Relational expertise in preschool–school transition

The complex and constantly evolving challenges of working life require individuals, groups and work communities to cooperate interprofessionally across sectors and institutional boundaries (Edwards, 2017). In this study, preschool-school transition is a context in which culturally and historically constructed institutional boundaries form an arena for professional learning. In interprofessional work, professionals’ different interpretations of the purpose of collaboration can bring challenges. How-ever, common understanding can be achieved through relational expertise. The aim of the study is to examine what kind of organizational and professional issues can be identified in the development towards relational expertise in the context of transi-tion. By studying the organizational narratives around boundary work, we seek to understand the nature of the processes involved in acquiring relational expertise. This study examines the development of relational expertise over a one-year period of interprofessional collaboration within the context of the boundary work of two institutions – preschool and primary school. The case study data consists of videoed authentic interprofessional planning and evaluation discussions (22.5 h) and was analysed drawing on organizational narratives. The findings of two different organ-izational narratives provide important information on the issues involved in achiev-ing relational expertise and of the possibilities for and obstacles to its development

Frequency and etiology of acute transverse myelitis in Southern Finland

Objective: Acute transverse myelitis is a relatively rare, frequently debilitating but potentially treatable emergency. The objective of this study was to evaluate the incidence and etiology of acute transverse myelitis in two major hospital districts in Southern Finland.Methods: We identified all patients with acute transverse myelitis admitted to Turku University Hospital and Päijät-Häme Central hospital during nine years. The two hospitals serve a catchment area of 673,000 people in Southern Finland. Acute transverse myelitis was diagnosed according to the 2002 Transverse Myelitis Consortium Working Group. Patient files were reviewed for details of the clinical presentation and disease outcome, for laboratory findings and for neuroimaging. Charts were re-evaluated after an average of 7.7 years for confirmation of the acute transverse myelitis etiology.Results: In total 63 patients fulfilled the Transverse Myelitis Consortium Working Group diagnostic criteria for acute transverse myelitis. The frequency of the condition was hence 1.04 cases/ 100,000 inhabitants/ year. In the studied cohort, 7/63 (11%) patients had idiopathic transverse myelitis after initial evaluation and in 4/63 (6.3%) patients the idiopathic transverse myelitis remained the final diagnosis after follow-up and re-evaluation. Of the disease-associated myelitis cases MS or clinically isolated syndrome was the largest group, explaining 41% of all myelitis cases. The mean follow-up time before a patient was diagnosed with MS was 1.7 ± 2.2 years. Other etiologies included acute disseminated encephalomyelitis (ADEM), neurosarcoidosis, neuromyelitis optica (NMO), systemic autoimmune diseases and infectious diseases.Conclusions: In more than half of the acute transverse myelitis cases the final diagnosis is other than MS. Careful diagnostic work-up is needed for correct early treatment and best long-term outcome.</p

Weight Loss Trajectories in Healthy Weight Coaching : Cohort Study

Background: As global obesity prevalence continues to increase, there is a need for accessible and affordable weight management interventions, such as web-based programs. Objective: This paper aims to assess the outcomes of healthy weight coaching (HWC), a web-based obesity management program integrated into standard Finnish clinical care. Methods: HWC is an ongoing, structured digital 12-month program based on acceptance and commitment therapy. It includes weekly training sessions focused on lifestyle, general health, and psychological factors. Participants received remote one-on-one support from a personal coach. In this real-life, single-arm, prospective cohort study, we examined the total weight loss, weight loss profiles, and variables associated with weight loss success and program retention in 1189 adults (963 women) with a BMI >25 kg/m(2) among participants of the program between October 2016 and March 2019. Absolute (kg) and relative (%) weight loss from the baseline were the primary outcomes. We also examined the weight loss profiles, clustered based on the dynamic time-warping distance, and the possible variables associated with greater weight loss success and program retention. We compared different groups using the Mann-Whitney test or Kruskal-Wallis test for continuous variables and the chi-squared test for categorical variables. We analyzed changes in medication using the McNemar test. Results: Among those having reached the 12-month time point (n=173), the mean weight loss was 4.6% (SE 0.5%), with 43% (n=75) achieving clinically relevant weight loss (>= 5%). Baseline BMI >= 40 kg/m(2) was associated with a greater weight loss than a lower BMI (mean 6.6%, SE 0.9%, vs mean 3.2%, SE 0.6%; P=.02). In addition, more frequent weight reporting was associated with greater weight loss. No significant differences in weight loss were observed according to sex, age, baseline disease, or medication use. The total dropout rate was 29.1%. Dropouts were slightly younger than continuers (47.2, SE 0.6 years vs 49.2, SE 0.4 years; P=.01) and reported their weight less frequently (3.0, SE 0.1 entries per month vs 3.3, SE 0.1 entries per month; P Conclusions: A comprehensive web-based program such as HWC is a potential addition to the repertoire of obesity management in a clinical setting. Heavier patients lost more weight, but weight loss success was otherwise independent of baseline characteristics.Peer reviewe

Weight Loss Trajectories in Healthy Weight Coaching: Cohort Study

BACKGROUNDAs global obesity prevalence continues to increase, there is a need for accessible and affordable weight management interventions, such as web-based programs.OBJECTIVEThis paper aims to assess the outcomes of healthy weight coaching (HWC), a web-based obesity management program integrated into standard Finnish clinical care.METHODSHWC is an ongoing, structured digital 12-month program based on acceptance and commitment therapy. It includes weekly training sessions focused on lifestyle, general health, and psychological factors. Participants received remote one-on-one support from a personal coach. In this real-life, single-arm, prospective cohort study, we examined the total weight loss, weight loss profiles, and variables associated with weight loss success and program retention in 1189 adults (963 women) with a BMI >25 kg/m² among participants of the program between October 2016 and March 2019. Absolute (kg) and relative (%) weight loss from the baseline were the primary outcomes. We also examined the weight loss profiles, clustered based on the dynamic time-warping distance, and the possible variables associated with greater weight loss success and program retention. We compared different groups using the Mann-Whitney test or Kruskal-Wallis test for continuous variables and the chi-squared test for categorical variables. We analyzed changes in medication using the McNemar test.RESULTSAmong those having reached the 12-month time point (n=173), the mean weight loss was 4.6% (SE 0.5%), with 43% (n=75) achieving clinically relevant weight loss (≥5%). Baseline BMI ≥40 kg/m² was associated with a greater weight loss than a lower BMI (mean 6.6%, SE 0.9%, vs mean 3.2%, SE 0.6%; P=.02). In addition, more frequent weight reporting was associated with greater weight loss. No significant differences in weight loss were observed according to sex, age, baseline disease, or medication use. The total dropout rate was 29.1%. Dropouts were slightly younger than continuers (47.2, SE 0.6 years vs 49.2, SE 0.4 years; P=.01) and reported their weight less frequently (3.0, SE 0.1 entries per month vs 3.3, SE 0.1 entries per month; PCONCLUSIONA comprehensive web-based program such as HWC is a potential addition to the repertoire of obesity management in a clinical setting. Heavier patients lost more weight, but weight loss success was otherwise independent of baseline characteristics.</p

Metabolic Regulation in Progression to Autoimmune Diabetes

Recent evidence from serum metabolomics indicates that specific metabolic disturbances precede β-cell autoimmunity in humans and can be used to identify those children who subsequently progress to type 1 diabetes. The mechanisms behind these disturbances are unknown. Here we show the specificity of the pre-autoimmune metabolic changes, as indicated by their conservation in a murine model of type 1 diabetes. We performed a study in non-obese prediabetic (NOD) mice which recapitulated the design of the human study and derived the metabolic states from longitudinal lipidomics data. We show that female NOD mice who later progress to autoimmune diabetes exhibit the same lipidomic pattern as prediabetic children. These metabolic changes are accompanied by enhanced glucose-stimulated insulin secretion, normoglycemia, upregulation of insulinotropic amino acids in islets, elevated plasma leptin and adiponectin, and diminished gut microbial diversity of the Clostridium leptum group. Together, the findings indicate that autoimmune diabetes is preceded by a state of increased metabolic demands on the islets resulting in elevated insulin secretion and suggest alternative metabolic related pathways as therapeutic targets to prevent diabetes

Suomalaiset laatutaimet tunnistaa FinE-tavaramerkistä

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Akuutti transversaalimyeliitti vaatii nopean hoidon

Transversaalimyeliitti on harvinainen, hankittu paikallinen tai laaja-alainen selkäytimen tulehduksellinen tila, johon liittyy subakuutisti kehittyvä lihasheikkous, tuntopuutos ja suolen tai virtsarakon toimintahäiriö. Transversaalimyeliitillä käsitetään immunologisella mekanismilla syntyvät selkäytimen tulehdukselliset tilat. Se voi esiintyä infektion, rokotuksen tai muun laukaisevan tekijän immuunivälitteisenä jälkitilana, osana (neuro)immunologisten sairauksien jatkumoa tai itsenäisenä entiteettinä, jolloin puhutaan idiopaattisesta transversaalimyeliitistä. Tärkeimmät akuuttivaiheen diagnostiset tutkimukset ovat selkäytimen magneettikuvaus, jolla osoitetaan selkäytimen patologia, sekä selkäydinnesteen analyysi, jolla osoitetaan tilan inflammatorinen luonne. Transversaalimyeliitti voi esiintyä millä tahansa selkäytimen tasolla. Selkäydinvaurio voi aiheuttaa bilateraaliset tai unilateraaliset oireet. Lähes puolelle potilaista kehittyy täydellinen paraplegia. Infektion poissulkeminen on akuuttivaiheessa lähes mahdotonta, joten nopeasti aloitetun suuriannoksisen glukokortikoidilääkityksen lisänä on suositeltavaa käyttää samanaikaista virus- ja mikrobilääkettä

The Effectiveness of eHealth Interventions for Weight Loss and Weight Loss Maintenance in Adults with Overweight or Obesity : A Systematic Review of Systematic Reviews

Purpose of ReviewThe purpose of this study is to evaluate the effectiveness of eHealth interventions for weight loss and weight loss maintenance among adults with overweight or obesity through a systematic review of systematic reviews.Recent FindingsThis study included 26 systematic reviews, covering a total of 338 original studies, published between 2018 and 2023. The review indicates that eHealth interventions are more effective than control interventions or no care and comparable to face-to-face interventions. The effect sizes remain relatively small when comparing eHealth interventions to any control conditions, with mean differences of weight loss results from - 0.12 kg (95% CI - 0.64 to 0.41 kg) in a review comparing eHealth interventions to face-to-face care to - 4.32 kg (- 5.08 kg to - 3.57 kg) in a review comparing eHealth interventions to no care. The methodological quality of the included studies varies considerably. However, it can be concluded that interventions with human contact work better than those that are fully automated.In conclusion, this systematic review of systematic reviews provides an updated understanding of the development of digital interventions in recent years and their effectiveness for weight loss and weight loss maintenance among adults with overweight or obesity. The findings suggest that eHealth interventions can be a valuable tool for delivering obesity care to more patients economically. Further research is needed to determine which specific types of eHealth interventions are most effective and how to best integrate them into clinical practice.Peer reviewe

Development and validation of a weight-loss predictor to assist weight loss management

Abstract This study aims to develop and validate a modeling framework to predict long-term weight change on the basis of self-reported weight data. The aim is to enable focusing resources of health systems on individuals that are at risk of not achieving their goals in weight loss interventions, which would help both health professionals and the individuals in weight loss management. The weight loss prediction models were built on 327 participants, aged 21–78, from a Finnish weight coaching cohort, with at least 9 months of self-reported follow-up weight data during weight loss intervention. With these data, we used six machine learning methods to predict weight loss after 9 months and selected the best performing models for implementation as modeling framework. We trained the models to predict either three classes of weight change (weight loss, insufficient weight loss, weight gain) or five classes (high/moderate/insufficient weight loss, high/low weight gain). Finally, the prediction accuracy was validated with an independent cohort of overweight UK adults (n = 184). Of the six tested modeling approaches, logistic regression performed the best. Most three-class prediction models achieved prediction accuracy of > 50% already with half a month of data and up to 97% with 8 months. The five-class prediction models achieved accuracies from 39% (0.5 months) to 89% (8 months). Our approach provides an accurate prediction method for long-term weight loss, with potential for easier and more efficient management of weight loss interventions in the future. A web application is available: https://elolab.shinyapps.io/WeightChangePredictor/ . The trial is registered at clinicaltrials.gov/ct2/show/NCT04019249 (Clinical Trials Identifier NCT04019249), first posted on 15/07/2019