Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD) : a randomized controlled trial

Introduction We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. Research design and methods 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. Results 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. Conclusion There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk.Peer reviewe

The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes

Background Between March 18(th) and May 13(th) 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown. Methods In this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy. Results In our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1-2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3-0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6-4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps. Conclusions The glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.Peer reviewe

First year on commercial hybrid closed-loop system - experience on 111 children and adolescents with type 1 diabetes

Objective The hybrid close-loop system (HCL) is a rapidly emerging treatment method for type 1 diabetes (T1D), but the long-term effectiveness of the system remains unclear. This study investigates the influence of the HCL on glycemic control in children and adolescents with T1D in a real-life setting during the first year on HCL. Research design and methods This retrospective study included all the patients (n = 111) aged 3 to 16 years with T1D who initiated the HCL system between 1st of December 2018 and 1st of December 2019 in the Helsinki University Hospital. Time in range (TIR), HbA1c, mean sensor glucose (SG) value, time below range (TBR), and SG coefficient of variance (CV) were measured at 0, 1, 3, 6, and 12 month. The changes over time were analyzed with a repeated mixed model adjusted with baseline glycemic control. Results After the initiation of HCL, all measures of glycemic control, except HbA1c, improved and the effect lasted throughout the study period. Between 0 and 12 month, TIR increased (beta = -2.5 [95%CI: -3.6 - (-1.3)], p < 0.001), whereas mean SG values (beta = -0.7 [95%CI: -0.9 - (-0.4)]), TBR (beta = -2.5 [95%CI: -3.6 - (-1.3)]), and SG CV (beta = -4.5 [95%CI: -6.3 - [-2.8]) decreased significantly (p < 0.001). Importantly, the changes occurred regardless of the age of the patient. Conclusions Measurements of glycemic control, except HbA1c, improved significantly after the initiation of the HCL system and the favorable effect lasted throughout the follow-up. These results support the view that HCL is an efficacious treatment modality for children and adolescents with T1D of all ages.Peer reviewe

Lapsen diabeettinen ketoasidoosi

English summar

Suositus kuvankatselunäytöille ja niiden laadunvalvontaan

Kansainvälisiin suosituksiin perustuva opas kuvankatselumonitorien suositelluista ominaisuuksista ja niiden laadunvalvonnasta

GDNF Overexpression from the Native Locus Reveals its Role in the Nigrostriatal Dopaminergic System Function

Peer reviewe

Common Inflammation-Related Candidate Gene Variants and Acute Kidney Injury in 2647 Critically Ill Finnish Patients

Acute kidney injury (AKI) is a syndrome with high incidence among the critically ill. Because the clinical variables and currently used biomarkers have failed to predict the individual susceptibility to AKI, candidate gene variants for the trait have been studied. Studies about genetic predisposition to AKI have been mainly underpowered and of moderate quality. We report the association study of 27 genetic variants in a cohort of Finnish critically ill patients, focusing on the replication of associations detected with variants in genes related to inflammation, cell survival, or circulation. In this prospective, observational Finnish Acute Kidney Injury (FINNAKI) study, 2647 patients without chronic kidney disease were genotyped. We defined AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We compared severe AKI (Stages 2 and 3, n = 625) to controls (Stage 0, n = 1582). For genotyping we used iPLEX(TM) Assay (Agena Bioscience). We performed the association analyses with PLINK software, using an additive genetic model in logistic regression. Despite the numerous, although contradictory, studies about association between polymorphisms rs1800629 in TNFA and rs1800896 in IL10 and AKI, we found no association (odds ratios 1.06 (95% CI 0.89-1.28, p = 0.51) and 0.92 (95% CI 0.80-1.05, p = 0.20), respectively). Adjusting for confounders did not change the results. To conclude, we could not confirm the associations reported in previous studies in a cohort of critically ill patients.Peer reviewe

Heme oxygenase-1 repeat polymorphism in septic acute kidney injury

Acute kidney injury (AKI) is a syndrome that frequently affects the critically ill. Recently, an increased number of dinucleotide repeats in the HMOX1 gene were reported to associate with development of AKI in cardiac surgery. We aimed to test the replicability of this finding in a Finnish cohort of critically ill septic patients. This multicenter study was part of the national FINNAKI study. We genotyped 300 patients with severe AKI (KDIGO 2 or 3) and 353 controls without AKI (KDIGO 0) for the guanine-thymine (GTn) repeat in the promoter region of the HMOX1 gene. The allele calling was based on the number of repeats, the cut off being 27 repeats in the S-L (short to long) classification, and 27 and 34 repeats for the S-M-L2 (short to medium to very long) classification. The plasma concentrations of heme oxygenase-1 (HO-1) enzyme were measured on admission. The allele distribution in our patients was similar to that published previously, with peaks at 23 and 30 repeats. The S-allele increases AKI risk. An adjusted OR was 1.30 for each S-allele in an additive genetic model (95% CI 1.01-1.66; p = 0.041). Alleles with a repeat number greater than 34 were significantly associated with lower HO-1 concentration (p<0.001). In septic patients, we report an association between a short repeat in HMOX1 and AKI risk

Valokuvan käyttö kriisityön tukena

Perinteinen kriisityö on asiakkaan kuuntelua ja tämän kanssa keskustelua senhetkisessä kriisitilanteessa. Kriisityön tavoitteena on auttaa asiakasta pääsemään tilanteesta yli ja jatkamaan ‎elämäänsä siten, että kriisi jää osaksi elämänhistoriaa, mutta ei enää vaikuta jokapäiväiseen ‎elämään. Tämän opinnäytetyön tarkoituksena on selvittää, miten valokuvaa voidaan käyttää ‎kriisityön tukena ja apuna keskustelun ohella. ‎ Opinnäytetyön työelämätilaajana toimii Lahden Seudun Kriisikeskus, jossa käytettään voimavara- ‎ja ratkaisukeskeisiä työmenetelmiä ja tilanteeseen kulloinkin soveltuvia toiminnallisia menetelmiä. ‎Lahden Seudun Kriisikeskuksen työntekijät toivoivat itselleen tietoa valokuvan käytöstä ja ‎työmenetelmää työskentelynsä tueksi, jossa apuna käytetään symbolisia valokuvia. ‎ Valokuvaa on käytetty erityisesti terapiatyöskentelyssä ja uusin valokuvan terapeuttista voimaa ‎hyödyntävä työmenetelmä on Miina Savolaisen kehittämä Voimauttava valokuva. Olemme tähän ‎opinnäytetyöhön keränneet ja koonneet teoriatietoa edellä mainituista aihealueista ja perehtyneet ‎myös siihen, mitä valokuva merkitsee ihmisten elämässä. Tämän teoriatiedon pohjalta ja sitä ‎apuna käyttäen olemme luoneet Lahden Seudun Kriisikeskuksen työntekijöille opuksen, jossa ‎kerromme valokuvasta ja sen käytöstä. Lisäksi työstimme heille työskentelyrungon, joka helpottaa ‎kuvien käyttöä asiakastilanteessa. Olemme ottaneet myös erilaisia symbolisia valokuvia, joita ‎työmme tilaaja voi hyödyntää asiakasprosessin eri vaiheissa. Opinnäytetyö on siis luonteeltaan ‎toiminnallinen.‎ Opinnäytetyömme teoreettiseen viitekehykseen kuuluvat myös käsitteet parisuhde sekä roolit ja ‎vallankäyttö parisuhteessa. Nämä käsitteet ovat keskeisiä tässä työssä, sillä valokuvia ja opusta on ‎tarkoitus käyttää ja hyödyntää ensisijaisesti parisuhdekriisien kanssa työskenneltäessä. ‎Teoreettiseen viitekehykseen tässä opinnäytetyössä kuuluvat luonnollisesti myös erilaiset kriisit, ‎kriisityö ja kriisikeskusten toiminta. Näin saimme selkiytettyä sitä, minkälaisessa työssä ja ‎minkälaisissa tilanteissa luomaamme materiaalia on tarkoitus käyttää. ‎ Opinnäytetyömme tavoitteena oli luoda kriisikeskuksen työntekijöitä parhaalla mahdollisella ‎tavalla hyödyttävä työmenetelmä. Emme tämän opinnäytetyöprosessin aikana ole tutkineet ja ‎selvittäneet sitä, kuinka luomamme työmenetelmä on toiminut käytässä tai onko siitä ollut apua ‎työntekijöille ja ennen kaikkea asiakkaille. Tämän asian selvittäminen olisikin oiva aihe jonkun ‎opiskelijan opinnäytetyölle tulevaisuudessa. ‎Use of photographs to support crisis work Traditional crisis work consists of listening to and discussing with the client about his current ‎situation. The purpose of crisis work is to help the client to overcome the situation and move on ‎with his life. The purpose of this thesis was to find out how a photo could be used as a support and ‎assistance to a conversation.‎ The study was commissioned by the crisis center of Lahti, in which they use resource- and solution- ‎oriented work methods and other functional methods. The employees of the crisis centre hoped ‎for themselves a new work method about photo and knowledge for how it can be used in support ‎of their work. This thesis is a functional.‎ A photo has been used especially in therapy work but the newest form that utilizes the therapeutic ‎force of photo is Miina Savolainen`s developed work method called The empowering photography. ‎The theoretical part of the study consists of the above-mentioned subjects and of the significance ‎that a photo has to a person. Based on theory we have created a booklet which consists of some ‎theory of photo and how the photo can be utilized in crisis work. In addition of these we took ‎symbolic photos, which employees can use when working with clients. The booklet and the ‎symbolic photos are the concrete output of this thesis.‎ The theoretical part consists of analysis of the essential concepts of the study, such as intimate ‎relationship, roles and use of authority in relationship. These are the essential concepts of this ‎thesis, because the booklet and the photos are supposed to be used especially when working with ‎couples. Crisis, crisis work and the function of crisis center were also essential concepts in this ‎thesis.‎ The aim of this thesis was to create a work method which serves the employees of crisis center in ‎the best possible way. The purpose of this thesis was not to find out how the work method, we ‎created, works in general. That would be a great subject for further research in the future.