Kroonilise neeruhaiguse levimus Eesti e-tervise andmete alusel

Taust. Kroonilise neeruhaiguse (KNH) levimus Eestis ei ole teada. Kuna KNH keskmine levimus maailmas on 9,1%, peaks KNH-patsientide arv Eestis olema umbes 118 300. Samas on 2017. aasta üleilmse aruande kohaselt KNH patsientide arv Eestis 258 859, mis on tõenäoliselt ülehinnatud.Eesti e-tervis on alustalaks tervishoiuandmete registreerimisele ja kogumisele. Samas on andmete analüüs tihti tüsilik, sest väljunddokumendid on erinevas formaadis, ja see raskendab oluliselt analüüsi. Lisaks pole haiguslugudes sageli märgitud diagnoosikoode ja/või KNH raskuskategooriat.Eesmärk. Töö eesmärk oli selgitada KNH levimust ja käsitlust Eestis, hinnates e-tervise infosüsteemi andmete põhjal retrospektiivselt täiskasvanud KNH-patsientide hulka ja jaotust vastavalt KNH riskiprofiilile, kasutades esimest korda ka tehisintellekti abi.Meetodid. Uuringu alusandmestiku moodustas Eesti elanikkonna 10% juhuvalimi raviarvete, digiretsepti ja tervise infosüsteemi andmete (e-tervise andmed) ühendväljavõte (sh eriarstiabi, perearstiabi, ostetud ravimid, laboratoorsed andmed). Uuringupopulatsioon määratleti kui kõik vähemalt 18aastased patsiendid, kellel oli ajavahemikul 2016–2019 diagnoositud vähemalt üks haigus, mis on KNH riskitegur, ja/ või kellel oli 2019. aasta jooksul vähemalt ühel korral registreeritud hinnangulise glomerulaarfiltratsiooni kiiruse (eGFR) ja/või uriinis albumiini-kreatiniini suhte (U-Alb/U-Crea, UACR) väärtus. Analüüsiti ka patsientide väljaostetud ravimeid, haiglaravi ja/või erakorralise meditsiini osakonna (EMO) juhtude arvu. Erinevas formaadis väljunddokumentide analüüsimiseks kasutati tehisintellekti abi, mille käigus transformeeriti epikriisi tekstifailis olev info analüüsis kasutatavale kujule.Tulemused. E-tervise andmete alusel tuvastati 5%-l elanikkonnast juba olemasolev KNH diagnoos ja lisaks 2,4%-l potentsiaalne KNH raskusastmega G3–G5. Nende andmete kohaselt võib Eestis kokku olla 83 710 KNH-patsienti ja KNH levimus täiskasvanud elanikkonnas on 7,4%. eGFR-i väärtused olid uuringus kättesaadavad 52%-l riskipatsientidest, UARC väärtused aga vaid 12%-l. Hulgihaigestumise hindamisel leiti, et KNH-patsientidel esineb kaasnevalt kõige sagedamini hüpertensioon (79%), südame-veresoonkonnahaigus (SVH) (63%) ja diabeet (28%). Ligi pooled KNH-patsientidest olid ühe aasta jooksul hospitaliseeritud või pöördunud EMOsse. Selle peamiseks põhjuseks oli olnud SVH (11%). KNH diagnoosiga patsiendid eristuvad KNH riskirühma kuuluvatest patsientidest (diabeet, hüpertensioon, SVH) suurema hospitaliseerimismäära ja erakorralise abi vajaduse poolest.Järeldused. KNH levimus Eestis täiskasvanud elanikkonnas on e-tervise andmetel 7,4%. Hoolimata riikliku KNH ravijuhendi olemasolust ning KNH sõeluuringu süsteemist diabeedi ja hüpertensiooni korral esineb lünki patsientide skriinimises, neeruhaiguse progresseerumise riski hindamises ja patsientide tõenduspõhises ravis. KNH tekkeriski ja progresseerumise tuvastamiseks ja asjakohase ravi tagamiseks on KNH riskirühmade seas vaja järgida ravijuhendit UARC väärtuse määramisel ning täpsustada alati ka KNH raskusaste koos albuminuuria kategooriaga. KNH-patsientide haiguskoormus on suur ning nende patsientide käsitlus nõuab tihedat koostööd esmatasandi tervishoiu ja eriarstide vahel. Seetõttu on KNH progresseerumise ennetamiseks tarvis enam ressursse

Operationalising a large research programme tackling complex urban and planetary health problems: A case study approach to critical reflections

Addressing increasingly urgent global challenges requires the rapid mobilisation of new research groups that are large in scale, co-produced, and focused explicitly on investigating root causes at a systemic level. This requires new ways of operationalising and funding research programmes to better support effective interdisciplinary and transdisciplinary (ID/TD) partnerships between a wide range of academic disciplines and stakeholder groups. Understanding of the challenges and approaches that teams can follow to overcome them can come through critical reflection on experiences initiating new research programmes of this nature and sharing of these reflections. We aimed to offer a framework for critical reflection and an overview of how we developed it, and to share our reflections on operationalising a newly formed large-scale ID/TD research programme. We present a framework of 10 areas for critical reflection: Systems, Unknowns and Imperfection; ID/TD Understanding; Values; Societal Impact; Context and Stakeholder Knowledge; Project Understanding and Direction; Team Cohesion; Decision-Making; Communications; and Method Development. We reflect on our experience of operationalising the research programme in these areas. Based on this critical examination of our experiences and the processes we adopted, we make recommendations for teams seeking to tackle important and highly complex global challenges, and for those who fund or support such research groups. Our reflections point to an overarching challenge of the structural and institutional barriers for cross-disciplinary research of this nature

Galanin pathogenic mutations in temporal lobe epilepsy

Temporal lobe epilepsy (TLE) is a common epilepsy syndrome with a complex etiology. Despite evidence for the participation of genetic factors, the genetic basis of TLE remains largely unknown. A role for the galanin neuropeptide in the regulation of epileptic seizures has been established in animal models more than two decades ago. However, until now there was no report of pathogenic mutations in GAL, the galanin-encoding gene, and therefore its role in human epilepsy was not established. Here, we studied a family with a pair of monozygotic twins affected by TLE and two unaffected siblings born to healthy parents. Exome sequencing revealed that both twins carried a novel de novo mutation (p.A39E) in the GAL gene. Functional analysis revealed that the p.A39E mutant showed antagonistic activity against galanin receptor 1 (GalR1)-mediated response, and decreased binding affinity and reduced agonist properties for GalR2. These findings suggest that the p.A39E mutant could impair galanin signaling in the hippocampus, leading to increased glutamatergic excitation and ultimately to TLE. In a cohort of 582 cases, we did not observe any pathogenic mutations indicating that mutations in GAL are a rare cause of TLE. The identification of a novel de novo mutation in a biologically-relevant candidate gene, coupled with functional evidence that the mutant protein disrupts galanin signaling, strongly supports GAL as the causal gene for the TLE in this family. Given the availability of galanin agonists which inhibit seizures, our findings could potentially have direct implications for the development of anti-epileptic treatmen

Ethnic Label Use in Adolescents from Traditional and Non-Traditional Immigrant Communities

Understanding adolescents’ use of ethnic labels is a key developmental issue, particularly given the practical significance of identity and self-definition in adolescents’ lives. Ethnic labeling was examined among adolescents in the traditional immigrant receiving area of Los Angeles (Asian n = 258, Latino n = 279) and the non-traditional immigrant receiving area of North Carolina (Asian n = 165, Latino n = 239). Logistic regressions showed that adolescents from different geographic settings use different ethnic labels, with youth from NC preferring heritage and panethnic labels and youth from LA preferring hyphenated American labels. Second generation youth were more likely than first generation youth to use hyphenated American labels, and less likely to use heritage or panethnic labels. Greater ethnic centrality increased the odds of heritage label use, and greater English proficiency increased the odds of heritage-American label use. These associations significantly mediated the initial effects of setting. Further results examine ethnic differences as well as links between labels and self-esteem. The discussion highlights implications of ethnic labeling and context

Pandemics, vulnerability and prevention: time to fundamentally reassess how we value and communicate risk?

Pandemics have long been recognised on the UK’s National Risk Register as both the likeliest and most severe of threats. Prior to the COVID-19 pandemic, the burden of non-communicable diseases (NCDs) such as obesity, heart failure and mental ill-health was already crippling our healthcare services and our economy. The quality of the places in which we live and to which we have access, most especially in deprived populations, compound that vulnerability significantly. When vulnerable, as we are now, we are forced to acknowledge what has weakened us, and to fundamentally reassess our actions and priorities

Tackling root causes upstream of unhealthy urban development (TRUUD): Protocol of a five-year prevention research consortium

Poor quality urban environments substantially increase non-communicable disease. Responsibility for associated decision-making is dispersed across multiple agents and systems: fast growing urban authorities are the primary gatekeepers of new development and change in the UK, yet the driving forces are remote private sector interests supported by a political economy focused on short-termism and consumption-based growth. Economic valuation of externalities is widely thought to be fundamental, yet evidence on how to value and integrate it into urban development decision-making is limited, and it forms only a part of the decision-making landscape. Researchers must find new ways of integrating socio-environmental costs at numerous key leverage points across multiple complex systems. This mixed-methods study comprises of six highly integrated work packages. It aims to develop and test a multi-action intervention in two urban areas: one on large-scale mixed-use development, the other on major transport. The core intervention is the co-production with key stakeholders through interviews, workshops, and participatory action research, of three areas of evidence: economic valuations of changed health outcomes; community-led media on health inequalities; and routes to potential impact mapped through co-production with key decision-makers, advisors and the lay public. This will be achieved by: mapping system of actors and processes involved in each case study; developing, testing and refining the combined intervention; evaluating the extent to which policy and practice changes amongst our target users, and the likelihood of impact on non-communicable diseases (NCDs) downstream. The integration of such diverse disciplines and sectors presents multiple practical/operational issues. The programme is testing new approaches to research, notably with regards practitioner-researcher integration and transdisciplinary research co-leadership. Other critical risks relate to urban development timescales, uncertainties in upstream-downstream causality, and the demonstration of impact. [Abstract copyright: Copyright: © 2022 Black D et al.

A phenomenological study of childminders' experiences of the preschool teacher's responsibility

The preschool teacher’s responsibility has changed over the years as the preschool's curricula has changed. The purpose of this essay is therefore to increase knowledge about childminders' expectations of the preschool teacher's responsibility. The research questions are what the preschool teacher should take responsibility for according to childminders experience and how this responsibility should be exercised. In order to understand the phenomenon of preschool teacher’s responsibility, theories about responsibility and leadership are used in the analysis of data.  The empirical data of the study is collected through a phenomenological approach where qualitative interviews were used. The interview questions have been of a semi-structured nature. The study includes interview with six childminders in metropolitan regions.  The results show that the preschool teacher’s responsibility, according to childminders experience, means leading the activities and teaching, being responsible for keeping the curriculum alive and being responsible for each child's development and learning. Childminders also include, due to the preschool teacher’s higher knowledge and competence, that they are responsible for communication with guardians and other parties, concerning children in need of support. The childminders experience is that everyone in the team is responsible for the daily tasks. Childminders experiences of how responsibility should be exercised show a complex leadership in which the preschool teacher's leadership is adapted based on the situation and person. The preschool teacher is expected to support the childminder and guide and explain how and why tasks should be carried out. In addition, the preschool teacher is expected to have a trust in the childminder's competence and thus also delegate tasks and make them involved in decisions. The essay discusses what happens to the preschool's assignment if there is not a preschool teacher in the department who undertakes the expected responsibility or if the preschool teacher does not see herself or himself as a leader.

Ocular complications of pediatric uveitis

To determine the cumulative proportion and the visual significance of ocular complications of pediatric uveitis. Cohort study. Patients with onset of endogenous or infectious uveitis before or at age 16 years. Retrospective review of existing records at a university-based uveitis clinic. Type and prevalence of complications related to uveitis, time to development of complications, and vision loss after initial diagnosis. There were 148 patients, 71 males and 77 females, with a mean age of 10.4+/-4.9 years (median, 10.3 years) for an estimated prevalence of pediatric uveitis of 13.8%. Noninfectious uveitis was present in 112 patients (75.7%); 105 (71%) patients had bilateral disease. Anterior uveitis accounted for 30.4%, intermediate uveitis for 27.7%, posterior uveitis for 23.7%, and panuveitis for 18.2% of patients. Patients were followed for a mean of 71.7 months (range, 0 months-44 years) after diagnosis. Approximately 34% of all patients had 1 or more complications at the time of first diagnosis of uveitis by an ophthalmologist, increasing to 61.6% by 3 months, 69.4% by 6 months, 75.2% by 1 year, and 86.3% by 3 years after diagnosis. There were a total of 617 complications of all types. Anterior and intermediate uveitis had a higher risk of band keratopathy (P = 0.005). Posterior and intermediate uveitis had a lower risk of cataract (P = 0.009) or posterior synechiae (P<0.001). Intermediate uveitis had a higher risk of cystoid macular edema compared with anterior or posterior uveitis (P = 0.002). The cumulative percentages (standard error) of patients with first loss to 20/200 or worse after diagnosis in the affected eyes of unilateral cases or in either eye of the bilateral cases were: 31.3% (3.9) at 1 month; 40.5% (4.1) at 6 months; 56.0% (4.3) at 24 months; and 69.6% (4.5) at 60 months. Fifty-four patients (48.2%) received systemic antiinflammatory or immunomodulatory therapy. Sixty-eight patients (45.9%) had ocular surgery, and 38 of these had ocular surgery in both eyes. Childhood uveitis is significant for numerous complications, many of which are vision threatening. Complications increase with duration of disease

Fusarium Endophthalmitis Following Keratitis Associated With Contact Lenses

A recent outbreak of fungal keratitis associated with contact lens use has been reported. During the past 4 months, a total of 36 patients with Fusarium keratitis have presented to one medical center. Two cases of Fusarium endophthalmitis resulting from this series of fungal keratitis associated with soft contact lens wear are described