the government and changes in legislation are required

Reoperation Rates Following Instrumented Lumbar Spine Fusion

Study Design. A prospective cohort study. Objective. This study evaluated the cumulative reoperation rate and indications for reoperation following instrumented lumbar spine fusion (LSF). Summary of Background Data. LSF reduces disability and improves health-related quality of life for patients with several spinal disorders. The rate of instrumented LSF has drastically increased over the last few decades. The increased incidence of LSF, however, has led to increased reoperation rates. Methods. The data are based on the prospective LSF database of Tampere University Hospital that includes all elective indications for LSF surgery. A total of 433 consecutive patients (64% women, mean age 62 years) who underwent LSF in Tampere University Hospital between 2008 and 2011 were evaluated and indications for reoperations were rechecked from patient records and radiographs. The most common diagnosis for the primary surgery was degenerative spondylolisthesis and the mean follow-up time was 3.9 years. The cumulative incidence of reoperations and the ‘‘time to event’’ survival rate was calculated by Kaplan-Meier analysis. Results. By the end of 2013, 81 patients had undergone at least one reoperation. The cumulative reoperation rate at 2 years was 12.5% (95% confidence interval: 95% CI: 9.7–16.0) and at 4 years was 19.3% (95% CI: 15.6–23.8). The most common pathology leading to reoperation was adjacent segment pathology with a cumulative reoperation rate of 8.7% (95% CI: 6.1–12.5) at 4 years. The corresponding rates for early and late instrumentation failure were 4.4% (95% CI: 2.7–7.0) and 2.9% (95% CI: 1.9–7.1), respectively, and for acute complications, 2.5% (95% CI: 1.4–4.5). Conclusion. Although previous studies reported that early results of spinal fusion are promising, one in five patients required reoperation within 4 years after surgery. Patients and surgeons should be aware of the reoperation rates when planning fusion surgery. Key words: adjacent segment, complications, instrumented lumbar spine fusion, pathology, reoperation. Level of Evidence: 4 Spine 2018;43:295–301peerReviewe

Disability, Health-Related Quality of Life and Mortality in Lumbar Spine Fusion Patients : A 5-Year Follow-Up and Comparison With a Population Sample

Study Design: Prospective follow-up study. Objectives: We aimed to assess the effect of lumbar spine fusion (LSF) on disability, health-related quality of life and mortality in a 5-year follow-up, and to compare these results with the general population. Methods: 523 consecutive LSF operations were included in a prospective follow-up. Disability was assessed by the Oswestry Disability Index (ODI), and HRQoL by the 36-item Short Form (SF-36) questionnaire using the physical and mental summary scores (PCS and MCS). The patients were compared with an age-, sex-, and residential area matched general population cohort. Results: The preoperative ODI in the patients was 46 (SD 16), and the change at 5 years was −26 (95% CI: −24 to −28), p < 0.001. In the population, ODI (baseline 13, SD 16) remained unchanged. The preoperative PCS in the patients was 27 (SD 7), in the population 45 (SD 11), and the increase in the patients at 5 years was 8 (95% CI: 7 to 9), p < 0.001. The patients did not reach the population in ODI or PCS. The baseline MCS in the patients was 47 (SD 13), and the change at 5 years 4 (95% CI: 3 to 7), p < 0.001. MCS of the females reached the population at 5-year follow-up. When analyzing short and long fusions separately, comparable changes were seen in both subgroups. There was no difference in mortality between the patients (3.4%) and the population (4.8%), hazard ratio (HR) 0.86. Conclusions: Although the patients who had undergone LSF benefited from surgery still at 5 years, they never reached the physical level of the population.peerReviewe

Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up

Purpose The aim of the study was to investigate the effectiveness of the postoperative 12-month exercise program compared to usual care on disability and health-related quality of life (HRQoL) in patients after lumbar spine fusion surgery (LSF). Methods Altogether, 98 patients with isthmic (31) or degenerative (67) spondylolisthesis were randomised to exercise therapy group (EG) (n = 48) or usual care group (UCG) (n = 50) 3 months after LSF. EG patients had home-based progressive strength and aerobic training program for 12 months. UCG patients received only oral and written instructions of exercises. Oswestry Disability Index (ODI) and HRQoL (RAND-36) were evaluated at the time of randomization, at the end of the intervention and 1 year after intervention. Results The mean ODI score decreased from 24 (12) to 18 (14) in the EG and from 18 (12) to 13 (11) in the UCG during intervention (between-groups p = 0.69). At 1-year follow-up, 25 % of the EG and 28 % of the UCG had an ODI score ≥20. No between-group differences in HRQoL change were found at any time point. The mean (95 % CI) physical functioning dimension of the HRQoL improved by 10.0 (4.6–15.3) in the EG and by 7.8 (2.5–13.0) in the UCG. In addition, the role physical score improved by 20.0 (7.7–32.3) in the EG and by 16.4 (4.4–28.4) in the UCG during the intervention. Conclusions The exercise intervention did not have an impact on disability or HRQoL beyond the improvement achieved by usual care. However, disability remained at least moderate in considerable proportion of patients.peerReviewe