Työkyvyn hallinta, seuranta ja varhainen tuki : Tutkimus sairausvakuutuslain vuoden 2011 muutoksen vaikutuksista työpaikkojen toimintaan

Tutkimuksessa selvitettiin vuoden 2011 sairausvakuutuslain muutoksen vaikutuksia työkyvyn hallintaan, seurantaan ja varhaiseen tukeen. Sairausvakuutuslakimuutos (L 1056/2010) edellyttää, että ”työpaikalla on yhteistyössä työterveyshuollon kanssa sovitut käytännöt siitä, miten työkyvyn hallintaa, seurantaa ja varhaista tukea toteutetaan työpaikan ja työterveyshuollon yhteisenä toimintana”, jotta työterveyshuollon korvausluokkaan 1 kuuluvista palveluista aiheutuvista kustannuksista korvattaisiin 50 %:n sijaan 60 %. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisessä vaiheessa tehtiin laaja, sähköinen kyselytutkimus, johon osallistui yli 1 000 työnantajaa. Toisessa vaiheessa kartoitettiin syvemmin työnantajien hyviksi kokemia työkyvyn hallinnan käytäntöjä sekä kehitysehdotuksia case-tutkimuksen menetelmin suppeammasta 22 työnantajan otoksesta. Tämän lisäksi haastateltiin viittä eri työterveyshuollon palveluntuottajaa. Yli 85 % kyselytutkimukseen osallistuneista ilmoitti sopineensa toimintakäytännöistä tai laatineensa toimenpideohjelman yhteistyössä työterveyshuollon kanssa, mikä on noin 10 prosenttiyksikköä enemmän kuin ennen vuotta 2011. Erilaisille toimintamalleille on laadittu suunnitelmia melko kattavasti, mutta suunnitelmien seuranta ei ole vielä systemaattista: suunnitelmiin ei ole kytketty tavoitteita, ja seurattavat mittarit puolestaan eivät välttämättä kytkeydy suunnitelmiin. Suurin osa tutkimuksen toiseen vaiheeseen osallistuneista organisaatioista koki lakimuutoksen onnistuneeksi tavaksi edistää työkyvyn hallintaa. Osallistuneissa organisaatioissa työkyvyn hallinta ja varhainen tuki on tullut viime vuosina keskimäärin systemaattisemmaksi ja tavoitteellisemmaksi. Haastateltavat kuitenkin korostivat organisaation omaa toimintaa ja valmiutta tärkeämmäksi työkyvyn hallinnassa. Haastateltavat pitivät suunnitelmien tekoa melko hyödyllisenä työkyvyn hallinnan kannalta ja osasivat mainita esimerkkejä hyvistä työkykykäytännöistä. Tavoitteiden seuranta ja mittaaminen ei kuitenkaan ole niin systemaattista kuin laajat suunnitelmat antaisivat olettaa. Tavoitteet on suunnitelmissa ilmaistu tyypillisesti yleisellä tasolla, jolloin niitä on vaikea mitata tai asettaa tavoitetasoja. Työpaikoilla seurataankin tyypillisesti helposti mitattavia asioita, kuten työtapaturmia, sairauspoissaoloja ja ennenaikaisia eläköitymisiä. Nämä kuvastavat myöhäisen vaiheen ongelmia. Varhaisen vaiheen tunnistamista tai ennaltaehkäisyn toteutumista ei seurata, oletettavasti niiden vaikean mitattavuuden vuoksi, vaikka tavoitteista nämä teemat löytyvät. Työkyvyn hallinnan kehittäminen on monivaiheinen prosessi, joka lähteäkseen käyntiin edellyttää yleistä tietoisuutta työkyvyn hallinnasta sekä henkilöstöasioista vastaavien tahojen kykyä kommunikoida muun johdon kanssa työkyvyn hallinnan kustannusvaikuttavuudesta. Onnistunut työkyvyn hallinta edellyttää lisäksi, että johto on sitoutunut siihen, sisäinen viestintä esimiehille ja työntekijöille toimii ja että henkilöstö osallistuu prosessiin

Increased incidence of melanoma in children and adolescents in Finland in 1990-2014 : nationwide re-evaluation of histopathological characteristics

Background Changes in the incidence of melanoma in children and adolescents have been reported in Europe and in the USA in the recent decades. Aims The aim of this study was to examine the incidence of paediatric and adolescent melanomas in Finland in 1990-2014, and the associated clinical and histopathological characteristics to reveal temporal trends, such as changes in diagnostic sensitivity of Spitzoid melanomas. Methods Information on 122 patients diagnosed with cutaneous melanoma at 0-19 years of age in Finland in 1990-2014 were retrieved from the Finnish Cancer Registry. 73 primary melanoma archival samples were re-evaluated by two dermatopathologists to allow comparability over time. Results A 5.6% annual increase was observed in the incidence of melanoma among children and adolescents during the study period. Fifty-six tumours were confirmed as malignant melanomas in the re-evaluation. After correction for tumour misclassification in the Cancer Registry, the age-adjusted annual incidence was estimated to have increased from 1.4/1 000 000 in 1990-1994 to 5.8/1 000 000 in 2010-2014. The change in incidence was most prominent among adolescents and in Spitzoid melanoma subtype. Melanomas diagnosed 1990-2002 and 2003-2014 did not differ in terms of their clinicopathological characteristics or prognosis (hazard ratio for melanoma-related death 1.53, 95% CI 0.30 to 7.88). Spitzoid melanomas were diagnosed at a younger age, were of higher stage and had higher Clark level than other melanomas, yet the hazard ratio for death was 0.52 (95% CI 0.10 to 2.58) for Spitzoid versus other melanomas. Conclusions The incidence of cutaneous melanoma has clearly increased among the young in Finland, especially among adolescents. No evidence for overdiagnosis of Spitzoid melanomas as the underlying cause of the increased incidence was observed. Key message A nationwide retrospective re-evaluation of the cutaneous melanomas recorded in the Finnish Cancer Registry among patients aged 0-19 years in Finland in 1990-2014 revealed an approximately 4-fold increase in the incidence. The increase in the incidence was most prominent among adolescents and in the Spitzoid melanoma subtype. Our results contrast those reported in other countries, where the incidence of melanoma among adolescents has declined.Peer reviewe

Increased incidence of melanoma in children and adolescents in Finland in 1990-2014: nationwide re-evaluation of histopathological characteristics

BackgroundChanges in the incidence of melanoma in children and adolescents have been reported in Europe and in the USA in the recent decades.AimsThe aim of this study was to examine the incidence of paediatric and adolescent melanomas in Finland in 1990-2014, and the associated clinical and histopathological characteristics to reveal temporal trends, such as changes in diagnostic sensitivity of Spitzoid melanomas.MethodsInformation on 122 patients diagnosed with cutaneous melanoma at 0-19 years of age in Finland in 1990-2014 were retrieved from the Finnish Cancer Registry. 73 primary melanoma archival samples were re-evaluated by two dermatopathologists to allow comparability over time.ResultsA 5.6% annual increase was observed in the incidence of melanoma among children and adolescents during the study period. Fifty-six tumours were confirmed as malignant melanomas in the re-evaluation. After correction for tumour misclassification in the Cancer Registry, the age-adjusted annual incidence was estimated to have increased from 1.4/1 000 000 in 1990-1994 to 5.8/1 000 000 in 2010-2014. The change in incidence was most prominent among adolescents and in Spitzoid melanoma subtype. Melanomas diagnosed 1990-2002 and 2003-2014 did not differ in terms of their clinicopathological characteristics or prognosis (hazard ratio for melanoma-related death 1.53, 95% CI 0.30 to 7.88). Spitzoid melanomas were diagnosed at a younger age, were of higher stage and had higher Clark level than other melanomas, yet the hazard ratio for death was 0.52 (95% CI 0.10 to 2.58) for Spitzoid versus other melanomas.ConclusionsThe incidence of cutaneous melanoma has clearly increased among the young in Finland, especially among adolescents. No evidence for overdiagnosis of Spitzoid melanomas as the underlying cause of the increased incidence was observed.Key messageA nationwide retrospective re-evaluation of the cutaneous melanomas recorded in the Finnish Cancer Registry among patients aged 0-19 years in Finland in 1990-2014 revealed an approximately 4-fold increase in the incidence. The increase in the incidence was most prominent among adolescents and in the Spitzoid melanoma subtype. Our results contrast those reported in other countries, where the incidence of melanoma among adolescents has declined.</p

Breast cancer in neurofibromatosis type 1: overrepresentation of unfavourable prognostic factors

AbstractBACKGROUND: An increased breast cancer incidence and poor survival have been reported for women with neurofibromatosis 1 (NF1). To explain the poor survival, we aimed to link the histopathology and clinical characteristics of NF1-associated breast cancers.METHODS: The Finnish Cancer Registry and the Finnish NF Registry were cross-referenced to identify the NF1 patients with breast cancer. Archival NF1 breast cancer specimens were retrieved for histopathological typing and compared with matched controls.RESULTS: A total of 32 breast cancers were diagnosed in 1404 NF1 patients during the follow-up. Women with NF1 had an estimated lifetime risk of 18.0% for breast cancer, and this is nearly two-fold compared with that of the general Finnish female population (9.74%). The 26 successfully retrieved archival NF1 breast tumours were more often associated with unfavourable prognostic factors, such as oestrogen and progesterone receptor negativity and HER2 amplification. However, survival was worse in the NF1 group (P=0.053) even when compared with the control group matched for age, diagnosis year, gender and oestrogen receptor status. Scrutiny of The Cancer Genome Atlas data set showed that NF1 mutations and deletions were associated with similar characteristics in the breast cancers of the general population.CONCLUSIONS: These results emphasise the role of the NF1 gene in the pathogenesis of breast cancer and a need for active follow-up for breast cancer in women with NF1.</p

Breast cancer in neurofibromatosis 1: survival and risk of contralateral breast cancer in a five country cohort study

PurposeNeurofibromatosis 1 (NF1) is an autosomal dominant condition caused by pathogenic variants of the NF1 gene. A markedly increased risk of breast cancer is associated with NF1. We have determined the breast cancer survival and risk of contralateral breast cancer in NF1.MethodsWe included 142 women with NF1 and breast cancer from five cohorts in Europe and 335 women without NF1 screened for other familial breast cancers. Risk of contralateral breast cancer and death were assessed by Kaplan–Meier analysis with delayed entry.ResultsOne hundred forty-two women with NF1 were diagnosed for breast cancer at a median age of 46.9 years (range 27.0–84.3 years) and then followed up for 1235 person-years (mean = 8.70 years). Twelve women had contralateral breast cancer with a rate of 10.5 per 1000 years. Cumulative risk for contralateral breast cancer was 26.5% in 20 years. Five and 10-year all-cause survival was 64.9% (95% confidence interval [CI] = 54.8–76.8) and 49.8% (95%CI = 39.3–63.0). Breast cancer–specific 10-year survival was 64.2% (95% CI = 53.5–77.0%) compared with 91.2% (95% CI = 87.3–95.2%) in the non-NF1 age-matched population at increased risk of breast cancer.ConclusionWomen with NF1 have a substantial contralateral breast cancer incidence and poor survival. Early start of breast cancer screening may be a way to improve the survival.</p

Cargo-specific recruitment in clathrin and dynamin-independent endocytosis

Spatially controlled, cargo-specific endocytosis is essential for development, tissue homeostasis, and cancer invasion and is often hijacked by viral infections. Unlike clathrin-mediated endocytosis, which exploits cargo-specific adaptors for selective protein internalization, the clathrin and dynamin-independent endocytic pathway (CLIC-GEEC, CG-pathway) has until now been considered a bulk internalization route for the fluid phase, glycosylated membrane proteins and lipids. Although the core molecular players of CG endocytosis have been recently defined, no cargo-specific adaptors are known and evidence of selective protein uptake into the pathway is lacking. Here, we identify the first cargo-specific adaptor for CG-endocytosis and demonstrate its clinical relevance in breast cancer progression. By combining unbiased molecular characterization and super-resolution imaging, we identified the actin-binding protein swiprosin-1 (EFHD2) as a cargo-specific adaptor regulating integrin internalization via the CG-pathway. Swiprosin-1 couples active Rab21-associated integrins with key components of the CG-endocytic machinery, IRSp53 and actin. Swiprosin-1 is critical for integrin endocytosis, but not for other CG-cargo and supports integrin-dependent cancer cell migration and invasion, with clinically relevant implications for breast cancer. Our results demonstrate a previously unknown cargo selectivity for the CG-pathway and opens the possibility to discover more adaptors regulating it