Aortan dissekoituma - päivystyksen musta joutsen

Vertaisarvioitu. English abstract.Aortan dissekoituminen on henkeä uhkaava tilanne, jossa aortan seinämäkerrokset irtoavat toisistaan sisäkalvossa tapahtuneen repeämän vuoksi. Klassinen oire on äkillisesti alkava ja dissekoituman edetessä paikkaa vaihtava rintakipu. Tämän oireen puuttuessa diagnoosiin pääsy voi olla haasteellista, sillä oireet tulevat useista eri elinjärjestelmistä dissekoituman sijainnin ja etenemisen mukaisesti. Kuvaamme kaksi potilastapausta, joissa molemmissa klassinen oirekuva puuttui

Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe

Summary Background Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m2), overweight (25·0–29·9 kg/m2), class I (mild) obesity (30·0–34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (Peer reviewe

Overweight, obesity and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120,813 adults from 16 cohort studies from the USA and Europe

Background Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight. Methods We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0–24·9 kg/m²), overweight (25·0–29·9 kg/m²), class I (mild) obesity (30·0–34·9 kg/m²), and class II and III (severe) obesity (≥35·0 kg/m²). We used an inclusive definition of underweight (<20 kg/m²) to achieve sufficient case numbers for analysis. The main outcome was cardiometabolic multimorbidity (ie, developing at least two from: type 2 diabetes, coronary heart disease, and stroke). Incident cardiometabolic multimorbidity was ascertained via resurvey or linkage to electronic medical records (including hospital admissions and death). We analysed data from each cohort separately using logistic regression and then pooled cohort-specific estimates using random-effects meta-analysis. Findings Participants were 120 813 adults (mean age 51·4 years, range 35–103; 71445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973–2012). During a mean follow-up of 10·7 years (1995–2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7–2·4; p<0·0001), almost five times higher for individuals with class I obesity (4·5, 3·5–5·8; p<0·0001), and almost 15 times higher for individuals with classes II and III obesity combined (14·5, 10·1–21·0; p<0·0001). This association was noted in men and women, young and old, and white and non-white participants, and was not dependent on the method of exposure assessment or outcome ascertainment. In analyses of different combinations of cardiometabolic conditions, odds ratios associated with classes II and III obesity were 2·2 (95% CI 1·9–2·6) for vascular disease only (coronary heart disease or stroke), 12·0 (8·1–17·9) for vascular disease followed by diabetes, 18·6 (16·6–20·9) for diabetes only, and 29·8 (21·7–40·8) for diabetes followed by vascular disease. Interpretation The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes

Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study

BackgroundAlthough some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.MethodsIn this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort–reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.ResultsWe identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13·9 years [SD 3·9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149·8 per 10 000 person-years) than in those without (97·7 per 10 000 person-years; mortality difference 52·1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1·68, 95% CI 1·19–2·35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78·1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5·9–44·0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2·01, 95% CI 1·18–3·43) and those with normal blood pressure and no dyslipidaemia (6·17, 1·74–21·9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress–mortality association were not significant, apart from effort–reward imbalance in men without cardiometabolic disease (mortality difference 6·6 per 10 000 person-years; multivariable-adjusted HR 1·22, 1·06–1·41).InterpretationIn men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.FundingNordForsk, UK Medical Research Council, and Academy of Finland.<br /

Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe.

BACKGROUND:Although overweight and obesity have been studied in relation to individual cardiometabolic diseases, their association with risk of cardiometabolic multimorbidity is poorly understood. Here we aimed to establish the risk of incident cardiometabolic multimorbidity (ie, at least two from: type 2 diabetes, coronary heart disease, and stroke) in adults who are overweight and obese compared with those who are a healthy weight.METHODS:We pooled individual-participant data for BMI and incident cardiometabolic multimorbidity from 16 prospective cohort studies from the USA and Europe. Participants included in the analyses were 35 years or older and had data available for BMI at baseline and for type 2 diabetes, coronary heart disease, and stroke at baseline and follow-up. We excluded participants with a diagnosis of diabetes, coronary heart disease, or stroke at or before study baseline. According to WHO recommendations, we classified BMI into categories of healthy (20·0-24·9 kg/m2), overweight (25·0-29·9 kg/m2), class I (mild) obesity (30·0-34·9 kg/m2), and class II and III (severe) obesity (≥35·0 kg/m2). We used an inclusive definition of underweight (FINDINGS:Participants were 120  813 adults (mean age 51·4 years, range 35-103; 71 445 women) who did not have diabetes, coronary heart disease, or stroke at study baseline (1973-2012). During a mean follow-up of 10·7 years (1995-2014), we identified 1627 cases of multimorbidity. After adjustment for sociodemographic and lifestyle factors, compared with individuals with a healthy weight, the risk of developing cardiometabolic multimorbidity in overweight individuals was twice as high (odds ratio [OR] 2·0, 95% CI 1·7-2·4; pINTERPRETATION:The risk of cardiometabolic multimorbidity increases as BMI increases; from double in overweight people to more than ten times in severely obese people compared with individuals with a healthy BMI. Our findings highlight the need for clinicians to actively screen for diabetes in overweight and obese patients with vascular disease, and pay increased attention to prevention of vascular disease in obese individuals with diabetes.FUNDING:NordForsk, Medical Research Council, Cancer Research UK, Finnish Work Environment Fund, and Academy of Finland.</p

Toiminnallisia menetelmiä ahdistuneisuushäiriöstä kärsivien potilaiden ryhmäinterventioissa : Narratiivinen kirjallisuuskatsaus

Ahdistuneisuushäiriöt ovat oireyhtymiä, joista kärsivillä henkilöillä pitkäkestoinen, voimakas ahdistus, sisältäen autonomisen hermoston aktivoitumisen oireita, aiheuttaa välttämiskäyttäytymistä. Ahdistuneisuushäiriöt rajoittavat siitä kärsivän sosiaalista ja psyykkistä toimintakykyä. Ne ovat yleisimpiä mielenterveyden häiriöitä ja niiden merkitys on suuri kansanterveydelle. Tutkittuun tietoon perustuvia Käypä hoito -suosituksia ollaan vasta laatimassa ahdistuneisuushäiriöiden hoidon osalta. Opinnäytetyön tarkoituksena oli kartoittaa jo olemassa olevaa tutkittua tietoa, jonka avulla toimintaterapian ryhmäinterventioita voidaan kehittää ahdistuneisuushäiriöistä kärsivien potilaiden hoidossa Keski-Suomen sairaanhoitopiirissä. Tavoitteena oli selvittää, millaisia toiminnallisia ryhmämuotoisia menetelmiä on käytetty tällä asiakasryhmällä ja miten asiakkaiden on kuvattu näistä hyötyvän. Tutkimusmenetelmänä oli narratiivinen kirjallisuuskatsaus, jonka tiedonhaussa käytettiin viittä kansainvälistä tietokantaa ja katsaukseen valittiin kymmenen vuosina 2007-2015 julkaistua tutkimusta. Tutkimustuloksina löytyi viisi menetelmää, joiden avulla oli saatu myönteisiä muutoksia ahdistusoireisiin. Nämä erityyppiset ryhmäinterventio-menetelmät liittyvät liikuntaan, tietoisuus- ja läsnäolotaitoihin sekä omistautumiseen ja hyväksymiseen pohjautuviin terapiamenetelmiin, Lifestyle-menetelmiin ja elämäntapamuutoksiin, päivittäisiin vapaa-ajantoimintoihin sekä kolmen interventiomuodon menetelmään.Patients with diagnoses of anxiety disorders have long-lasting and strong anxiety, which includes symptoms of the activation of the autonomic nervous system that causes evasive behaviour. People who suffer from anxiety disorders have limitations in their social and mental performance. Anxiety disorders are the most common mental health problems, and they have a significant impact on public health. The Finnish Käypä Hoito – recommendations, in other words, evidence-based best practice guidelines, are still being compiled for anxiety disorders. The purpose of the thesis was to examine existing knowledge that would enable the development of group interventions in occupational therapy for those suffering from anxiety disorders in the region of The Central Finland Hospital District. The goal was to determine what kinds of functional activities and group oriented methods were used with this patient group, and what kinds of descriptions of the benefits of these methods could be found. The method used in this study was a narrative literature review in which five international databases were used to find the data. Ten articles were selected for the final review. The articles were published between 2007 and 2015. According to the results, five methods were found that had caused positive changes in patients with diagnoses of anxiety disorders. These different types of group intervention methods were related to physical exercise, awareness and presence skills, mindfulness and acceptance-based interventions, lifestyle changes, recreational activities of daily living and the three modes of intervention-method

"Stairway to Heaven" : Toiminnallinen seksuaalikasvatustapahtuma yläkoulun 8. -luokkalaisille

Tämä opinnäytetyö toteutettiin projektina, jonka tarkoituksena oli suunnitella ja toteuttaa toiminnallinen seksuaalikasvatustapahtuma yläkoulun 8. -luokkalaisille. Tärkeimpinä seksuaaliopetuksen sisältöinä tutkimusten mukaan nuoret pitävät murrosikää, tunteita, raskaudenehkäisyä ja seksitauteja.Projektin seksuaalikasvatustapahtuma toteutettiin kolmena oppituntina, joista jokainen kesti 45 minuuttia Kuopion Yhteiskoulun 8. C-luokan oppilaille. Oppitunneilla käsiteltiin murrosikää Itsenäistyvän nuoren roolikartan avulla, tunteisiin ja seurusteluun liittyviä asioita Väestöliiton seurustelutestin avulla ja raskaudenehkäisyyn ja seksitautien torjuntaan liittyviä asioita Punaisen Ristin kondomiajokortin muodossa sekä kertomalla raskaudenehkäisytuotteista.Projektin mukaan Itsenäistyvän nuoren roolikartan käsitteiden aukaiseminen nuorille vaati ohjaajilta aktiivista otetta. Turvallisen ilmapiirin luominen on tärkeää seksuaaliopetuksessa. Tunteisiin ja seurusteluun liittyvät asiat olivat oppilaille läheisiä. Yksilötyönä tehtävä seurustelutesti sai oppilaat keskittymään ja kuuntelemaan. Oppilaat osallistuivat aktiivisesti kondomiajokortin suorittamiseen ja saivat haluamaansa tietoa. Kokonaiskuva oppitunneista jäi onnistuneeksi, oppilaat osallistuivat oppitunneilla ja palaute oli innostunutta ja positiivista. Toiminnallisuus seksuaalikasvatuksessa osoittautui toimivaksi.Työ on hyödynnettävissä yläkoulujen seksuaaliopetukseen ja voi olla kaikkien yläkoulujen käytössä tulevaisuudessa.This thesis was carried out as a project, the meaning of which was to plan and realise an operational sex education event to 8-graders in secondary school. According to studies young people considered puberty, feelings, contraception and sexually transmitted diseases as the main content of sex education.The functional thesis was carried out in Kuopio Yhteiskoulu 8. C-class students. The project was held for three sessions, each of which lasted 45 minutes. On lessons puberty was dealed with using the role map of growing young, matters dealing with emotions and relationships with the help of courtship test by Population and Family Welfare Federation, and matters dealing with sexual prevention and fight of sexually transmitted diseases in the form of Red Cross condom driving licence. The pregnancy prevention products were introduced.The project results indicate that explaining the concepts of the role map of growing youth to the young demanded an active grip of the tutors. Creating a secure atmosphere is important in sex education. Emotional and relationship matters were issues close to the students. The dating test that was done by the students individually made them to concentrate and to listen. Students actively participated in the condom driving licence test to perform the desired information. The overall picture was successful in science lessons, the students participated in the lessons and the feedback was positive and enthusiastic.Functionality in sex education turned out to be successful. This thesis can be profited from in sex education lessons in secondary school and it can be used by all secondary schools in the future

Laadukas hoitopalvelu : mistä mielikuva hyvästä laadusta muodostuu yksityisellä lääkäriasemalla?

Siirretty Doriast

Work stress and risk of death in men and women with and without cardiometabolic disease : a multicohort study

Background Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease. Methods In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease. Results We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13.9 years [SD 3.9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149.8 per 10 000 person-years) than in those without (97.7 per 10 000 person-years; mortality difference 52.1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1.68, 95% CI 1.19-2.35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78.1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5.9-44.0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2.01, 95% CI 1.18-3.43) and those with normal blood pressure and no dyslipidaemia (6.17, 1.74-21.9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6.6 per 10 000 person-years; multivariable-adjusted HR 1.22, 1.06-1.41). Interpretation In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.Peer reviewe

Body mass index and risk of dementia : Analysis of individual-level data from 1.3 million individuals

Introduction: Higher midlife body mass index (BMI) is suggested to increase the risk of dementia, but weight loss during the preclinical dementia phase may mask such effects. Methods: We examined this hypothesis in 1,349,857 dementia-free participants from 39 cohort studies. BMI was assessed at baseline. Dementia was ascertained at follow-up using linkage to electronic health records (N = 6894). We assumed BMI is little affected by preclinical dementia when assessed decades before dementia onset and much affected when assessed nearer diagnosis. Results: Hazard ratios per 5-kg/m2 increase in BMI for dementia were 0.71 (95% confidence interval = 0.66-0.77), 0.94 (0.89-0.99), and 1.16 (1.05-1.27) when BMI was assessed 10 years, 10-20 years, and &amp;gt;20 years before dementia diagnosis. Conclusions: The association between BMI and dementia is likely to be attributable to two different processes: a harmful effect of higher BMI, which is observable in long follow-up, and a reverse-causation effect that makes a higher BMI to appear protective when the follow-up is short. Available online 21 November 2017</p