Prediction of Gestational Diabetes and Hypertensive Pregnancy by serum Leptin, C-Reactive Protein, Aspartate Transaminase levels, and Resting Heart Rate

Hypertensive pregnancy including pregnancy-induced hypertension (PIH), preeclampsia (PE) and gestational diabetes (GDM) are common adverse outcomes related to insulin resistance in pregnancy. Objective: To find out, whether factors related to insulin resistance leptin, high-sensitivity C-reactive protein (hs-CRP), aspartate transaminase (AST) and resting heart rate (RHR) could predict hypertensive pregnancy and GDM later in woman´s life. Material and methods: In this nested case-control study the data was obtained from The Cardiovascular Risk in Young Finns Study and The Medical Birth Register of Finland. Altogether, 1257 women, aged 24-39 years, were included in this study. They gave blood samples and arranged to measurement of RHR in 2001. Of these 1257 women 511 later became pregnant. Follow-up time was 14 years up to November 2015. Women who were pregnant at the moment of the blood sampling were excluded initially. The final research material consisted of 293 women, of whom 71 developed GDM, 21 PIH, 6 PE and 201 were controls, who experienced normal pregnancy. Six women had a pregnancy with GDM and PIH. Results: Serum leptin levels were higher in women who developed gestational diabetes or hypertensive pregnancy later on: serum leptin 16,4 ng/ml (IQR: 10,2-24,2), 16,4 ng/ml (IQR: 11,2-24) respectively compared to control women 11,5 ng/ml (IQR: 7,5-15,4), p<0.0001 and 0,0002). After matching for BMI, difference remained significant in GDM group (p=0,0081) yet not in PIH/PE group (p=0,89). OR of GDM in upper leptin quartile compared to rest of quatiles was 3,05 (95%Cl: 1,60-5,80). In other markers (hs-CRP, AST and RHR) there were no statistically significant differences between control and PIH/PE or GDM group in BMI-matched, and unmatched models Conclusion: High serum leptin levels predicted gestational diabetes independent of BMI. Elevated leptin levels were also associated with hypertensive pregnancies, however, the association vanished after adjusting for BMI. Hs-CRP, AST nor resting heart rate did not associate with development of hypertensive pregnancy or GDM.Raskausdiabetes, pre-eklampsia ja raskauden aikainen verenpaineen nousu ovat yleisiä raskauteen liittyviä komplikaatioita, joilla on vaikutusta synnyttävän äidin sekä syntyneen sikiön sairastuvuuteen sekä myöhemmällä iällä, että diagnoosivaiheessa. Tutkimuksen tarkoituksena oli vertailla seerumin leptiinin, herkän C-reaktiivisen proteiinin (hs-CRP), aspartaatti transaminaasin (ASAT) ja leposykkeen eroja ennen raskauksia ja vertailla näitä terveisiin, normaalin raskauden läpikäyneisiin kyseisten muuttujien osalta. Tämän tutkimuksen aineisto kerättiin lasten sepelvaltimotaudin riskitekijät -tutkimuksesta ja syntyneiden lasten rekisteristä. Yhteensä tässä tutkimuksessa oli 511 naista, joista otettiin näytteitä vuonna 2001, ja jotka myöhemmin tulivat raskaaksi. Seuranta-aika oli 14 vuotta. Poissulkukriteereiden jälkeen tarkasteltavaksi jäi 71 raskausdiabetekseen, 21 raskauden aikaiseen verenpaineen nousuun ja pre-eklampsiaan sairastunutta. 201 oli normaalin raskauden läpikäyneitä kontrolleja. Leptiinitasot olivat tilastollisesti korkeammat naisilla, jotka myöhemmin kehittivät raskausdiabeteksen 16,4 ng/ml (IQR: 10,2-24,2) (p<0,0001) tai hypertensiivisen raskauden 16,4 ng/ml (IQR: 11,2-24) (p=0,0002) (pre-eklampsia tai raskauden aikainen verepaineen nousu) verrattuna kontrolliiryhmään 11,5 ng/ml (IQR: 7,5-15,4). Tilastollinen merkittävyys säilyi raskausdiabeteksen osalta painoindeksikaltaistamisen jälkeen. Ylimmässä leptiinikvartaalissa OR (”odds ratio”) raskausdiabeteksen suhteen oli 3,05 (95%Cl: 1,60-5,80), kun sitä verrattiin kaikkiin muihin kolmeen alimpaan kvartaaliin. Tertiilien suhteen vastaava OR oli 2,38 (95%Cl: 1,31-4,31). Hs-CRP, ASAT ja leposyke ei ollut yhteydessä myöhempään raskausdiabetekseen tai hypertensiiviseen raskauteen. Tulosten perusteella korkea seerumin leptiinipitoisuus on yhteydessä myöhempään raskausdiabetekseen BMI-riippumattomasti. Korkea leptiinipitoisuus liittyy myös myöhempään hypertensiiviseen raskauteen, kun BMI:tä ei oteta huomioon. Seerumin leptiinikonsentraation mittaamisesta voi olla hyötyä raskausdiabeteksen riskiryhmään kuuluvien naisten määrittämisessä

Improving efficiency in surgical services a production planning and control approach

The pressure to improve health while spending less money has forced healthcare organizations to find new ways of arranging their services. Healthcare organizations have widely discussed the needs of both evidence-based medicine and evidence-based management. Surgical operating units are cost-intensive, multi-professional parts of health-service production. Managing operating units efficiently is essential when hospitals and healthcare systems aim to maximize health outcomes with limited resources. The research questions this study addresses explore the phenomenon of efficiency and its improvement in operating units. The main objective is to define the features of production planning and control that maximize efficiency. Based on a literature, several strategic and operative variables could promote high efficiency. However, performance measures recently applied to operating units fail to include all relevant phenomena that affect their total efficiency. The study developed economic and technical efficiency measures that include relevant aspects when measuring operating units' output and input. We tested the measure in single-case settings. After that, we tested, in a multi-hospital study that included 26 units, 12 hypotheses that propose connections between the use of strategic and operative practices and efficiency. The study's results indicate that personnel incentive systems, especially for surgeons, and personnel flexibility improve efficiency most significantly. Units' size does not affect their performance. In general, the study reveals that operative practices, such as personnel management, case scheduling and performance measurement, affect efficiency more remarkably than do strategic decisions that relate to, e.g., units' size, scope or academic status. We also found that units with different strategic positions should apply different operative practices. Focused hospital units benefit most from hard-based practices such as sophisticated case scheduling, parallel processing and performance measurement; whereas central and ambulatory units with a wide range of services and specialties should apply soft-based initiatives, such as flexible working hours, incentives and multi-skilled personnel. This study highlights staffing issues' role in improving operating units' efficiency

Perspectives of mass customisation and modularisation in health service delivery : a scoping review

Mass customisation and modularisation are considered means to enhance patient-centredness and control increasing healthcare expenditures. The purpose of this study is to identify existing knowledge regarding the application of mass customisation and modularisation in healthcare delivery while focusing specifically on outcomes. A scoping review was conducted with various combinations of search terms using Scopus. Nearly 2,000 studies were identified of which 18 met inclusion criteria. Patient experience, customisation, and the economic impact on service delivery were analysed. Mass customisation and modularisation may be applicable in healthcare. The model may increase patient satisfaction. However, more knowledge of the outcomes of mass customisation is needed. As the number of studies in this area is limited, more empirical mixed methods research on the implementation and outcomes of mass customisation is needed to understand the expected benefits and to determine the possible effects on patient satisfaction and financial implications.Peer reviewe

International benchmarking of tertiary trauma centers: productivity and throughput approach

<p>Abstract</p> <p>Background</p> <p>Care process in tertiary trauma centers consists of a chain of care phases in different departments from the emergency department (ED) to post-operative rehabilitation. The historical evolution of healthcare systems and organizations has led to variations in trauma patient processes in different countries. The present study is aimed at revealing differences in the throughput and productivity of trauma patient processes between German (UKB) and Finnish (HUS) tertiary trauma centers. Problems related to the comparison of different healthcare systems were also identified. The share of patients discharged was used as a control measure.</p> <p>Results</p> <p>The biggest differences between the hospitals were found in the use of resources in the ED and in post-operative care. Despite problems in defining comparable patients and resources, ED productivity was significantly higher in UKB. Post-operative care was, on average, 41% shorter in HUS. However, the share of patients discharged was significantly higher in UKB (96.5% vs. 68.9%). Differences were also found in the pre-operative length of stay of patients with proximal femoral fractures (UKB: 0.97 days, HUS: 1.57 days). The productivity of the operating unit was quite similar in the hospitals. In terms of ED mortality, no statistically significant differences were found.</p> <p>Conclusions</p> <p>The results of the present study showed significant differences in the use of resources and throughput times in trauma patient processes between Finnish and German hospitals. However, due to system-level differences between German and Finnish healthcare, the results cannot be directly transformed into development proposals for the organizations. On the other hand, in spite of certain differences regarding the healthcare systems, the demographic data of the trauma patients and medical procedures are comparable. Based on the present study, the ED process of severe trauma, pre-operative care, and operating unit processes were the most comparable parts of trauma care between the hospitals. The study also showed that the international benchmarking approach could be used to reveal bottlenecks in system-level policies and practices.</p

Preconceptual leptin levels in gestational diabetes and hypertensive pregnancy

Pregnancy - induced hypertension (PIH), preeclampsia (PE), and gestational diabetes (GDM) are common adverse outcomes in pregnancy. Objective To find out whether preconceptual leptin levels differ in subsequent pregnancy between control vs. GDM and hypertensive pregnancy groups. Materials and Methods Data was from The Cardiovascular Risk in Young Finns Study and The Medical Birth Register of Finland. Of 293 subjects 71 developed GDM, 27 PIH/PE and 201 were controls. Results Leptin was higher in GDM (p Conclusion Leptin was higher in GDM (p < 0.0001) and PIH/PE (p = 0.0002) groups compared to control. GDM group was robust to BMI matching (p = 0,0081).</p

Facilitating autonomous, confident and satisfying choices : a mixed-method study of women's choice-making in prenatal screening for common aneuploidies

Background: Population-based prenatal screening has become a common and widely available obstetrical practice in majority of developed countries. Under the patient autonomy principle, women should understand the screening options, be able to take their personal preferences and situations into account, and be encouraged to make autonomous and intentional decisions. The majority of the current research focuses on the prenatal screening uptake rate, women's choice on screening tests, and the influential factors. However, little attention has been paid to women's choice-making processes and experiences in prenatal screening and their influences on choice satisfaction. Understanding women's choice-making processes and experiences in pregnancy and childbirth is the prerequisite for designing women-centered choice aids and delivering women-centered maternity care. This paper presents a pilot study that aims to investigate women's experiences when they make choices for screening tests, quantify the choice making experience, and identify the experiential factors that affect women's satisfaction on choices they made. Method: We conducted a mixed-method research at Helsinki and Uusimaa Hospital District (HUS) in Finland. First, the women's choice-making experiences were explored by semi-structured interviews. We interviewed 28 women who participated in prenatal screening. The interview data was processed by thematic analysis. Then, a cross-sectional self-completion survey was designed and implemented, assessing women's experiences in choice-making and identifying the experiential factors that influence choice satisfaction. Of 940 distributed questionnaires, 185 responses were received. Multivariable linear regression analysis was used to detect the effects of the variables. Results: We developed a set of measurements for women's choice-making experiences in prenatal screening with seven variables: activeness, informedness, confidence, social pressure, difficulty, positive emotion and negative emotion. Regression revealed that activeness in choice-making (beta = 0.176; p = 0.023), confidence in choice-making (beta = 0.388; p <0.001), perceived social pressure (beta = -0.306; p <0.001) and perceived difficulty (beta = -0.274; p <0.001) significantly influenced women's choice satisfaction in prenatal screening. Conclusions: This study explores the experiential dimension of women's choice-making in prenatal screening. Our result will be useful for service providers to design women-centered choice environment. Women's willingness and capabilities of making active choices, their preferences, and social reliance should be well considered in order to facilitate autonomous, confident and satisfying choices.Peer reviewe

Comparing modular and personal service delivery in specialised outpatient care : A survey of haematology and oncology patient preferences

Background Oncology and haematology are shifting from inpatient to outpatient care, requiring new care delivery models. This study compares preferences of oncology patients treated by named nurses in a traditional specialty-focused day hospital and haematology patients treated without named nurses in a modularised day hospital. Methods Questionnaires to explore patient preferences on number of treating nurses and named nurses, and satisfaction in day hospital care were distributed to 300 haematology and 410 oncology patients. Binomial logistic regressions were performed to study how background variables influenced preferences for having (i) a named nurse or (ii) maximum three treating nurses in the day hospital. Results In 2016, 156 (52%) haematology and 289 (70%) oncology surveys were completed and returned. Both groups were satisfied with day hospital care. Haematology patients preferred named nurses less often than oncology patients (odds ratio (OR) = 0.09, p <0.0005). Haematology patients were less likely to prefer a maximum of three treating nurses (OR = 0.12, p <0.0005). Conclusion This study suggests that patients can be satisfied with outpatient care with or without named nurses. However, as several factors affect patient satisfaction and experience, more in-depth research is needed to understand how modularisation and patient preferences may be linked.Peer reviewe

Kannettava keräilylaite lisää laatua ja tehokkuutta lääkkeiden jakeluun sairaala-apteekissa

Johdanto Sairaala-apteekin lääkejakelu on perinteisesti ollut työvoimaintensiivistä. Lääkejakelun virheet saattavat vaarantaa potilasturvallisuutta ja sairaalan lääkitysturvallisuutta. Kannettavia keräilylaitteita on kokeiltu Suomessa ja maailmalla hyvin tuloksin lääkelogistisissa työtehtävissä. Aineisto ja menetelmät Tutkimuksessa mitattiin lääketilauksien keräilyn ohjaamista kannettavalle keräilylaitteelle ja tämän menetelmän vaikutusta keräilynopeuteen ja -tarkkuuteen. Tässä osiossa mitattiin ensin lääkkeiden tarkistus- ja keräilyaika kerättäessä lääkkeet perinteisesti paperista keräilylistaa apuna käyttäen. Seuraavaksi mitattiin lääketilauksen keräilyn läpimenoaika, kun lääketilauksien keräilylistat ohjattiin sähköisesti suoraan kannettavalle keräilylaitteelle. Nämä mittaukset toteutettiin sekä kellottamalla manuaalisesti että analysoimalla kannettavien keräilylaitteiden ohjelmiston rekisteröimiä aikaleimoja. Toinen osio käsitteli kannettavien keräilylaitteiden käyttöönoton vaikutusta lääkkeiden vastaanottoprosessissa HUS Apteekki Helsingin lääketoimituksessa. Tutkimuksessa mitattiin, kuinka nopeasti lääkkeet pystyttiin vastaanottamaan perinteisellä tavalla vastaanotettuina, ja käyttämällä lääkkeiden tunnistuksessa apuna kannettavia keräilylaitteita lääkkeiden vastaanotossa. Mittaukset toteutettiin kellottamalla manuaalisesti eri työvaiheiden läpimenoaikoja. Lisäksi analysoitiin kannettavien keräilylaitteiden ohjelmiston rekisteröimiä aikaleimoja. Tulokset kerättiin taulukoiksi, jotka analysoitiin Microsoft Excel -ohjelmiston avulla. Tulokset ja johtopäätökset Kannettavien keräilylaitteiden käyttöönotto vähensi keräilyvirheiden määrää ja paransi keräilytoiminnan tehokkuutta. Farmaseuttityövoimaa voidaan siirtää farmaseuttista arvoa lisääviin työtehtäviin, kuten kliiniseen osastofarmasiaan, vaarantamatta potilasturvallisuutta. Sekä lääketoimitusten keräilyn että lääkkeiden tavaravastaanoton nopeus paranivat käyttämällä työssä kannettavia keräilylaitteita. HUS Apteekki on laajentanut kannettavien keräilylaitteiden käyttöä kaikkiin toimipaikkoihinsa.Peer reviewe

A Magyar Tudományos Akadémia Meteorológiai Tudományos Bizottságának állásfoglalása éghajlatunk jövőjéről

Short-form of the State Scale of the Spielberger State-Trait Anxiety Inventory. (PDF 15 kb

Maakuntien ja kuntien yhteistyö ikääntyneiden ja erityisryhmien asumisessa ja asumispalveluissa

Maakuntien ja kuntien välinen yhteistyö tulee olemaan tärkeää ikääntyneiden ja erityisryhmiin kuuluvien ihmisten asumiseen liittyvissä kysymyksissä, sillä vastuu asumisesta ja asumispalveluista hajautuu eri tahoille sosiaali- ja terveyspalvelujen siirtyessä maakuntien järjestettäväksi. Kuntien toteuttamat asumi-sen ja yhdyskuntasuunnittelun tehtävät, sekä hyvinvoinnin ja terveyden edistäminen ovat ratkaisevassa asemassa kotona asumisen tukemisessa sekä erilaisten tulevaisuuden asumismuotojen kehittämisessä. Selvitystyön tavoitteena oli tehdä ehdotuksia siitä, millaisia yhteistyömalleja maakuntien ja kuntien välille tulisi luoda. Ehdotusten muodostamiseksi kerättiin tietoja kyselyllä ja haastatteluilla nykyisestä yhteis-työstä ja yhteistyötarpeista kunnissa ja valituissa kuntayhtymissä sekä tehtiin kirjallisuuskatsaus ulko-maisten esimerkkien kartoittamiseksi. Tulevaisuuden yhteistyömalleja ideoitiin lisäksi eri hallinnonalojen asiantuntijoiden yhteisissä työpajoissa. Selvitystyön pohjalta muodostettiin yksitoista ehdotusta yhteistyölle. Tärkeimmiksi yhteistyön kehittämis-alueiksi tunnistettiin maakunnan ja kuntien yhteisen strategisen suunnittelun mahdollistavat yhteistyöra-kenteet sekä asumisessa että palveluissa, tarvelähtöinen ja tietoon pohjautuva palveluverkon suunnittelu sekä asiakastason yhteistyöprosessit asumisen ja asumisen tuen järjestämisessä. Valmiita maakunnan ja kuntien välisiä yhteistyömalleja on toistaiseksi vähän, mutta kuntien käyttämiä poikkihallinnollisen yh-teistyön toimintatapoja voidaan hyödyntää maakunnan laajuisen yhteistyön organisoinniss