Tutkimustoiminta terveyskeskuksissa. Nykytila ja tulevaisuus. Selvityshenkilöiden raportti

Selvitystyössä kartoitettiin terveyskeskuksissa tehtävän tutkimuksen, sen rahoituksen ja sitä tukevan koulutuksen nykytilaa. Kartoituksen perusteella on tehty ehdotuksia perusterveydenhuollon tutkimuksen vahvistamiseksi. Ehdotukset on koottu kahdeksi kokonaisuudeksi: tutkimustyön kehittämisen kannalta oleelliset toimenpiteet ja erikseen keinot, joilla perusterveydenhuoltoa voidaan kehittää lisääntyvän tutkimuksen avulla. Selvitystyö tähtäsi perusterveydenhuoltoa tukevan ja kehittävän tutkimuksen edistämiseen terveyskeskuksissa, päämääränä väestön terveyden parantaminen. Selvityksessä tehtiin kysely terveyskeskusten johtaville lääkäreille, haastateltiin yliopistojen edustajia ja terveyskeskuksessa toimivia tutkijoita, kartoitettiin perusterveydenhuoltoa koskevia tieteellisiä julkaisuja sekä tutustuttiin muiden maiden järjestelyihin, joilla tuetaan tutkimusta perusterveydenhuollossa. Selvityshenkilöt ovat tiivistäneet johtopäätöksensä kolmeentoista ehdotukseen. Ensimmäiset kahdeksan pyrkivät tukemaan perusterveydenhuollon tutkimusta tavoilla, jotka voidaan toteuttaa myös erillisinä. Jälkimmäiset viisi tähtäävät sellaisen uuden kokonaisuuden rakentamiseen, jonka avulla parhaiten voitaisiin tukea tutkimustiedon hyödyntämistä ja ohjata perusterveydenhuollon kehittämist

Swimming and Campylobacter Infections1

A matched case-control study was conducted to study risk factors for domestically acquired sporadic Campylobacter infections in Finland. Swimming in natural sources of water was a novel risk factor. Eating undercooked meat and drinking dug-well water were also independent risk factors for Campylobacter infection

Psychometric evaluation of social phobia and anxiety inventory for children (SPAI-C) and social anxiety scale for children-revised (SASC-R)

The study evaluated the psychometric properties of Finnish versions of the Social Phobia and Anxiety Inventory for Children (SPAI-C) and the Social Anxiety Scale for Children-Revised (SASC-R). 352 students (M = 12.2 years) participated in the study and completed the SPAI-C and SASC-R. In addition, 68 participants (M = 12.2 years) and their parents were interviewed with the Schedule for Affective Disorders and Schizophrenia for School Aged Children (K-SADS-PL). The SPAI-C was more sensitive for identifying youth meeting criteria for social phobia (SP), whereas the SASC-R demonstrated greater specificity. The youth in this sample had lower mean total scores on the self-report questionnaires than did those in the original validitation studies of the SPAI-C and SASC-R conducted in America. These findings question whether cross-cultural differences in the expression of SP influence the clinical cut-off scores used in translated versions of social anxiety questionnaires

When does the Autism Spectrum Screening Questionnaire (ASSQ) predict autism spectrum disorders in primary school-aged children?

The aims of this study were, firstly, to study the association between parents’ and teachers’ ratings for the Finnish version of the Autism Spectrum Screening Questionnaire (ASSQ), secondly, to find out whether the original cut-off scores of the ASSQ identify primary school-aged children with Asperger syndrome (AS) or autism by using the Finnish ASSQ, and thirdly, to evaluate the validity of the ASSQ. Parents and/or teachers of higher-functioning (full-scale intelligence quotient ≥ 50) 8-year-old total population school children (n = 4,408) and 7–12-year-old outpatients with AS/autism (n = 47) completed the Finnish version of the ASSQ. Agreement between informants was slight. In the whole total population, low positive correlation was found between parents’ and teachers’ ratings, while in the sample of high-scoring children the correlation turned out to be negative. A cut-off of 30 for parents’ and teacher's summed score and 22 for teachers’ single score is recommended. A valid cut-off for parents’ single score could not been estimated. The clinicians are reminded that the ASSQ is a screening instrument, not a diagnosing instrument. The importance of using both parents’ and teachers’ ratings for screening in clinical settings is underlined

Lasten ja nuorten mielenterveyskuntoutus : Terveydenhuollon ja Kelan yhteistyötä

Suositus on tehty Kelan ja julkisen terveydenhuollon asiantuntijoiden valtakunnallisessa yhteistyössä. Suositus on suunnattu kuntoutusta suunnitteleville ja toteuttaville tahoille. Lapsi tai nuori voi saada Kelan vaativaa lääkinnällistä kuntoutusta, kun • hän ei ole julkisessa laitoshoidossa • hänellä on sairaus tai vamma sekä siihen liittyvä suoritus- ja osallistumisrajoite • suoritus- ja osallistumisrajoite on niin suuri, että hänellä on sen vuoksi huomattavia vaikeuksia arjen toiminnoista suoriutumisessa ja osallistumisessa kotona, opiskelussa, työelämässä tai muissa elämäntilanteissa • rajoite aiheuttaa vähintään vuoden kestävän kuntoutustarpeen • kuntoutus ei liity välittömään sairaanhoitoon • kuntoutuksen tavoitteet eivät ole ainoastaan hoidollisia • kuntoutus on perustellusti tarpeen mahdollistamaan aktiivista ja harkittua arjen toiminnoista suoriutumista ja osallistumista. Suosituksessa ei esitetä yksityiskohtaisesti kuntoutusmenetelmiä eikä vaikuttavuusnäyttöä. Näiltä osin suosituksessa viitataan Käypä hoito -suosituksiin, ajankohtaisiin oppikirjoihin ja tutkimuksiin. Muihin kuin mielenterveyshäiriöiden diagnooseihin, kuten esimerkiksi aistivammaisuuteen tai kehitysvammaisuuteen liittyviä erityistarpeita ei käsitellä tässä suosituksessa. Suosituksessa kuvataan julkisen terveydenhuollon järjestämisvastuu sekä ikäryhmäkohtainen toimintakyvyn arvioinnin ja kuntoutuksen valinnan, käynnistämisen ja seuraamisen prosessi. Suosituksessa kuvataan Kelan järjestämien kuntoutustoimenpiteiden asiakkuuskriteerit vaativan lääkinnällisen kuntoutuksen (luvut 9 ja 10), harkinnanvaraisen kuntoutuksen (luvut 10, 11 ja 12), kuntoutuspsykoterapian (luku 13) sekä ammatillisen kuntoutuksen (luku 14) osalta. Lisäksi suosituksessa esitetään keskeiset lapsen ja nuoren kuntoutusta tukevat etuudet (luvut 15 ja 16) ja se, milloin lapsella tai nuorella voi olla mahdollisuus Kelan maksamaan opiskelun apuvälineeseen (luku 17).nonPeerReviewedVertaisarvioimato

Familiality of Quantitative Autism Traits

Autistic traits exist along a continuum that extends into social functioning in the general population, and they aggregate in the family members of children with autism spectrum disorder (ASD). Quantitative measures are therefore essential when investigating the patterns of familiality of these traits. Prior studies have suggested differential inheritance patterns of autistic traits that depend on the cognitive level of the child with ASD as well as the family type.Our goal was to examine the family patterns of quantitative autism traits (QAT) in a group of simplex autism families of high-functioning children with ASD.We used the Social Responsiveness Scale (SRS) to evaluate QAT in 47 ASD families and 46 control families. SRS assessments (parental/spousal evaluations) were collected for the children with ASD, their siblings, and their parents as well as for the control children and their parents.The SRS was able to distinguish individuals with ASD from the control children and from their unaffected siblings. Significant group differences were also found when comparing the fathers of ASD families to control fathers and when comparing the brothers of individuals with ASD to control boys, with male members of ASD families having higher SRS scores. Gender differences were observed in the group of siblings of children with ASD and the group of parents of children with ASD, with males having higher scores than females. In ASD families, a positive trend between child and father QAT was found, whereas mothers' scores were not associated with child outcomes. By contrast, in control families, mothers' QAT correlated more strongly with child QAT.Autistic traits aggregate in the fathers and brothers of children with ASD in simplex autism families. The QAT levels of the family members should be taken into consideration when planning the rehabilitation of the child or adolescent with ASD and when designing family interventions

How young adults with autism spectrum disorder watch and interpret pragmatically complex scenes

The aim of the current study was to investigate subtle characteristics of social perception and interpretation in high-functioning individuals with autism spectrum disorders (ASDs), and to study the relation between watching and interpreting. As a novelty, we used an approach that combined moment-by-moment eye tracking and verbal assessment. Sixteen young adults with ASD and 16 neurotypical control participants watched a video depicting a complex communication situation while their eye movements were tracked. The participants also completed a verbal task with questions related to the pragmatic content of the video. We compared verbal task scores and eye movements between groups, and assessed correlations between task performance and eye movements. Individuals with ASD had more difficulty than the controls in interpreting the video and during two short moments there were significant group differences in eye movements. Additionally, we found significant correlations between verbal task scores and moment-level eye movement in the ASD group, but not among the controls. We concluded that participants with ASD had slight difficulties in understanding the pragmatic content of the video stimulus and attending to social cues, and that the connection between pragmatic understanding and eye movements was more pronounced for participants with ASD than for neurotypical participants.Our Research Report for 2000-2002 reflects an outstanding level of achievement throughout the institution and demonstrates once again our high level of commitment to strategic and applied research particularly in areas that enhance the quality of life.casl70pub4526pub1

Reelin Associated With Restricted and Stereotyped Behavior Based on Principal Component Analysis on Autism Diagnostic Interview-Revised

Tämä artikkeli ei ole avattavissa lehden sivuilta, koska linkit ja DOI vievät väärään artikkeliin samoin PDF sen ohessa. Kustantajalle ilmoitettu ja pyydetty korjausta.Abstract Background: Twin and family studies have indicated a strong genetic component in autism spectrum disorders, and genetic studies have revealed highly heterogeneous risk factors. The range and severity of the symptom presentation also vary in the spectrum. Thus, symptom-based phenotypes are putatively more closely related to the underlying biology of autism than the end-state diagnosis. Methods: We performed principal component analysis on Autism Diagnostic Interview-Revised algorithm for 117 Finnish families and 594 families from the Autism Genetic Research Exchange (AGRE). The resulting continuous component scores were used as quantitative phenotypes in family-based association analysis. In addition, K-means clustering was performed to cluster and visualize the results of the PCA. Unaffected siblings were included in the study. Results: The components were interpreted as Social Component (SC), communication component and Restricted and Stereotyped Behavior Component (RSBC). K-means clustering showed that, especially in SC, the range of the symptom severity was increased by the siblings. The association of neuroligin 1 with SC was increased, compared to a previous study where only the end-state diagnosis was used. In RSBC, the range of the symptom severity of siblings overlapped greatly with that of patients, which could explain why no association of reelin was found in previous studies in which only the end-state diagnosis was used, but a significant association of reelin with RSBC was now found in the Finnish families (Bonferroni-corrected p=0.029 for rs362644). Although, the Finnish sample is isolated and genetically very homogeneous, compared to the heterogeneous background of AGRE families, many single-nucleotide polymorphisms in reelin, showed modest association with RSBC in the AGRE sample, too. Conclusions: This study demonstrates how the quantitative phenotypes can affect the association analyses, and yields further support to the use of siblings in the study of complex neuropsychiatric disorders.Peer reviewe

Resting state fMRI reveals a default mode dissociation between retrosplenial and medial prefrontal subnetworks in ASD despite motion scrubbing

In resting state functional magnetic resonance imaging (fMRI) studies of autism spectrum disorders (ASDs) decreased frontal-posterior functional connectivity is a persistent finding. However, the picture of the default mode network (DMN) hypoconnectivity remains incomplete. In addition, the functional connectivity analyses have been shown to be susceptible even to subtle motion. DMN hypoconnectivity in ASD has been specifically called for re-evaluation with stringent motion correction, which we aimed to conduct by so-called scrubbing. A rich set of default mode subnetworks can be obtained with high dimensional group independent component analysis (ICA) which can potentially provide more detailed view of the connectivity alterations. We compared the DMN connectivity in high-functioning adolescents with ASDs to typically developing controls using ICA dual-regression with decompositions from typical to high dimensionality. Dual-regression analysis within DMN subnetworks did not reveal alterations but connectivity between anterior and posterior DMN subnetworks was decreased in ASD. The results were very similar with and without motion scrubbing thus indicating the efficacy of the conventional motion correction methods combined with ICA dual-regression. Specific dissociation between DMN subnetworks was revealed on high ICA dimensionality, where networks centered at the medial prefrontal cortex and retrosplenial cortex showed weakened coupling in adolescents with ASDs compared to typically developing control participants. Generally the results speak for disruption in the anterior-posterior DMN interplay on the network level whereas local functional connectivity in DMN seems relatively unaltered