Medical certificate education:controlled study between lectures and flipped classroom

Abstract Background: Finnish permanent residents are covered by social security insurance administered by the Social Insurance Institution of Finland. The procedure of insurance is initiated with medical certificate written by the treating doctor. Thus, the doctor must have certificate writing skills accompanied with the knowledge of the content and goals for insurance. Quality certificates are important part of doctors’ professional skills worldwide and most effective teaching methods for learning these should be investigated. Methods: Medical certificate data were collected from two independent courses of fourth-year student taught in autumn 2015 (N = 141) and 2016 (N = 142) in the medical faculty of the University of Eastern Finland. A random sample of 40 students per course was drawn for the analysis. All certificates were analyzed as one sample. This was done to obtain reliable results with internal control group on the differences between two teaching methods, the traditional approach and the flipped classroom (FC) approach, in 2015 and 2016, respectively. The medical certificates were evaluated and scored with a rubric (range: − 4.00–14.25) by two independent experienced specialists. Results: Compared to students in the traditional classroom, students involved in the FC received significantly higher scores in all relevant sections of the assessed certificates. The mean of the total scores was 8.87 (SD = 1.70) for the traditional group and 10.97 (SD = 1.25) for the FC group. Based on the common language effect size, a randomly selected student from the FC group had an 85% probability of receiving a higher total score than a student from the traditional group. Conclusions: In this study, the FC approach resulted in a statistical significant improvement in the content and technical quality of the certificates. The results suggest that the FC approach can be applied in the teaching of medical certificate writing

Gender differences in thyroid function and obesity among finnish women and men:the FIN-D2D-study

Abstract Background: Our aim was to study the relationship between thyroid function and body weight in a large Finnish adult population, taking into account the effect of gender, because the results of previous studies are conflicting. Methods: A random sample of 4500 Finnish subjects aged 45–74 years old was selected from the National Population Register. The participation rate was 64%. Height, weight, waist circumference, and blood pressure were measured. Medications used, current smoking, the use of alcohol, and leisure-time physical activity (LTPA) wereas queried. Thyroid values (free T4, free T3, and TSH) were measured in 1307 men and 1434 women. Subjects receiving thyroid hormone (N=92) were excluded. Results: The mean age of the subjects was 59.7 years and their mean body mass index (BMI) was 27.4 kg/m². After adjustment for age, LTPA, and current smoking, TSH showed no linearity (p=0.09) across increasing BMI; in women TSH ranged from 1.85 ± 1.15 to 2.02 ± 1.29 IU/L and in men, from 1.79 ± 1.19 to 2.04 ± 1.33 IU/L (p=0.13). FT3 -values increased from 3.85 ± 0.67 to 3.97 ± 0.59 pmol/L in women (p=0.004), but not in men, with increasing BMI. FT4 -values decreased from 13.78 ± 2.07 to 13.31 ± 1.91 pmol/L with increasing BMI in men (p<0.001 for linearity), but not in women. Conclusions: TSH values did not increase along with BMI in men and women with BMI, but FfT3 levels increased in women, and FfT4 levels decreased in men along with increasing BMI. The reasons for these gender differences need further research

Decreased serum total cholesterol is associated with a history of childhood physical violence in depressed outpatients

Abstract Associations between adverse childhood experiences (ACEs) and cholesterol in depressed patients are unclear. Therefore, we compared 78 adult outpatients with major depressive disorder (MDD) with (n = 24) or without (n = 54) experiences of physical violence in childhood. Background data were collected with questionnaires, and total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured from fasting blood samples. Patients with a history of childhood physical violence had lower levels of TC than the control group. No differences were observed in HDL-C, LDL-C, or low-grade inflammation levels between the two groups. In multivariate models, decreased levels of TC were associated with childhood physical violence, and these associations remained significant after adjustments for age, gender, lifestyle, metabolic condition, socioeconomic situation, psychiatric status, suicidality, low-grade inflammation, the chronicity of depression, medications used and somatic diseases. At the 8-month follow-up, the results were essentially the same when the Trauma and Distress Scale (TADS) was used as the measure of ACEs. The specific mechanisms underlying cholesterol alterations associated with ACEs are a topic for future studies. Better understanding of these mechanisms might lead to possible new interventions in the prevention of adverse health effects resulting from ACEs