Betydelsen av fysisk träning och hemmiljö vid förebyggande av fallolyckor för äldre : Förverkligande av ett informationstillfälle för seniorer

Examensarbetet har förverkligats som ett praktiskt inriktat arbete som lett till ett informationstillfälle (4.4.2013) för seniorer i Kyrkslätt kommun. Syftet var att informera och uppmärksamma seniorer och närståendevårdare om faktorer som inverkar på fallrisken i vardagen och hur dessa kan förhindras. Utgångspunkten har varit ett multiprofessionellt närmelsesätt, vilket rekommenderas vid prevention av fallolyckor. Detta examensarbete har utgått från ett fysioterapeutiskt perspektiv med inriktning på den fysiska träningens och hemmiljöns betydelse. Arbetet baseras på Institutet för hälsa och välfärds (Terveyden ja hyvinvoinnin laitos, THL) nyutgivna handbok IKINÄ, Iäkkäiden kaatumisten ehkäisy och finska Fysioterapiförbundets rekommendationer vid förebyggande av fallolyckor. Vi har därmed omsatt IKINÄ-materialet i praktiken och bidragit till en större användning av IKINÄ-materialet. Det praktiskt inriktade examensarbetet har lagts upp enligt Vilkka & Airaksinens rekommendationer i Toiminnallinen opinnäytetyön ohjaajan käsikirja. Teorin har sammanställts och presenterats på ett pedagogiskt och lättförståeligt sätt för seniorerna. Efter informationstillfället fick deltagarna frivilligt fylla i en kort utvärderingsblankett för att ge riktgivande respons på presentationerna ”Förebygg fallolyckor med fysisk träning” och ”Hemmet - en säker plats?”. Med utvärderingen kan planerandet och utförandet av liknande tillfällen i framtiden underlättas. Genomförandet av informationstillfället fick god respons. Examensarbetets forskningsfrågor hur man förverkligar ett informationstillfälle för seniorer och hur man minskar fallrisken med fysisk träning samt påverkar hemmiljön vid förebyggandet av fallolyckor besvarades. Examensarbetet var ett samarbete mellan THL, Arcada – Nylands svenska yrkeshögskola, Kyrkslätts svenska församling samt Kyrkslätts vård- och omsorgsväsende.This thesis has been carried out as a practice-based thesis that lead to an informative event (4.4.2013) for seniors in the community of Kyrkslätt. The purpose was to inform seniors and those family members who look after another family member to pay attention to factors that affect the risk of falling in everyday life and how to prevent these factors. It is taking a multiprofessional approach. Our starting point is the physiotherapeutic perspective focusing on the impact of physical exercise and home environment. The thesis is based on the manual called IKINÄ (2012) published by the National Institute for Health and Welfare (THL) and the physiotherapy recommendations for prevention of falls by the Finnish Association of Physiotherapists. We hope this thesis will contribute to making use of the IKINÄ-material. The practice-based thesis was structured according to the recommendations in the guidebook “Toiminnallinen opinnäytetyön ohjaajan käsikirja” by Vilkka & Airaksinen. The theory was presented in an easily understandable way. After the event the seniors were asked to fill in a short evaluation form to provide feedback for the presentations "Preventing falls through physical exercise" and "Home - a safe place?". Evaluations make execution of similar events easier for future occasions. The informative event received positive response. The research questions how to organise an informative event for seniors, how to reduce the risks of falls with the help of physical exercise and the significance of the home environment to prevent falls have been addressed. The thesis was a cooperation between THL, Arcada - University of Applied Sciences, the Swedish-speaking parish of Kyrkslätt and the health care organisation of Kyrkslätt.Opinnäytetyö on toteutettu toiminnallisena opinnäytetyönä, joka johti senioreille suunnattuun infotilaisuuteen Kirkkonummella (4.4.2013). Sen tarkoituksena oli valistaa senioreita ja omaishoitajia kaatumisvaaroista arjessa, ja miten niiltä voidaan välttyä. Lähtökohtana on ollut moniammatillinen lähestymistapa, ja tätä suositellaan kaatumisvaarojen ennaltaehkäisyssä. Tässä opinnäytetyössä on tarkasteltu harjoittelu- ja kotiolojen merkitystä fysioterapeuttisesta näkökulmasta. Työ perustuu Terveyden ja hyvinvoinnin laitoksen (THL) äskettäin julkaisemaan IKINÄ- oppaaseen, Iäkkäiden kaatumisten ehkäisy, ja Suomen Fysioterapeuttien fysioterapiasuosituksiin kaatumisvaarojen ennaltaehkäisystä. Työn myötä olemme soveltaneet IKINÄ- materiaalia käytännössä ja edesauttaneet IKINÄ-materiaalin laajempaa käyttöä jatkossa. Toiminnallinen opinnäytetyö on tehty Vilkka & Airaksisen ”Toiminnallinen opinnäytetyön ohjaajan käsikirja”- oppaan suosituksien mukaisesti. Teoria on koottu ja esitelty pedagogisesti ja helposti ymmärrettävällä tavalla senioreita varten. Infotilaisuuden jälkeen osanottajat saivat vapaaehtoisesti täyttää lyhyehkön arviointilomakkeen, jotta saataisiin suuntaa antavaa palautetta esityksistä ”Ennaltaehkäise kaatumistapaturmia fyysisen harjoittelun avulla” ja ” Koti – turvallinen ympäristö?”. Arvioinnin avulla voidaan helpottaa samanlaisten tapahtumien suunnittelua ja toteutusta tulevaisuudessa. Infotilaisuuden toteutus sai hyvää palautetta. Opinnäytetyön tutkimuskysymyksiin, kuinka infotilaisuus toteutetaan senioreille ja miten kaatumisvaaraa pienennetään fyysisen harjoittelun avulla, sekä kotiolojen merkitys kaatumistapaturmissa, näihin kaikkiin kysymyksiin saatiin vastaus. Opinnäytetyö oli yhteistyö THL:n, Arcada – Nylands svenska yrkeshögskola:n, Kirkkonummen ruotsinkielisen seurakunnan ja Kirkkonummen terveys- ja hyvinvointilaitoksen välillä

Putting a Price Tag on Personal Information - A Literature Review

In the digital age, personal information is claimed to be the new commodity with a rising market demand and profitability for businesses. Simultaneously, people are becoming aware of the value of their personal information while being concerned about their privacy. This increases the demand of direct compensation or protection. In response to the commodification of privacy and the increased demand for compensation, a number of scholars have shed light on the value people assign to their personal information. However, these findings remain controversial as their results differ tremendously due to different research methods and contexts. To address this gap, we conducted a systematic literature review to gain insights into the current research state and to identify further research avenues. By synthesizing and analyzing 37 publications, we provide an integrative framework along with seven contextual factors affecting individuals’ valuation of privacy

Medical students\u27 attitudes towards terminology of obesity

Introduction: Obesity, one of the most common health problems encountered in medicine with implications in various other health issues, is nowadays omnipresent. Terminology describing diagnosis of obesity might be considered rude or offensive. Since perception of obese people is sometimes associated with negative attitudes and stereotypes, proper terminology used by physicians is crucial

LAPAROSCOPIC TREATMENT OF POST-TRAU- MATIC SPLENIC CYST

Post-traumatic splenic cysts are classified as secondary cysts. It is possible diagnosis in patient with lump in the left upper quadrant with or without other symptoms. After diagnosis is established, surgery should be performed early due to possible complications such as rupture and abscess formation

Sulphide donors affect the expression of mucin and sulphide detoxification genes in the mucosal organs of Atlantic salmon (Salmo salar)

Hydrogen sulphide (H2S) is a gas that affects mucosal functions in mammals. However, its detrimental effects are less understood in fish despite being known to cause mass mortality. Here we used explant models to demonstrate the transcriptional responses of Atlantic salmon (Salmo salar) mucosa to the sulphide donor sodium hydrosulphide (NaHS). The study focused on two groups of genes: those encoding for sulphide detoxification and those for mucins. Moreover, we performed pharmacological studies by exposing the organ explants to mucus-interfering compounds and consequently exposed them to a sulphide donor. Exposure to NaHS significantly affected the expression of sulphide:quinone oxidoreductase (sqor1, sqor2) and mucin-encoding genes (muc5ac, muc5b). The general profile indicated that NaHS upregulated the expression of sulphide detoxification genes while a significant downregulation was observed with mucins. These expression profiles were seen in both organ explant models. Pharmacological stimulation and inhibition of mucus production used acetylcholine (ACh) and niflumic acid (NFA), respectively. This led to a significant regulation of the two groups of marker genes in the gills and olfactory rosette explants. Treatment of the mucosal organ explants with the mucus-interfering compounds showed that low dose NFA triggered more substantial changes while a dose-dependent response could not be established with ACh. Pharmacological interference demonstrated that mucins played a crucial role in mucosal protection against H2S toxicity. These results offer insights into how a sulphide donor interfered with mucosal responses of Atlantic salmon and are expected to contribute to our understanding of the least explored H2S-fish interactions—particularly at the mucosa.Sulphide donors affect the expression of mucin and sulphide detoxification genes in the mucosal organs of Atlantic salmon (Salmo salar)publishedVersio

En studie av en klinisk population inom späd- och småbarnspsykiatrin-relationen mellan föräldrars anknytningsmönster, föräldrastress och kontaktanledning.

Inom späd- och småbarnspsykiatrin behandlas familjer av en mängd olika anledningar. Det kan bero på dåligt mående hos föräldern, att känslorna för barnet inte är så starka som förväntat, att relationen mellan barn och förälder är konfliktfylld eller att det finns en oro över barnets symtom. Föreliggande studie syftade till att undersöka och beskriva den kliniska populationen inom två späd- och småbarnspsykiatriska verksamheter i Skåne. Studien hade designen av en deskriptiv, tvärsnittstudie i vilken alla föräldrar som påbörjade behandling tillfrågades om att delta. Studien baserades på 73 föräldrar som fyllt i självskattningsformulär. Skillnader mellan föräldrar med olika anknytningsmönster i relation till föräldrastress och kontaktanledning undersöktes. Utöver detta undersöktes eventuella könsskillnader. Resultaten visade att föräldrarna i denna studie hade signifikant högre förekomst av symtom på psykisk ohälsa, högre föräldrastress och otrygg anknytning jämfört med normalpopulationen. Föräldrarna med ambivalent anknytningsmönster hade signifikant högre föräldrastress än de andra föräldrarna. De föräldrar som sökte för barnrelaterade problem hade en signifikant högre föräldrastress än de som sökte för föräldrarelaterade problem. Mammorna hade signifikant högre föräldrastress än papporna. Majoriteten av föräldrarna levde i parförhållanden och hade en hög utbildningsnivå. Kliniska implikationer är vikten av att tidigt upptäcka en hög föräldrastress, samt att förälderns anknytningsmönster och kontaktanledning kan ha betydelse för hur behandlingen bör utformas.In child and infant mental health clinics families are treated for a variety of reasons. It may be that the feelings expressed for the child by the parent may not be as expected, due to the mental health problems of the parent, or that the relationship between the child and parent is filled with conflict, or that there is a parental concern for the child's symptoms. This study aimed at investigating and describing the clinical population in two child and infant mental health clinics in Skåne. The study had the design of a descriptive, cross-sectional study in which all parents who started treatment were asked to participate. The study was based on 73 parents who filled in self-assessment forms. Distinctions between parents with different attachment patterns were investigated in relation to parental stress and reason for contact. Gender differences were also explored. The results showed that the parents in this study had a significantly higher incidence of symptoms of mental health issues, higher parental stress and insecure attachment compared to the normal population. The parents with ambivalent attachment patterns had significantly higher parental stress than the other parents. The parents who sought contact for child-related problems had a significantly higher parental stress than those who sought for parent-related problems. The mothers showed significantly higher parental stress than the fathers. The majority of parents lived in pair relationships and had a high level of education. Clinical implications are that the importance of both early detection of high parental stress as well as the parents’ attachment patterns and reasons for contact, should be considered when regarding appropriate treatment

aEEG Use in Pediatric Critical Care—An Online Survey

Background: Evidence supporting continuous EEG monitoring in pediatric intensive care is increasing, but continuous full-channel EEG is a scarce resource. Amplitude-integrated EEG (aEEG) monitors are broadly available in children's hospitals due to their use in neonatology and can easily be applied to older patients. Objective: The aim of this survey was to evaluate the use of amplitude-integrated EEG in German and Swiss pediatric intensive care units (PICUs). Design: An online survey was sent to German and Swiss PICUs that were identified via databases provided by the German Pediatric Association (DGKJ) and the Swiss Society of Intensive Care (SGI). The questionnaire contained 18 multiple choice questions including the PICU size and specialization, indications for aEEG use, perceived benefits from aEEG, and data storage. Main results: Forty-three (26%) PICUs filled out the questionnaire. Two thirds of all interviewed PICUs use aEEG in non-neonates. Main indications were neurological complications or disease and altered mental state. Features assessed were mostly seizures and side differences, less frequently height of amplitude and background pattern. Interpretation of raw EEG also played an important role. All interviewees would appreciate the establishment of reference values for toddlers and children. Conclusions: aEEG is used in a large proportion of the interviewed PICUs. The wide-spread use without validation of data generates the need for further evaluation of this technique and the establishment of reference values for non-neonates

Preoperative oncologic therapy and the prolonged risk of venous thromboembolism in resectable pancreatic cancer

Background Pancreatic cancer is one of the most prothrombotic cancers. Among patients receiving preoperative chemotherapy followed by surgery, chemotherapy and surgery represent a compound risk for venous thromboembolism (VTE), rendering the postoperative time a period of interest. We aimed to analyze whether preoperative oncologic therapy increases the risk for VTE after surgery and identify which characteristics associate with VTE. Methods We first identified patients surgically treated for pancreatic cancer at Helsinki University Hospital between 2000 and 2017, collecting the following data: gender, age at surgery, preoperative medication, body mass index (BMI), preoperative chemo(radio)therapy, tumor size, positive node ratio, perineural and perivascular invasion, tumor grade, surgical technique, postoperative anticoagulation, adjuvant therapy, time of VTE, time of local disease recurrence, time of distant metastasis, and time of death. With a follow-up period of at least 2 years or until death, we compared a total of 93 preoperative oncologic therapy and 291 upfront surgery patients (n = 384, median age 66.5 years). Results Preoperative oncologic therapy increased the risk for thrombosis after surgery (hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.03-2.53). The VTE incidence rate remained high for up to 2 years after surgery. BMI >= 30 kg/m(2), prior anticoagulation, and disease recurrence (p < 0.05, respectively) associated with VTE. VTE is also associated with shorter overall survival (HR 3.25; 95% CI 2.36-4.44). In 71.6% (95% CI 60.5-81.1) of patients, VTE was diagnosed after disease recurrence. Conclusions Preoperative oncologic therapy represents an independent risk factor for VTE, not only during the immediate postoperative period but up to 2 years after surgery. VTE is associated with obesity, prior anticoagulation, and disease recurrence and diminishes overall survival.Peer reviewe

Preoperative Biomarker Panel, Including Fibrinogen and FVIII, Improves Diagnostic Accuracy for Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is a deadly cancer often diagnosed late. Earlier detection is urgently needed. Pancreatic ductal adenocarcinoma is known to associate with increased coagulation activity. We studied whether preoperative coagulation biomarkers are useful in distinguishing PDAC from a benign tumor, intraductal papillary mucinous neoplasm (IPMN) in this observational study. We analyzed standard clinical and coagulation variables in patients operated during 2010 and 2015 at Helsinki University Hospital. Pancreatic ductal adenocarcinoma with preoperative coagulation variables available and no neoadjuvant treatment or other active cancer was observed in 80 patients (stage I-III in 67 and IV in 13) and IPMN in 18 patients. Fibrinogen, factor VIII (FVIII), carbohydrate antigen (CA) 19-9, albumin, alkaline phosphatase, and conjugated bilirubin were higher in both stages I to III and IV PDAC compared to IPMN (P <.05). Factor VIII was highest in stage IV (P <.05). Combining these variables in a panel increased sensitivity and specificity for PDAC. In receiver operating characteristic analysis, the area under the curve (95% confidence interval) was 0.95 (0.90-1.00) for the panel, compared to 0.80 (0.71-0.88) for CA 19-9 alone (P <.01). In conclusion, PDAC was associated with increased fibrinogen and FVIII. Combining these coagulation biomarkers with CA 19-9, albumin, and alkaline phosphatase improves diagnostic accuracy.Peer reviewe