Älylaitteiden käytön vaikutukset alle kouluikäisiin lapsiin

Tiivistelmä. Tutkimuksen tavoitteena oli selvittää, kuinka älylaitteiden käyttö vaikuttaa alle kouluikäisiin (0–6 vuotta) lapsiin. Älylaitteista keskityttiin tutkimaan erityisesti älypuhelinten ja tablettitietokoneiden käytön vaikutuksia, koska ne ovat pienten lasten yleisimmin käyttämiä älylaitteita. Aihe on tärkeä, koska alle kouluikäisten lasten neurologinen kehitys on nopeaa ja herkässä iässä tapahtuneet mahdollisesti haitalliset asiat vaikuttavat pitkälle lapsen tulevaisuuteen. Tutkimus toteutettiin kirjallisuuskatsauksena. Kirjallisuuskatsauksessa havaittiin, että runsas älylaitteiden käyttö voi vaikuttaa pieniin lapsiin monin tavoin. Lisääntynyt aika älylaitteiden parissa vähentää tutkimusten mukaan lasten yöunien pituutta, mutta kasvattaa päiväunien pituutta. Paljon laitteita käyttävien lasten kehitys voi olla myöhässä karkea-, ja hienomotoriikassa, sekä visuomotoriikassa. Lisääntyneellä tablettitietokoneiden ja älypuhelimien käytöllä on myös havaittu yhteys puhetaidon kehityksen hidastumiseen, sekä suppeampaan sanavarastoon, jos käyttö on passiivista katselua ilman laitteen ja lapsen välistä vuorovaikutusta. Runsaasti älylaitteita käyttävillä lapsilla on myös todettu enemmän ylipainoa, ADHD:tä, sekä keskittymisvaikeuksia. Haittavaikutuksiin vaikuttaa olennaisesti älylaitteiden parissa vietetyn ajan määrä, sekä niiden käyttötavat. Korkeintaan tunnin päivittäisellä käytöllä ei tutkimuksissa havaittu olevan juuri haittavaikutuksia millään osa-alueella. Haittoja alkoi ilmetä, kun lasten päivittäinen älylaitteiden käyttöaika ylitti 2 tai 3 tuntia. Merkitystä havaittiin olevan myös sillä, käyttääkö lapsi laitteita yksin, vai yhdessä vanhempien kanssa, sekä sillä minkälaista sisältöä lapsi kuluttaa. Tutkimuksen mukaan, pelit ja oppimista tukevat sovellukset, joissa on lapsen ja laitteen välistä interaktiota, ovat vähemmän haitallisia kehitykselle, kuin passiivinen katselu. Yhdessä vanhemman kanssa tapahtuvan opettavaisen sovelluksen käytön on tutkittu myös olevan hyödyllistä puhetaidon ja sanavaraston kehittymiselle. Vaikka kirjallisuuskatsauksessa havaittiin, että älylaitteiden käytöllä on sekä positiivisia, että negatiivisia vaikutuksia lapsiin, katsauksen perusteella älylaitteiden käytön aloittamista varhain ei voi suositella, sillä havaitut haitat vaikuttavat olevan hyötyjä suuremmat

Usefulness of Post-coronary Dilation to Prevent Recurrent Myocardial Infarction in Patients Treated With Percutaneous Coronary Intervention for Acute Coronary Syndrome (from the BASE ACS Trial)

Stent underexpansion is associated with worse outcome after stent implantation. Whether post-dilation (PD) improves outcome in patients with acute coronary syndrome (ACS) remains unclear. We performed post hoc analysis of outcome in patients from the BASE ACS (A prospective randomized comparison of titanium-nitride-oxide-coated bioactive stents with everolimus-eluting stents in acute coronary syndrome) trial who underwent PD versus those who did not. The BASE ACS trial randomized 827 patients (1:1) with ACS to receive either titanium-nitride-oxide coated bioactive stents or everolimus-eluting stents. The primary end point was major adverse cardiac events (MACE): a composite of cardiac death, nonfatal myocardial infarction (MI), or ischemia-driven target lesion revascularization. Follow-up was planned at 12 months and yearly thereafter for up to 7 years. Of 827 patients enrolled in the BASE ACS trial, 357 (43.2%) underwent PD. Median follow-up duration was 5 years. Patients who, underwent PD had less frequent nonfatal MI events at long-term follow-up, compared with those who did not (4.5% vs 8.5%, respectively, p = 0.02). The rates of MACE (15.7% vs 15.1%, respectively, p = 0.81), and the other endpoints, were not significantly different (p >0.5 for all). The results were consistent in propensity score matched analysis (270 pairs). In patients treated with bioactive stents, those who underwent PD had a trend for a fewer nonfatal MI events (p = 0.076). Comparably, in patients treated with everofimus-eluting stents, MACE and all the individual end points were comparable (p >0.5 for all). In conclusion, patients treated with early percutaneous coronary intervention for ACS who underwent PD had less frequent nonfatal MI events at long-term follow-up, compared with those who did not; MACE rates were not significantly different. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

IMPACT OF ANEMIA ON CLINICAL OUTCOME IN PATIENTS WITH ATRIAL FIBRILLATION UNDERGOING PERCUTANEOUS CORONARY INTERVENTION: INSIGHTS FROM THE AFCAS REGISTRY

OBJECTIVES: Anaemia has an adverse impact on the outcome in the general patient population undergoing percutaneous coronary intervention (PCI). The aim of this study was to analyse the impact of anaemia on the 12-month clinical outcome of patients with atrial fibrillation (AF) undergoing PCI and therefore requiring intense antithrombotic treatment. We hypothesised that anaemia might be associated with a worse outcome and more bleeding in these anticoagulated patients. SETTING: Data were collected from 17 secondary care centres in Europe. PARTICIPANTS: Consecutive patients with AF undergoing PCI were enrolled in the prospective, multicenter AFCAS (Atrial Fibrillation undergoing Coronary Artery Stenting) registry. Altogether, 929 patients participated in the study. Preprocedural haemoglobin concentration was available for 861 (92.7%; 30% women). The only exclusion criteria were inability or unwillingness to give informed consent. Anaemia was defined as a haemoglobin concentration of <12 g/dL for women and <13 g/dL for men. OUTCOME MEASURES: The primary endpoint was occurrence of major adverse cardiac and cerebrovascular events (MACCE) or bleeding events. RESULTS: 258/861 (30%) patients had anaemia. Anaemic patients were older, more often had diabetes, higher CHA(2)DS(2)-VASc scores, prior history of heart failure, chronic renal impairment and acute coronary syndrome. Anaemic patients had more MACCE than non-anaemic (29.1% vs 19.4%, respectively, p=0.002), and minor bleeding events (7.0% vs 3.3%, respectively, p=0.028), with a trend towards more total bleeding events (25.2% vs 21.7%, respectively, p=0.059). No difference was observed in antithrombotic regimens at discharge. In multivariate analysis, anaemia was an independent predictor of all-cause mortality at 12-month follow-up (hazard ratio 1.62, 95% CI 1.05 to 2.51, p=0.029). CONCLUSIONS: Anaemia was a frequent finding in patients with AF referred for PCI. Anaemic patients had a higher all-cause mortality, more thrombotic events and minor bleeding events. Anaemia seems to be an identification of patients at risk for cardiovascular events and death. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00596570

Structural validity of the Boston Carpal Tunnel Questionnaire and its short version, the 6-Item CTS symptoms scale: a Rasch analysis one year after surgery

Background The Boston Carpal Tunnel Questionnaire (BCTQ) and its shorter version, the Six-Item Carpal Tunnel Symptoms Scale (CTS-6), are widely used for assessing function and/or symptoms in patients with carpal tunnel syndrome. This study examined the structural validity of the BCTQ and CTS-6 among patients who had undergone surgery for treatment of carpal tunnel syndrome. Methods The data for this cross-sectional analysis were obtained from 217 adult patients who had undergone carpal tunnel release surgery 1 year earlier. All patients completed the CTS-6, Symptom Severity Scale (SSS) and Functional Status Scale (FSS) of the BCTQ at 12 months after surgery. The Rasch Measurement Theory (RMT) was applied to investigate the unidimensionality, residual correlation, differential item functioning, scale coverage/targeting, and person separation of the CTS-6, SSS and FSS of the BCTQ. Results The FSS showed unidimensionality and good scale and item fit. All items showed ordered response category thresholds. Eight of the FSS items displayed differential item functioning favoring age or gender. The multidimensional structure of the CTS-6 was absorbed by creating a testlet for frequency of symptoms or testlets for pain and numbness. The testlets supported unidimensionality in the BCTQ SSS. One item in the CTS-6 and two items in the BCTQ SSS showed differential item functioning favoring age or gender. Four items in the BCTQ SSS and two items in the CTS-6 exhibited disordered response category thresholds. Merging of the relevant response categories led to ordered response category thresholds. The person separation indices were 0.73, 0.86 and 0.77 for the CTS-6, BCTQ SSS and FSS, respectively. Conclusions Based on the RMT analysis, the CTS-6 has superior psychometric properties compared to the BCTQ SSS in surgically treated patients. The CTS-6 might be more accurate when separated into item sets measuring pain or numbness. The FSS of the BCTQ has acceptable construct validity, although gender differences at some ages were observed in responses.</div

Synergic impact of oral anticoagulation control and renal function in determining major adverse events in atrial fibrillation patients undergoing percutaneous coronary intervention: insights from the AFCAS registry

In patients with atrial fibrillation (AF), quality of oral anticoagulation control as well as impaired renal function are associated with adverse outcomes. Our objective was to analyze if there was a synergistic impact of these factors in determining adverse outcomes in AF patients undergoing percutaneous coronary intervention and stent (PCI-S).Post-hoc analysis from the Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry. Poor oral anticoagulation control was defined as time in therapeutic range (TTR) < 65%, while impaired renal function as creatinine clearance (CrCl) < 60 ml/min.Of the whole cohort, 448 were eligible for this post-hoc analysis. Of these, 27.9% had TTR < 65%only (Group I), 19.2% had CrCl < 60 ml/min only (Group II), while 13.8% had both conditions (Group III). At follow-up, patients in Group III had a higher rate of major adverse cardiovascular and cerebrovascular events (MACCE) (p = 0.007), while patients in Groups I and III had higher rates of major bleeding. Kaplan-Meier analyses showed that patients in Group III had higher risk for MACCE (LogRank: 14.406, p = 0.003), while Group I and Group III patients had higher risk for major bleeding (LogRank: 12.290, p = 0.006). On Cox regression, presence of both conditions independently increased MACCE risk (p = 0.001), while TTR < 65% alone and the presence of both conditions were independently associated with major bleeding (p = 0.004 and p = 0.028, respectively).There was a synergic impact of oral anticoagulation control and renal function in determining major adverse events in AF patients undergoing PCI-S. Use of poor anticoagulation control and impaired renal function in combination would help identify AF patients undergoing PCI-S at risk for MACCE and/or major bleeding

Synergic impact of oral anticoagulation control and renal function in determining major adverse events in atrial fibrillation patients undergoing percutaneous coronary intervention: insights from the AFCAS registry

BACKGROUND: In patients with atrial fibrillation (AF), quality of oral anticoagulation control as well as impaired renal function are associated with adverse outcomes. Our objective was to analyze if there was a synergistic impact of these factors in determining adverse outcomes in AF patients undergoing percutaneous coronary intervention and stent (PCI-S). METHODS: Post-hoc analysis from the Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry. Poor oral anticoagulation control was defined as time in therapeutic range (TTR) <65%, while impaired renal function as creatinine clearance (CrCl) <60 ml/min. RESULTS: Of the whole cohort, 448 were eligible for this post-hoc analysis. Of these, 27.9% had TTR <65%only (Group I), 19.2% had CrCl <60 ml/min only (Group II), while 13.8% had both conditions (Group III). At follow-up, patients in Group III had a higher rate of major adverse cardiovascular and cerebrovascular events (MACCE) (p = 0.007), while patients in Groups I and III had higher rates of major bleeding. Kaplan-Meier analyses showed that patients in Group III had higher risk for MACCE (LogRank: 14.406, p = 0.003), while Group I and Group III patients had higher risk for major bleeding (LogRank: 12.290, p = 0.006). On Cox regression, presence of both conditions independently increased MACCE risk (p = 0.001), while TTR <65% alone and the presence of both conditions were independently associated with major bleeding (p = 0.004 and p = 0.028, respectively). CONCLUSIONS: There was a synergic impact of oral anticoagulation control and renal function in determining major adverse events in AF patients undergoing PCI-S. Use of poor anticoagulation control and impaired renal function in combination would help identify AF patients undergoing PCI-S at risk for MACCE and/or major bleeding

A partial loss-of-function variant in AKT2 is associated with reduced insulin-mediated glucose uptake in multiple insulin-sensitive tissues: A genotype-based callback positron emission tomography study

Rare fully penetrant mutations in AKT2 are an established cause of monogenic disorders of glucose metabolism. Recently, a novel partial loss-of-function AKT2 coding variant (p.Pro50Thr) was identified that is nearly specific to Finns (frequency 1.1%), with the low-frequency allele associated with an increase in fasting plasma insulin level and risk of type 2 diabetes. The effects of the p.Pro50Thr AKT2 variant (p.P50T/AKT2) on insulin-stimulated glucose uptake (GU) in the whole body and in different tissues have not previously been investigated. We identified carriers (N = 20) and matched noncarriers (N = 25) for this allele in the population-based Metabolic Syndrome in Men (METSIM) study and invited these individuals back for positron emission tomography study with [18F]-fluorodeoxyglucose during euglycemic hyperinsulinemia. When we compared p.P50T/AKT2 carriers to noncarriers, we found a 39.4% reduction in whole-body GU (P = 0.006) and a 55.6% increase in the rate of endogenous glucose production (P = 0.038). We found significant reductions in GU in multiple tissues—skeletal muscle (36.4%), liver (16.1%), brown adipose (29.7%), and bone marrow (32.9%)—and increases of 16.8–19.1% in seven tested brain regions. These data demonstrate that the p.P50T substitution of AKT2 influences insulin-mediated GU in multiple insulin-sensitive tissues and may explain, at least in part, the increased risk of type 2 diabetes in p.P50T/AKT2 carriers

Vaelluskalojen palauttaminen rakennettuihin jokiin: Rakennettujen jokien tutkimustuloksia vuosilta 2011–2018

Vaelluskalakantojen palauttaminen rakennettuihin vesistöihin edellyttää monialaista tutkimustietoa kalojen elinkierron eri vaiheisiin liittyvistä haasteista ja niiden korjaustoimista. Myös vesistöjen eri käyttäjien ja intressiryhmien on löydettävä yhteinen tahtotila jokiympäristön ja sen kalaston kestävälle käytölle. Tämä puolestaan edellyttää viranomaisten, eri toiminnanharjoittajien ja sidosryhmien välillä avointa vuoropuhelua, yhteisten sovitteluratkaisujen hakemista ja omista eduista joustamista. Vaelluskalojen palauttamiseen liittyviin tietotarpeisiin on vastattu Luonnonvarakeskuksen (Luke) monialaisilla tutkimushankkeilla, joita on toteutettu rakennetuissa vesistöissä eri puolilla maatamme sekä Luken Kainuun kalantutkimusaseman kokeellisissa olosuhteissa. Tähän raporttiin on koottu vuosina 2011–2018 toiminnassa olleiden Luonnonvarakeskuksen (vuoteen 2015 asti Riista- ja kalatalouden tutkimuslaitos) hankkeiden tärkeimmät tulokset sekä julkaisuluettelo. Tässä esiteltäviä hankkeita ja raportin koostamista ohjasi erikoistutkija Aki Mäki-Petäys kevääseen 2019 asti. Useat näistä hankkeista on tehty yhteistyössä Helsingin, Itä-Suomen, Jyväskylän ja Oulun yliopistojen, Suomen ympäristökeskuksen (SYKE), Elintarviketurvallisuusviraston (Evira), Metsähallituksen, ELY-keskusten ja Pohjois-Pohjanmaan liiton kanssa, ja joissakin tapauksissa nämä tahot ovat olleet myös hankkeiden päävastuullisia toteuttajia. Tutkimushankkeita on rahoitettu myös osana laajempia ja useampivuotisia Public-Private-Partnership (PPP) – hankekokonaisuuksia, missä vesivoimayhtiöiden rahoitus on ollut merkittävässä osassa. Vaelluskalojen palauttaminen on monin paikoin mahdollista, jos eri käyttäjät ja intressiryhmät ovat sitoutuneet pitkäjänteiseen yhteistyöhön. Vesistökohteet ovat erilaisia, joten kaikkiin kohteisiin sopivaa ratkaisua ei yleensä ole, vaan toimenpiteissä on aina huomioitava vesistöjen erityispiirteet sekä mahdolliset muut reunaehdot. Kohteesta riippuen, toimenpiteinä tarvitaan: Toimivat kalojen vaellusväylät patojen ohitse sekä ylä- että alavirtaan, Elinympäristökunnostuksia sekä joki- ja purouomissa että niiden valuma-alueilla, Istutuskalojen sekä – toiminnan laadullista kehittämistä, Riittävää kalastuksen säätelyä, Myös muiden eliöryhmien kuin vaelluskalojen elinolosuhteiden parantamista, Realistisesti asetettuja vesistökohtaisia tavoitteita, Toimenpiteiden vaikuttavuuden seurantaa, Tehokasta ja yleistajuista viestintää sekä kaikkien sidosryhmien sitouttamista yhteistyöhön, Ajallisia ja taloudellisia resursseja. Aihepiirin tutkimustoimintaa viedään Lukessa eteenpäin vuodesta 2019 alkaen mm. Sateenvarjo III-, Kalatalouden ympäristöohjelma-, RiverGo- sekä monissa muissa yhteistyöhankkeissa. Toivomme, että tämä työ toimii tietopakettina monille muillekin hankkeille!201

A Partial Loss-of-Function Variant in AKT2 is Associated with Reduced Insulin-Mediated Glucose Uptake in Multiple Insulin Sensitive Tissues: a Genotype-Based Callback Positron Emission Tomography Study

Rare fully penetrant mutations in AKT2 are an established cause of monogenic disorders of glucose metabolism. Recently, a novel partial loss-of-function AKT2 coding variant (p.Pro50Thr) was identified that is nearly specific to Finns (frequency 1.1%), with the low-frequency allele associated with an increase in fasting plasma insulin level and risk of type 2 diabetes. The effects of p.Pro50Thr on insulin-stimulated glucose uptake (GU) in the whole body and in different tissues have not previously been investigated.  We identified carriers (N=20) and matched non-carriers (N=25) for this allele in the population-based METSIM study and invited these individuals back for positron emission tomography study with [18F]-fluorodeoxyglucose during euglycemic hyperinsulinemia. When we compared p.P50T/AKT2 carriers to non-carriers, we found a 39.4% reduction in whole body GU (P=0.006) and a 55.6% increase in the rate of endogenous glucose production (P=0.038). We found significant reductions in GU in multiple tissues: skeletal muscle (36.4%), liver (16.1%), brown adipose (29.7%), and bone marrow (32.9%), and increases of 16.8-19.1% in 7 tested brain regions. These data demonstrate that the P50T substitution of AKT2 influences insulin-mediated GU in multiple insulin sensitive tissues, and may explain, at least in part, the increased risk of type 2 diabetes in p.P50T/AKT2 carriers.</p