Effects of changes in the level of service on rail passenger volumes

Ilmastonmuutoksen aikakautena on tärkeää nostaa ympäristöystävällisen rautatieliikenteen matkustajamääriä mahdollisimman paljon. Tämän diplomityön tavoitteena on selvittää, miten kaukoliikenteen palvelutason muutokset ovat vaikuttaneet niihin. Työssä tarkastellaan matkustajamäärien kehitystä valtakunnantasolla sekä ratakäytävissä Helsinki – Turku, Helsinki – Tampere – Oulu, Tampere – Jyväskylä, Helsinki – Kuopio/Joensuu ja Turku – Tampere. Matkustajamäärien kehitystä parannustoimien seurauksena selvitetään myös kansainvälisesti. Tuloksista havaitaan, että matka-aikojen voimakkaalla nopeuttamisella voidaan saada pitkilläkin matkoilla junan markkinaosuus yli 50 %:iin otettaessa huomioon vain juna- ja lentoliikenne. Suomen matkustajamäärien kehityksestä havaitaan, että niihin vaikuttavat junaliikenteen palvelutason muutokset, kuten matka-aikojen lyheneminen tai pidentyminen, junatarjonnan lisääntyminen, muutokset junalippujen hinnoittelussa, täsmällisyys ja kalustouusinnat. Jos junaliikenteessä ei tapahdu selviä parannuksia tai huononnuksia, suuri vaikutus on erityisesti lyhyemmillä matkoilla myös yksityisautoilun palvelutason muutoksilla ja bensiinin hinnan kehityksellä suhteessa junalippujen hintoihin. Lisäksi myös talouselämän aktiivisuus, työllisyys ja väestönmuutokset vaikuttavat matkustaja-määriin. Matka-aikojen nopeutumisella on huomattavasti suurempi vaikutus matkustajamääriin kuin prosentuaalisesti yhtä suurella junatarjonnan kasvattamisella. Vuosina 2006 – 2007 10 % suuruinen esimerkkinopeutus nosti matkustajamääriä 9 – 10 % reitillä Helsinki – Tampere, 8 – 11 % reitillä Helsinki – Kouvola, 10 – 16 % 250 – 350 km pitkillä reiteillä, 14 – 17 % reitillä Helsinki – Joensuu ja 15 – 18 % reitillä Helsinki – Kuopio. Aikajousto jäänee kuitenkin pienemmäksi, jos taloudessa ei ole noususuhdannetta. 10 % vuorovälin tihentäminen nostaa ruotsalaisen joustokertoimen mukaan matkustajamääriä 5 %, mutta Suomessa sen vaikutukset havaitaan tämän tutkimuksen pohjalta pienemmiksi. Kuitenkin tasaisen tunnin vuorovälin käyttöönotolla on suurempi merkitys. Myös pendelöintireiteillä tiheä vuoroväli on tärkeä. Kaluston ja täsmällisyyden vaikutukset ovat vähäisemmät. Myös lisääntyvä ympäristötietoisuus vaikuttaa kulkumuodon valintaan. Matkustajamäärien vähenemistä aiheuttavat erityisesti pitkäkestoiset ja pitkille reiteille kohdistuvat matka-aikojen pidennykset sekä sellaiset remontit, joiden yhteydessä kaikki junat korvataan linja-autoilla. Myös voimakas lippuhintojen nousu vuonna 2001 aiheutti vähenemistä. /Kir1

How Can We Increase Postpartum Glucose Screening in Women at High Risk for Gestational Diabetes Mellitus?

Women with a history of gestational diabetes mellitus (GDM) are at increased risk for diabetes mellitus but postpartum followup is problematic for frequent nonattendance. Our aim was to increase coverage of postpartum oral glucose tolerance tests (ppOGTTs) and examine associated factors. This was a prospective observational study of altogether 266 high-risk women for GDM from 2005 to 2008 in four Finnish municipalities. The groups were as follows: women (n = 54) who had previously participated in early pregnancy lifestyle intervention study and high-risk women (n = 102) from the same municipalities studied within one-year after delivery. Furthermore, in two neighboring municipalities nurses were reminded to perform a ppOGTT on high-risk women (n = 110). The primary outcome was the prevalence of ppOGTT performed and associated factors. Overall the ppOGTT was performed in 35.7% of women. Only 14.7% of women returned for testing to health care centers, 30.9% after a reminder in municipalities, and 82.5% to the central hospital, respectively. The most important explaining factor was a special call or reminder from the central hospital (OR 13.4 (4.6–38.1), P < 0.001). Thus, additional reminders improved communication between primary care and secondary care and more attention to postpartum oral glucose testing in primary care are of great importance

Clinical Study How Can We Increase Postpartum Glucose Screening in Women at High Risk for Gestational Diabetes Mellitus?

Women with a history of gestational diabetes mellitus (GDM) are at increased risk for diabetes mellitus but postpartum followup is problematic for frequent nonattendance. Our aim was to increase coverage of postpartum oral glucose tolerance tests (ppOGTTs) and examine associated factors. This was a prospective observational study of altogether 266 high-risk women for GDM from 2005 to 2008 in four Finnish municipalities. The groups were as follows: women (n = 54) who had previously participated in early pregnancy lifestyle intervention study and high-risk women (n = 102) from the same municipalities studied within oneyear after delivery. Furthermore, in two neighboring municipalities nurses were reminded to perform a ppOGTT on high-risk women (n = 110). The primary outcome was the prevalence of ppOGTT performed and associated factors. Overall the ppOGTT was performed in 35.7% of women. Only 14.7% of women returned for testing to health care centers, 30.9% after a reminder in municipalities, and 82.5% to the central hospital, respectively. The most important explaining factor was a special call or reminder from the central hospital (OR 13.4 (4.6-38.1), P &lt; 0.001). Thus, additional reminders improved communication between primary care and secondary care and more attention to postpartum oral glucose testing in primary care are of great importance

The Relationship between Thyroid Function and Depressive Symptoms—the FIN-D2D Population-Based Study

The association between thyroid function and depression is controversial. Both conditions express many similar symptoms, but the studies done give conflicting results. This study draws on a random, population-based sample of 4500 subjects aged 45–75 years old from Finland. The basic clinical study was done in 2007 for 1396 men and 1500 women (64% participation rate). Thyroid stimulating hormone (TSH), free thyroxine (F-T4), and free triiodothyronine (F-T3) were measured in 2013 from frozen samples. The 21-item Beck Depression Inventory (BDI-21) was applied to assess depressive symptoms (score ≥10 points). The prevalence of depressive symptoms was 17.5% in women and 12.5% in men. In women, the mean levels of TSH, F-T4, and F-T3 without depressive symptoms vs. with the presence of depressive symptoms were 1.92/1.97 mU/L, 13.1/13.1 pmol/L, and 3.91/3.87 pmol/L (NS), respectively. In men, the levels were 1.87/1.94 mU/L, 13.5/13.7 pmol/L, and 4.18/4.12 pmol/L (NS), respectively. In multiple regression analysis, TSH had no relationship to BDI-21 total score. We found no association between depressive symptoms and thyroid values.Peer reviewe

Non-alcoholic and alcoholic Fatty Liver Disease - two Diseases of Affluence associated with the Metabolic Syndrome and Type 2 Diabetes: the FIN-D2D Survey

Peer reviewe

Pediatric Parathyroid Carcinoma: A Case Report and Review of the Literature.

Primary hyperparathyroidism (PHPT) is a rare endocrine disease in the pediatric population. Sporadic parathyroid adenomas remain the most common cause of pediatric PHPT. Parathyroid carcinoma (PC) is an extremely rare cause of pediatric PHPT. We report a 16-year-old boy presenting with a nonhealing fragility fracture of the right leg along with florid features of rickets. Examination revealed a neck mass, mimicking a goiter. Biochemical findings were consistent with PHPT. Imaging was suggestive of a right inferior parathyroid mass infiltrating the right lobe of thyroid. The patient underwent en bloc surgical excision of the parathyroid mass along with the right lobe of thyroid. Histopathology was suggestive of a PC. He achieved biochemical remission with normalization of serum calcium and parathyroid hormone levels. At follow-up, there was no biochemical or imaging evidence of recurrence or metastasis. Genetic analysis revealed heterozygous germline deletion of CDC73. An extensive literature search on PC was conducted, with an emphasis on the pediatric population. Thirteen cases of pediatric PC were identified. The median age of presentation was 13 years; there was no sex predilection. All cases were symptomatic; 31% had a visible neck mass. The median serum calcium and intact parathyroid hormone levels were 14.3 mg/dL and 2000 pg/mL, respectively. All patients underwent surgical excision, with 27% showing metastatic relapse. Our findings indicate that the preoperative features that could point toward a diagnosis of PC in a child with PHPT are a tumor size of >3 cm, thyroid infiltration on imaging, and severe hypercalcemia at presentation

Conduct and reporting of acceptability, attitudes, beliefs and experiences of pregnant women in randomised trials on diet and lifestyle interventions: A systematic review

Objective To evaluate the conduct and reporting of views of pregnant women on the acceptability, attitudes, beliefs and their experiences in randomised trials on diet and lifestyle interventions. Study design We undertook a systematic review of literature of randomised trials identified from our previous search in major electronic databases (until February 2017) without language restrictions. We included trials on diet and lifestyle interventions that reported acceptability, attitudes, beliefs and experiences of pregnant women. The quality of papers was evaluated using the Critical Skills Appraisal Programme (CASP) framework. Data were extracted for the following domains: acceptability, intention, behaviour, attitudes and factors influencing participation. The proportion of studies that reported the various components in each domain was reported in percentages. Results Of the 110 trials on diet and lifestyle in pregnancy, 24 reported on views of pregnant women. Acceptability of the provided information to the woman was reported in 84% (20/24), compared to 12% (3/24) on acceptability to partner or to family. Mother’s intention to adhere to intervention in pregnancy was reported in 68% (17/24) of studies vs.only 16% (4/24) on family’s intentions to support adherence. Changes in mother’s behaviour were reported for consuming specific components of diet such as nuts (8%, 2/24), olive oil (12%, 3/24) and fruit (40%, 10/24) vs. 16% (4/24) of trials reporting changes in family’s behaviour. While knowledge of food ingredients (72%, 18/24), and attitude to gestational weight gain were commonly reported (66%, 16/24) in over two-thirds of studies, only half assessed attitude to participation in research (45%, 11/24). All studies reported facilitators for uptake of intervention such as personalised support (100%, 24/24), with half (52%, 13/24) on beliefs about weight, and less than 10% (2/24) about baby’s health. Conclusion The focus on studies is mainly on the mother, and less on family. Further studies are needed with a holistic approach to ensure that such interventions when implemented are accepted by women and their families

The use of fasting vs. non-fasting triglyceride concentration for estimating the prevalence of high LDL-cholesterol and metabolic syndrome in population surveys

<p>Abstract</p> <p>Background</p> <p>For practical reasons it is not easy to obtain fasting samples in large population health surveys. Non-fasting triglyceride (Tg) values are difficult to interpret. The authors compared the accuracy of statistically corrected non-fasting Tg values with true fasting values and estimated the misclassification of subjects with high low-density lipoprotein cholesterol (LDL-C) and the metabolic syndrome.</p> <p>Methods</p> <p>Non-fasting blood was obtained from a population-based sample of 4282 individuals aged 24-75 years in the National FINRISK 2007 Study. Fasting blood samples were drawn from the same persons 3 months later. Non-fasting serum Tg values were converted into fasting values using previously published formula. LDL-C was calculated and classification of the metabolic syndrome was carried out according to three different latest guidelines.</p> <p>Results</p> <p>The median (25^th, 75th percentile) non-fasting serum Tg concentration was 1.18 (0.87, 1.72) mmol/L and after postprandial correction 1.06 (0.78, 1.52) mmol/L. The true-fasting serum Tg concentration was 1.00 (0.75, 1.38) mmol/L (<it>P </it>< 0.001) vs. non-fasting and corrected value. Bias of the corrected value was +5.9% compared with the true-fasting Tg. Of the true fasting subjects, 56.4% had LDL-C ≥3.00 mmol/L. When calculated using non-fasting serum Tg, the prevalence of high LDL-C was 51.3% and using statistically corrected Tg it was 54.8%. The prevalence of metabolic syndrome was 35.5% among fully fasted persons and among non-fasting subjects 39.7%, which after statistical correction of Tg decreased to 37.6% (P < 0.001 for all comparisons).</p> <p>Conclusions</p> <p>Correction of non-fasting serum Tg to fasting values plays a minor role in population studies but nevertheless reduces misclassification of calculated high LDL-C from 5.1 to 1.6% and the metabolic syndrome from 4.2 to 2.1%.</p