Sairaan lapsen leikki

Tämän opinnäytetyön tarkoituksena oli tuottaa kirjallisuuskatsaus sairaan lapsen leikistä. Opinnäytetyö tulee Lastenklinikan leikki- ja nuorisotoiminnan yksikön käyttöön Helsingissä. Työn sisältöä voivat hyödyntää myös muut lasten parissa työskentelevät sekä kaikki aiheesta kiinnostuneet henkilöt. Tavoitteena oli löytää uusinta tutkittua tietoa sairaan lapsen leikistä ja sen merkityksestä pohjautuen luotettaviin lähteisiin. Opinnäytetyö toteutettiin integroivan kirjallisuuskatsauksen menetelmällä. Kirjallisuuskatsauksen aineistohaku toteutettiin tammi- elokuussa 2016. Tiedonhaku kohdistettiin viiteen eri tietokantaan, jotka olivat Google Scholar, EBSCOhost, Proquest, CINAHL ja SAGE. Aineisto koostui 14:sta kansainvälisestä tutkimusartikkelista, jotka käsittelivät sairaan lapsen leikin merkitystä sairaalaympäristössä. Opinnäytetyön tutkimuskysymys oli: Millainen merkitys sairaan lapsen leikillä on? Tulosten perusteella leikillä on suuri merkitys sairaan lapsen psyykkisen kehityksen tukemisessa ja hoidon sujuvuuden kannalta. Tärkeimpänä tuloksena oli sairaalassa olevan lapsen ahdistuksen lieventyminen leikin avulla, jolloin lapsen hoitaminen oli helpompaa ja hän suhtautui hoitotoimenpiteisiin myönteisemmin. Lisäksi vanhempien sairaalakokemukset olivat myönteisempiä, kun leikkiterapiaa käytettiin osana hoitopolkua. Leikki nopeutti myös sairaudesta toipumista ja toimi kipua lieventävänä tekijänä. Koska sairaan lapsen leikistä löytyy niukasti suomalaisia tutkimusartikkeleita, tulisi aihetta tutkia Suomessa lisää esimerkiksi tapaus-verrokki- tai kohorttitutkimuksilla. Myös toiminnallinen opinnäytetyö antaisi hyödyllistä lisätietoa siitä, minkälainen merkitys sairaan lapsen leikillä on. Tutkimuksia voisi vielä laajentaa koskemaan erilaisia lasten sairauksia, kuten syöpään, kirurgiaan tai haavanhoitoon liittyen. Lisäksi lapsen eri ikäkausien huomiointi tutkimuksissa olisi kiinnostava tutkimusaihe.The purpose of this thesis was to produce a literature review of sick child’s play. The work will be deployed to Play and Activity Unit in Children’s Hospital. However, anyone working or associating with children or having interest in this subject can utilise it. The aim of this thesis was to find newest publications of reliable researches of the topic; sick child’s play. The method of this thesis was an integrative literature review. The research data was accomplished from January to August 2016. Information retrieval was made into five different databases, which were Google Scholar, EBSCOhost, Proquest, CINAHL and SAGE. The material consisted of 14 international researches that included information of the meaning of sick child’s play in hospital. The survey question of this thesis was: What kind of meaning sick child’s play has? The results showed that play has a major meaning in supporting sick child’s psychic development and also with fluency treatment. Both children’s and parents’ hospital experiences were more positive when play therapy was part of care pathway. The play also accelerated recovery and relieved the pain. Because finnish research articles of sick child’s play can be found limitedly, the topic should be studied more for example as case control- or cohort study. Practise-based thesis would also give beneficial information of what kind of meaning sick child’s play has. Researches could be expanded to regard also different kinds of children's diseases such as cancer or diseases related to surgery or wond healing. In addition, paying attention to children's different age phases would be an interesting research topic

Market trading or parking lot at St: Erik's Square in Uppsala : a cost-benefit analysis

Med en växande befolkning och förtätning av innerstaden ökar konkurrensen om markytan i centrala Uppsala. I denna uppsats analyseras användningen av markytan på St: Eriks torg i Uppsala. St: Eriks torg är beläget mitt i centrala Uppsala, omgivet av flera kulturhistoriska byggnader, och används för nuvarande som en parkeringsplats. Alternativen som analyseras är att fortsätta låta torget användas som en parkeringsplats eller att konvertera torget till dess ursprungliga användningsområde, ett torg med torghandel. Alternativen analyseras med hjälp utav en kostnadsnyttoanalys där kostnader och nyttor för alternativen monetäriseras i största möjliga mån. Detta med mål om att avgöra vilket alternativ som genererar högst samhällsekonomisk välfärdsnytta ur ett långsiktigt hållbart perspektiv. Utifrån analysens antaganden och beräkningar genererar ett torg med torghandel en betydligt högre nettonytta än en parkering på platsen. Torghandel är inte nödvändigtvis är den bästa alternativa användningen av markytan. Dock åstadkommer torghandeln betydligt högre nytta än parkeringsplatsen som genererar en väldigt begränsad välfärdsnytta för staden. Analysen har begränsningar och antaganden vilka gör att man vidare bör utreda de alternativa användningsområden och faktorer som inte belysts i denna analys. Detta bör göras med bakgrund av Uppsala kommuns hållbara mål och respekt för torgets kulturhistoriska omgivning.The competition of land surface in the inner city of Uppsala is increasing with a growing population. This paper analyzes the use of the ground surface at St. Erik's Square in Uppsala. St. Erik square is located in central Uppsala, surrounded by several historical buildings, and is currently used as a parking lot. The options analyzed are to continue to include the square used as a parking lot or to convert the square into a square with market trade. The options are analyzed by a cost-benefit analysis in which costs and benefits are monetized as far as possible in order of determining which option generates the socioeconomic welfare benefits. A square with market trade reach significantly higher net benefits than a parking lot, based on the papers assumptions and calculations. The analysis underlines that a square with market trade is not necessarily the best alternative use of the land surface, there could be other alternatives that generates even higher net benefits which this paper does not include. What can be concluded from the analysis, with its calculations and assumptions, is that the parking lot on St. Erik Square generates very limited welfare benefits for the city. The analysis has limitations and assumptions, which means that you should further investigate the factors and alternative uses that are not highlighted in this analysis. This should be done in light of the sustainable goals of the city and respect for the square's cultural environment

Phenotypic frailty and multimorbidity are independent 18-year mortality risk indicators in older men The Helsinki Businessmen Study (HBS)

Purpose Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised. Methods In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919-1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (>= 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses. Results Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13-2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17-2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10-4.07). Conclusion Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality. Key summary pointsObjective Multimorbidity, phenotypic prefrailty and frailty are frequent in ageing populations Findings This long-term follow-up of home-dwelling older men reveals the relationship of phenotypic frailty to long-term prognosis, independently of the presence of significant chronic diseases and disability. Message Assessment of phenotypic frailty and already prefrailty provides extra clinical value for the assessment of prognosis in old age.Peer reviewe

Differences in survival for patients with familial and sporadic cancer

Family history of cancer is a well-known risk factor but the role of family history in survival is less clear. The aim of this study was to investigate the association between family history and cancer survival for the common cancers in Sweden. Using the Swedish population-based registers, patients diagnosed with the most common cancers were followed for cancer-specific death during 1991-2010. We used multivariate proportional hazards (Cox) regression models to contrast the survival of patients with a family history of cancer (individuals whose parent or sibling had a concordant cancer) to the survival of patients without a family history. Family history of cancer had a modest protective effect on survival for breast cancer (hazard ratio (HR) = 0.88, 95% confidence interval (95% CI) = 0.81 to 0.96) and prostate cancer (HR = 0.82, 95% CI = 0.75 to 0.90). In contrast, family history of cancer was associated with worse survival for nervous system cancers (HR = 1.24, 95% CI = 1.05 to 1.47) and ovarian cancer (HR = 1.20, 95% CI = 1.01 to 1.43). Furthermore, the poorer survival for ovarian cancer was consistent with a higher FIGO stage and a greater proportion of more aggressive tumors of the serous type. The better survival for patients with a family history of breast and prostate cancer may be due to medical surveillance of family members. The poor survival for ovarian cancer patients with an affected mother or sister is multifactorial, suggesting that these cancers are more aggressive than their sporadic counterparts.VetenskapsrådetForteAccepte

Cause-specific mortality in women with breast cancer in situ

The long-term mortality remains unknown in women diagnosed with breast cancer in situ (BCIS). Here, we assessed the cause-specific mortality in BCIS patients. This population-based cohort study included 12,243 women diagnosed with BCIS in Sweden between 1980 and 2011. Patients were followed until death, emigration, or 31 December 2013, whichever came first. The 30-year cumulative incidence of breast cancer-specific mortality was 6.3%, which is considerably lower than 49.7% observed for other-cause mortality. Women diagnosed with BCIS were more likely to die from breast cancer (standardized mortality ratio [SMR], 3.85; 95% CI, 3.47-4.27) but less likely to die from cardiovascular disease (SMR, 0.88; 95% CI, 0.82-0.95) than women in the general population. Specifically, the SMRs for breast cancer-specific mortality decreased over time from 5.19 (95% CI, 3.95-6.81) among BCIS diagnosed during 1980-1989 to 3.03 (95% CI, 2.35-3.91) among those diagnosed during 2000-2011. Furthermore, higher risk of death from other causes was seen among those with older age at BCIS diagnosis, lower levels of education, nulliparity, higher Charlson Comorbidity Index, and being hospitalized before BCIS diagnosis; whereas, lower risk of death from breast cancer was seen among BCIS diagnosed in the later time period and those with younger age at first birth. We conclude that most women diagnosed with BCIS die from causes other than breast cancer, which highlights the need for actions not only to reduce nonbreast cancer mortality but also to identify patient where extensive curative BCIS treatment is not adding to survival.NoneAccepte

Breast cancer genetic risk profile is differentially associated with interval and screen-detected breast cancers

Background: Polygenic risk profiles computed from multiple common susceptibility alleles for breast cancer have been shown to identify women at different levels of breast cancer risk. We evaluated whether this genetic risk stratification can also be applied to discriminate between screen-detected and interval cancers, which are usually associated with clinicopathological and survival differences. Patients and methods: A 77-SNP polygenic risk score (PRS) was constructed for breast cancer overall and by estrogen-receptor (ER) status. PRS was inspected as a continuous (per standard deviation increment) variable in a case-only design. Modification of the PRS by mammographic density was evaluated by fitting an additional interaction term. Results: PRS weighted by breast cancer overall estimates was found to be differentially associated with 1,865 screen-detected and 782 interval cancers in the LIBRO-1 study (age-adjusted ORperSD [95% confidence interval]=0.91 [0.83-0.99], p=0.023). The association was found to be more significant for PRS weighted by ER-positive breast cancer estimates (ORperSD=0.90 [0.82-0.98], p=0.011). This result was corroborated by two independent studies (combined ORperSD=0.87 [0.76-1.00], p=0.058) with no evidence of heterogeneity. When enriched for “true” interval cancers among nondense breasts, the difference in the association with PRS in screen-detected and interval cancers became more pronounced (ORperSD=0.74 [0.62-0.89], p=0.001), with a significant interaction effect between PRS and mammographic density (pinteraction=0.017). Conclusion: To our knowledge, this is the first report looking into the genetic differences between screendetected and interval cancers. It is an affirmation that the two types of breast cancer may have unique underlying biology.Swedish Research CouncilSwedish Cancer SocietyStockholm County CouncilBreast Cancer Theme Centre Consortium (BRECT)Accepte

Intratumor Heterogeneity of the Estrogen Receptor and the Long-term Risk of Fatal Breast Cancer.

Background:Breast cancer patients with estrogen receptor (ER)-positive disease have a continuous long-term risk for fatal breast cancer, but the biological factors influencing this risk are unknown. We aimed to determine whether high intratumor heterogeneity of ER predicts an increased long-term risk (25 years) of fatal breast cancer. Methods:The STO-3 trial enrolled 1780 postmenopausal lymph node-negative breast cancer patients randomly assigned to receive adjuvant tamoxifen vs not. The fraction of cancer cells for each ER intensity level was scored by breast cancer pathologists, and intratumor heterogeneity of ER was calculated using Rao's quadratic entropy and categorized into high and low heterogeneity using a predefined cutoff at the second tertile (67%). Long-term breast cancer-specific survival analyses by intra-tumor heterogeneity of ER were performed using Kaplan-Meier and multivariable Cox proportional hazard modeling adjusting for patient and tumor characteristics. Results:A statistically significant difference in long-term survival by high vs low intratumor heterogeneity of ER was seen for all ER-positive patients (P < .001) and for patients with luminal A subtype tumors (P = .01). In multivariable analyses, patients with high intratumor heterogeneity of ER had a twofold increased long-term risk as compared with patients with low intratumor heterogeneity (ER-positive: hazard ratio [HR] = 1.98, 95% confidence interval [CI] = 1.31 to 3.00; luminal A subtype tumors: HR = 2.43, 95% CI = 1.18 to 4.99). Conclusions:Patients with high intratumor heterogeneity of ER had an increased long-term risk of fatal breast cancer. Interestingly, a similar long-term risk increase was seen in patients with luminal A subtype tumors. Our findings suggest that intratumor heterogeneity of ER is an independent long-term prognosticator with potential to change clinical management, especially for patients with luminal A tumors

Effect of lifestyle intervention for people with diabetes or prediabetes in real-world primary care: propensity score analysis

<p>Abstract</p> <p>Background</p> <p>Many lifestyle interventions for patients with prediabetes or type 2 diabetes mellitus (T2DM) have been investigated in randomised clinical trial settings. However, the translation of these programmes into primary care seems challenging and the prevalence of T2DM is increasing. Therefore, there is an urgent need for lifestyle programmes, developed and shown to be effective in real-world primary care. We evaluated a lifestyle programme, commissioned by the Dutch government, for patients with prediabetes or type 2 diabetes in primary care.</p> <p>Methods</p> <p>We performed a retrospective comparative medical records analysis using propensity score matching. Patients with prediabetes or T2DM were selected from ten primary healthcare centres. Patients who received the lifestyle intervention (n = 186) were compared with a matched group of patients who received usual care (n = 2632). Data were extracted from the electronic primary care records. Propensity score matching was used to control for confounding by indication. Outcome measures were exercise level, BMI, HbA1c, fasting glucose, systolic and diastolic blood pressure, total cholesterol, HDL and LDL cholesterol and triglycerides and the follow-up period was one year.</p> <p>Results</p> <p>There was no significant difference at follow-up in any outcome measure between either group. The reduction at one year follow-up of HbA1c and fasting glucose was positive in the intervention group compared with controls, although not statistically significant (-0.12%, <it>P </it>= 0.07 and -0.17 mmol/l, <it>P </it>= 0.08 respectively).</p> <p>Conclusions</p> <p>The effects of the lifestyle programme in real-world primary care for patients with prediabetes or T2DM were small and not statistically significant. The attention of governments for lifestyle interventions is important, but from the available literature and the results of this study, it must be concluded that improving lifestyle in real-world primary care is still challenging.</p

Is Genetic Background Important in Lung Cancer Survival?

BACKGROUND:In lung cancer, a patient's survival is poor with a wide variation in survival within the stage of disease. The aim of this study was to investigate the familial concordance in lung cancer survival by means of analyses of pairs with different degrees of familial relationships. METHODS:Our population-based Swedish family database included three million families and over 58,100 lung cancer patients. We modelled the proband (parent, sibling, spouse) survival utilizing a multivariate proportional hazard (Cox) model adjusting for possible confounders of survival. Subsequently, the survival in proband's relative (child, sibling, spouse) was analysed with a Cox model. FINDINGS:By use of Cox modelling with 5 years follow-up, we noted a decreased hazard ratio for death in children with good parental survival (Hazard Ratio [HR] = 0.71, 95% CI = 0.51 to 0.99), compared to those with poor parental survival. Also for siblings, a very strong protective effect was seen (HR = 0.14, 95% CI = 0.030 to 0.65). Finally, in spouses no correlation in survival was found. INTERPRETATION:Our findings suggest that genetic factors are important in lung cancer survival. In a clinical setting, information on prognosis in a relative may be vital in foreseeing the survival in an individual newly diagnosed with lung cancer. Future molecular studies enhancing the understanding of the underlying mechanisms and pathways are needed