Isyyden tunnustamisen vastaanottaminen neuvolassa osana terveydenhoitajan työtä

Hartikainen, Mari & Hedman, Päivi. Isyyden tunnustamisen vastaanottaminen neuvolassa osana terveydenhoitajan työtä. Helsinki, kevät 2017. 61 s, Liitteitä 2. Diakonia-ammattikorkeakoulu, hoitotyön koulutusohjelma, terveydenhoitaja (AMK). Opinnäytetyön tarkoituksena oli tutkia, miten 1.1.2016 voimaan tullut Suomen isyyslakiuudistus on vaikuttanut terveydenhoitajien työnkuvaan. Lakimuutoksen myötä äitiysneuvolan terveydenhoitaja voi ottaa vastaan ennakollisen isyyden tunnustamisen niissä tapauksissa, joissa isyydestä ei ilmene epäselvyyttä. Opinnäytetyön tavoitteena oli selvittää terveydenhoitajien kokemuksia uudesta työtehtävästä. Halusimme selvittää, onko tehtävä sujunut ennakoidun mukaisesti, onko koulutus ja valmistautuminen ollut terveydenhoitajien mukaan riittävää ja ovatko he kokeneet menettelyn vaikuttaneen isien asiakkuuteen neuvolassa. Tutkimuksen kohderyhmänä olivat Helsingin ja Espoon kaupungin äitiysneuvoloiden terveydenhoitajat. Tutkimus toteutettiin laadullisena tutkimuksena. Aineisto kerättiin sähköisellä Webropl- kyselylomakkeella syksyllä 2016. Kyselylomake sisälsi taustatietojen lisäksi avoimia kysymyksiä. Kysely toteutettiin anonyymisti ja siihen vastaaminen oli vapaaehtoista. Kerätty aineisto analysoitiin induktiivisellä sisällönanalyysillä. Tutkimuksessa kävi ilmi, että menettely koetaan perheiden kannalta hyväksi palveluksi. Se on kuitenkin lisännyt terveydenhoitajien työmäärää ennakoitua enemmän. Työtehtävä koetaan vastuulliseksi ja sen hoitaminen vaatii huolellisuutta ja itsenäistä päätöksentekoa. Koulutus ja perehdytys tehtävään eivät ole aina toteutuneet tarpeiden mukaisesti. Terveydenhoitajat arvioivat uuden käytännön vaikutukset isien asiakkuuteen neuvolassa vähäisiksi. Tehtävänlisäys ilman huomiointia palkkauksessa koetaan epäoikeudenmukaisena. Terveydenhoitajat toivovat lisäkoulutusta yhdessä lastenvalvojien kanssa. Koulutukselta toivotaan avointa keskustelua, kokemuksien jakamista ja käytännön esimerkkejä. Yhteisöllinen koulutus olisi tärkeää työn kehittämisen kannalta. Asiasanat: isyyden tunnustaminen, isyys, äitiysneuvola, terveydenhoitaja.Hartikainen, Mari & Hedman, Päivi. Acceptance of the acknowledgement of paternity in maternity clinic as a part of Public Health Nurses’ work. 60 p., 2 appendices. Language: Finnish. Helsinki, Spring 2017. Diaconia University of Applied Sciences. Option in Health Care. Degree: Public Health Nurse. The purpose of this study was to find out how the modernization of the paternity law in Finland 1.1.2016 has affected the job description of public health nurses in maternity clinics. After the amendment the public health nurse can accept the acknowledgement of paternity in those cases where determination can be considered reliable. The aim of this study was to research the public health nurses’ experience of the assignment. The aim was to find out whether performing the task has proceeded as anticipated, whether the training and preparation was adequate, and whether the new policy from the perspective of nurses contributed to fathers’ customership at maternity clinics. The target group of the study were the public health nurses at the maternity clinics in Helsinki and Espoo. This research involved qualitative methods. The research data was collected by using the Webropol program in autumn 2016. The questionnaire contained background information and open questions. The questionnaire survey was carried out anonymously and replying to it was voluntary. The data was analyzed by inductive content analysis. The investigation revealed that the procedure is perceived as good service for families. However, it has increased the workload of public health nurses more than expected. The task is considered as responsible and it requires accuracy and asks independent decision-making. Training and familiarization for the new task was not always achieved as needed. The public health nurses estimated that, the effect of the new practice on the fathers’ customership at marernity clinics is minimal. The added task without taking salaries into account is considered as unfair. Public Health Nurses wish additional training together with Child Welfare Supervisors. It could contain open discussion, sharing of experiences and practical examples. Collective learning would be important in terms of work development. Keywords: Acknowledgement of paternity, paternity, fatherhood, maternity clinic, public health nurse

Multiple sclerosis in Finland 2018-Data from the national register

Objectives Finland is a high-risk multiple sclerosis (MS) region, but a national MS register has not existed until 2014. In this paper, we present the Finnish MS register variables and data collected by 31 December 2018. Materials and Methods Numbers and data counts of MS patients in the register (ICD-10 code G35) are presented. The disease types and proportion of patients receiving disease-modifying treatments (DMTs) were analysed in five hospital districts with most complete data sets. MS prevalence in Finland was estimated using administrative hospital discharge data as an additional resource. Results There were a total of 8722 MS patients in the Finnish MS register by 31 December 2018 (71.5% females). Mean age at MS diagnosis was 38.7 years and peak prevalence was at age 50-54 years. Disease course was relapsing remitting (RRMS) in 66.7%, secondary progressive (SPMS) in 13.5%, and primary progressive (PPMS) in 7.9% of the 5365 MS patients in the selected districts with most complete data. A total of 66.0% of RRMS patients, 19.6% of SPMS patients and 9.9% of PPMS patients were receiving DMTs. By combining MS register data with databases of those hospitals that had not joined the register, the nationwide prevalence estimate was between 10 and 11 thousand patients (corresponding to crude prevalence 180-200/100 000). Conclusions The Finnish MS register is currently used in 15/21 Finnish hospital districts. By register integration into the electronic patient files, the coverage of the register has increased to approximately 80% of the estimated Finnish MS population.Peer reviewe

Inadequate oral anticoagulation with warfarin in women with cerebrovascular event and history of atrial fibrillation: the FibStroke study

Background: Women with atrial fibrillation (AF) may be treated less actively with oral anticoagulation (OAC) than men.Patients and methods: We assessed sex differences in the implementation of stroke risk stratification with CHADS(2) and CHA(2)DS(2)-VASc scores and reasons not to use OAC in 1747 AF patients suffering their first cerebrovascular event after the AF diagnosis.Results: Women were older and had more often a high stroke risk (CHADS(2)/CHA(2)DS(2)-VASc >= 2) than men (p = 2 (p < .001). Conversely, 34.8% of men and 17.5% of women on OAC had a low or moderate risk (CHADS(2)/CHA(2)DS(2)-VASc 0-1, p < .001). A valid reason to omit OAC was reported in 38.6% of patients and less often in women (p < .001).Conclusions: OAC was underused in high-risk AF patients, particularly women, but prescribed often in men with low or moderate stroke risk. Reasons for omitting OAC treatment were poorly reported, particularly for women

Quality of the ryegrass and lettuce yields as affected by selenium fertilization

The effect of Se-fertilization on the chemical composition and anti-oxidative properties of ryegrass and lettuce was studied in a pot experiment. The addition of Se enhanced its relative incorporation in soluble and insoluble proteins and diminished it in free amino acids. It also affected the anti-oxidative systems of the plants. The glutathione peroxidase (GSH-Px) activity found in both plant species increased with increasing Se-fertilization, whereas the superoxide dismutase (SOD) activity as well as the concentration of vitamin E decreased. This may indicate that the synthesis of SOD and vitamin E was reduced because the requirement of these anti-oxidants was diminished by antioxidative function of Se

Usefulness of the CHA2DS2-VASc and HAS-BLED Scores in Predicting the Risk of Stroke Versus Intracranial Bleeding in Patients With Atrial Fibrillation (from the FibStroke Study)

CHA2DS2-VASc and HAS-BLED scores stratify the risk of thromboembolic and bleeding events respectively in patients with atrial fibrillation. There is only little information on how they differentiate which of the 2 clinically most important complications (ischemic stroke [IS] or an intracranial bleeding [IB]) the patient is more prone to suffer.We evaluated both scores in patients with either of these major complications. The FibStroke Study collected data on all patients with atrial fibrillation with either an IS or an IB event between 2003and 2012 in 4 Finnish hospital districts. Individual electronic patient records were manually reviewed to collect the study data. To assess the relative risk of IS and IB, an IS/IBratio was calculated by dividing the absolute number of ISs with the absolute number of IBs within each score category. A total of 3,816 (82.7%) ISs and 798 (17.3%) IBs were detected in 3,909 patients. In general, ISs occurred more often than IBs in patients on oral anticoagulation in each score category (ratio 1.6 to 5.1). The ratio decreased below 1, however,only with very high HAS-BLED scores (>4). Moreover, 221 ISs and 53 IBs occurred in patients with HAS-BLED > CHA2DS2-VASc, of whom only 19.7% were on anticoagulation. In conclusion, IS was the predominant intracranial event irrespective of CHA2DS2-VASc score, HAS-BLED score ≤4, or use of oral anticoagulation, also in patients with low estimated thromboembolic risk (CHA2DS2-VASc 0 to 1). Furthermore, the HAS-BLED score predicted the excess of IBs over ISs only at very high-risk levels.</p

Psychiatric disorders are a common prognostic marker for worse outcome in patients with idiopathic intracranial hypertension

Objective Idiopathic intracranial hypertension (IIH) is aetiologically unknown disorder that associates with endocrinological disturbances, including dysfunction of hypothalamic-pituitary-adrenal-axis. Neuroendocrinological dysfunctions have also been characterized in psychiatric disorders, and therefore we investigated the presence of psychiatric disorders of patients with IIH in a well-defined cohort. Patients and Methods A total of 51 patients with IIH were included. Patient demographics, symptoms, imaging data, ophthalmological and clinical findings were collected. Results At the time of diagnosis the mean age was 32.5years (SD 10.7), the body mass index was 37.1 kg/m2 (SD 7.4), and the opening pressure 29.1 mmHg (SD 6.2). A total of 88.2% of patients were female and 45.1% were diagnosed with a psychiatric co-morbidity prior to IIH diagnosis. The mean follow-up time was 4.4 years (SD 5.4). The overall treatment outcome was significantly poorer on a group of patients with psychiatric diagnosis when compared to individuals without such history (p = 0.001), but there were no differences in the resolution of papilledema (p = 0.405). Patients with IIH and psychiatric disorders had more often empty sella on their imaging at diagnosis when compared to patients without psychiatric co-morbidity (p = 0.044). Conclusion Psychiatric disorders are highly prevalent in patients with IIH and associate with worse subjective outcomes. These findings advocate for monitoring the mental health of patients with IIH and warrant further multidisciplinary research to understand the potentially underlying psychosocial and neuroendocrinological mechanisms.Peer reviewe

Real-world treatment outcomes and safety of natalizumab in Finnish multiple sclerosis patients

Objectives: The primary objective was to evaluate long-term treatment persistence and safety of natalizumab in Finnish multiple sclerosis patients. The secondary objectives were to assess patient characteristics, use of natalizumab-related safety protocol, and treatment persistence in patients with different anti-John Cunningham virus antibody statuses (John Cunningham virus status). Materials & Methods: All adult multiple sclerosis patients in the Finnish multiple sclerosis register who started natalizumab between 1/2006 and 12/2018 were included in this study and followed retrospectively until treatment discontinuation or end of follow-up (12/2019). Results: In total, 850 patients were included. Median duration of natalizumab treatment was 7.8 years in John Cunningham virus negative (n = 229) and 2.1 years in John Cunningham virus positive patients (n = 115; p < 0.001). The most common cause for treatment discontinuation was John Cunningham virus positivity. After natalizumab discontinuation, patients who had a washout duration of less than 6 weeks had fewer relapses during the first 6 months (p = 0.012) and 12 months (p = 0.005) compared with patients who had a washout duration of over 6 weeks. During the median follow-up of 3.6 years, 76% of patients remained stable or improved on their Expanded Disability Status Scale. Conclusions: Treatment persistence was very high among John Cunningham virus negative patients. The study supports long-term effectiveness of natalizumab and a washout duration of less than 6 weeks after discontinuation.Peer reviewe

Cerebrospinal Fluid TDP-43 in Frontotemporal Lobar Degeneration and Amyotrophic Lateral Sclerosis Patients with and without the C9ORF72 Hexanucleotide Expansion

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Case-control analysis of truncating mutations in DNA damage response genes connects TEX15 and FANCD2 with hereditary breast cancer susceptibility

Several known breast cancer susceptibility genes encode proteins involved in DNA damage response (DDR) and are characterized by rare loss-of-function mutations. However, these explain less than half of the familial cases. To identify novel susceptibility factors, 39 rare truncating mutations, identified in 189 Northern Finnish hereditary breast cancer patients in parallel sequencing of 796 DDR genes, were studied for disease association. Mutation screening was performed for Northern Finnish breast cancer cases (n = 578-1565) and controls (n = 337-1228). Mutations showing potential cancer association were analyzed in additional Finnish cohorts.c.7253dupT in TEX15, encoding a DDR factor important in meiosis, associated with hereditary breast cancer (p = 0.018) and likely represents a Northern Finnish founder mutation. A deleterious c.2715 + 1G > A mutation in the Fanconi anemia gene, FANCD2, was over two times more common in the combined Finnish hereditary cohort compared to controls. A deletion (c.640_644del5) in RNF168, causative for recessive RIDDLE syndrome, had high prevalence in majority of the analyzed cohorts, but did not associate with breast cancer. In conclusion, truncating variants in TEX15 and FANCD2 are potential breast cancer risk factors, warranting further investigations in other populations. Furthermore, high frequency of RNF168 c.640_644del5 indicates the need for its testing in Finnish patients with RIDDLE syndrome symptoms.Peer reviewe