Radium-223 dichloride treatment in metastatic castration-resistant prostate cancer in Finland : A real-world evidence multicenter study

Background Radium-233 dichloride is an alpha emitter that specifically targets bone metastases in prostate cancer. Results of a previously reported phase III randomized trial showed survival benefit for radium-223 compared to best supportive care in castration-resistant prostate cancer (CRPC) with bone metastases. However, real-world data are also needed with wider inclusion criteria. Methods We report results of a retrospective multicenter study including all patients with metastatic CRPC treated with radium-223 in all five university hospitals in Finland since the introduction of the treatment. We identified 160 patients who had received radium-223 in Finland in 2014-2019. Results The median overall survival (OS) was 13.8 months (range 0.5-57 months), and the median real-world progression-free survival (rwPFS) was 4.9 months (range 0.5-29.8 months). Alkaline phosphatase (ALP) values within the normal range before and during the radium-223 treatment or the reduction of elevated ALP to normal range during treatment were associated with better OS when compared to elevated ALP values before and during treatment (p = 100 mu g/L) before radium-223 treatment was associated with poor OS compared to low PSA level (Peer reviewe

Pilaantuneen maa-alueen kunnostushankkeen tilaaminen

Tässä ohjeistuksessa esitellään pilaantuneen tai pilaantuneeksi epäillyn alueen tutkimus-, suunnittelu- ja kunnostustoimia. Samalla kuvataan kunnostushankkeen tavanomainen eteneminen, siihen sisältyviä vaiheita sekä eri osapuolten rooleja ja tehtäviä. Tavoitteena on tukea pilaantuneisuusselvitysten ja kunnostustoimien tilaajaa tekemään oikea-aikaisia ja tarkoituksenmukaisia päätöksiä

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

Non-COVID-19 intensive care admissions during the pandemic: a multinational registry-based study

Background: The COVID-19 pandemic resulted in a large number of critical care admissions. While national reports have described the outcomes of patients with COVID-19, There is limited international data of the pandemic impact on non-COVID-19 patients requiring intensive care treatment. Methods: We conducted an international, retrospective cohort study using 2019 and 2020 data from 11 national clinical quality registries covering 15 countries. Non-COVID-19 admissions in 2020 were compared with all admissions in 2019, prepandemic. The primary outcome was intensive care unit (ICU) mortality. Secondary outcomes included in-hospital mortality and standardised mortality ratio (SMR). Analyses were stratified by the country income level(s) of each registry. Findings: Among 1 642 632 non-COVID-19 admissions, There was an increase in ICU mortality between 2019 (9.3%) and 2020 (10.4%), OR=1.15 (95% CI 1.14 to 1.17, p<0.001). Increased mortality was observed in middle-income countries (OR 1.25 95% CI 1.23 to 1.26), while mortality decreased in high-income countries (OR=0.96 95% CI 0.94 to 0.98). Hospital mortality and SMR trends for each registry were consistent with the observed ICU mortality findings. The burden of COVID-19 was highly variable, with COVID-19 ICU patient-days per bed ranging from 0.4 to 81.6 between registries. This alone did not explain the observed non-COVID-19 mortality changes. Interpretation: Increased ICU mortality occurred among non-COVID- 19 patients during the pandemic, driven by increased mortality in middle-income countries, while mortality decreased in high-income countries. The causes for this inequity are likely multi-factorial, but healthcare spending, policy pandemic responses, and ICU strain may play significant roles

Cardiac Troponin I and Incident Stroke in European Cohorts Insights From the BiomarCaRE Project

Background and Purpose: Stroke is a common cause of death and a leading cause of disability and morbidity. Stroke risk assessment remains a challenge, but circulating biomarkers may improve risk prediction. Controversial evidence is available on the predictive ability of troponin concentrations and the risk of stroke in the community. Furthermore, reports on the predictive value of troponin concentrations for different stroke subtypes are scarce. Methods: High-sensitivity cardiac troponin I (hsTnI) concentrations were assessed in 82 881 individuals (median age, 50.7 years; 49.7% men) free of stroke or myocardial infarction at baseline from 9 prospective European community cohorts. We used Cox proportional hazards regression to determine relative risks, followed by measures of discrimination and reclassification using 10-fold cross-validation to control for overoptimism. Follow-up was based upon linkage with national hospitalization registries and causes of death registries. Results: Over a median follow-up of 12.7 years, 3033 individuals were diagnosed with incident nonfatal or fatal stroke (n=1654 ischemic strokes, n=612 hemorrhagic strokes, and n=767 indeterminate strokes). In multivariable regression models, hsTnI concentrations were associated with overall stroke (hazard ratio per 1-SD increase, 1.15 [95% CI, 1.10-1.21]), ischemic stroke (hazard ratio, 1.14 [95% CI, 1.09-1.21]), and hemorrhagic stroke (hazard ratio, 1.10 [95% CI, 1.01-1.20]). Adding hsTnI concentrations to classical cardiovascular risk factors (C indices, 0.809, 0.840, and 0.736 for overall, ischemic, and hemorrhagic stroke, respectively) increased the C index significantly but modestly. In individuals with an intermediate 10-year risk (5%-20%), the net reclassification improvement for overall stroke was 0.038 (P=0.021). Conclusions: Elevated hsTnI concentrations are associated with an increased risk of incident stroke in the community, irrespective of stroke subtype. Adding hsTnI concentrations to classical risk factors only modestly improved estimation of 10-year risk of stroke in the overall cohort but might be of some value in individuals at an intermediate risk.</div

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

Vakuutusyhtiön vaihtamiseen vaikuttavat tekijät : case: LähiTapiola Vellamon asiakaspoistuma

Opinnäytetyössä tutkittiin vakuutusyhtiön vaihtamiseen vaikuttavia tekijöitä ja mitä asiakkaat pitävät tärkeänä vakuuttamisessa. Opinnäytetyön toimeksiantajana toimi LähiTapiola Vellamo. Kilpailu on kiristynyt vakuutusalalla ja yritykset kilpailevat palvelun laadulla, lisäpalveluiden avulla sekä ennen kaikkea hinnalla. Digitalisoitumisen myötä vakuutusyhtiön vaihtaminen on tehty asiakkaan kannalta helpoksi. Vakuutusalalla tuotteilla erottuminen kilpailijoista on hankalaa, joten vakuutusyhtiön on käytettävä muita keinoja pysyäkseen mukana kilpailussa. Teoreettisen osuuden ensimmäinen luku käsittelee lyhyesti finanssialaa. Seuraavat kaksi lukua käsittelevät asiakkuudenhallintaa ja asiakkaan sitouttamista sekä palvelujen valintaan vaikuttavia tekijöitä. Asiakkuudenhallinta sisältää asiakkuuden elinkaaren eri vaiheet ja asiakkaan sitouttamisen keinoja. Vakuutusalalla palvelujen valintaan vaikuttavia tekijöitä ovat tuote, hinta, asiakaspalvelu, saatavuus ja korvauspäätös. Empiirinen osuus käsittelee tutkimusmenetelmän valintaa, tavoitetta, toteutusta ja tuloksia. Tutkimuksessa on käytetty sekä kvantitatiivista että kvalitatiivista tutkimusmenetelmää. Molemmat tutkimusosiot on toteutettu puhelinhaastatteluina. Laadullinen tutkimus on toteutettu määrällisen tutkimuksen tuloksien pohjalta. Tutkimustuloksista selviää, että hinta vaikuttaa olennaisesti vakuutusyhtiön valintaan, vaikka tulokset kuitenkin osoittavat, että asiakkaat arvostavat hintaa enemmän asiakaspalvelua, korva-uspäätöstä ja tuotetta ja sen sisältöä.This thesis examines the factors that lead to changing insurance company and what customers appreciate in insurance services. This study was commissioned by LähiTapiola Vellamo. Competition in insurance industry has become more intense and companies are competing in the quality of services, with additional services and especially with price. Exchanging insurance company is made easy for the customer along digitalization. It is difficult to stand out with the product in insurance, so insurance companies need to use other ways to stay in the competition. First chapter of the theoretical part shortly introduces the financial industry. Following two chapters are about customer relationship management, customer engagement and the factors that lead to the customer selecting an insurance company. Customer Relationship Management section contains two different angles to the subject: the different phases of the customer lifecycle and the ways of engaging a customer in the insurance company. In the insurance industry, the factors affecting the decision making process are the product, price, quality of the customer service, availability and compensation order. The empirical part describes the selection process of the research method and the aim, the execution and the results of the research. The empirical part contains both quantitative and qualitative research methods. Both parts of the research were executed by using phone interviews. The qualitative research is based on the results of the quantitative research. The study results reveal that the price affects fundamentally the process of choosing an insurance company. However, the results indicate that the customer values customer service, compensation order and the product itself more highly than the price

Synnytyksen aikainen tuki isien kokemana : näkökulmana kuusi eri sairaalaa

Tämän opinnäytetyön tarkoituksena oli selvittää isien kokemuksia kätilön heille antamasta synnytyksen aikaisesta tuesta sekä isien taustatekijöiden vaikutusta tuen kokemiseen kuudessa eri sairaalassa. Tavoitteena oli tuottaa uutta tietoa isien kokemasta synnytyksen aikaisesta tuesta ja edistää näyttöön perustuvaa kätilötyötä. Opinnäytetyö toteutettiin osana Hyvä syntymä -hanketta. Yhteistyökumppanit olivat HUS/Hyvinkään sairaalan ja Oulun yliopistollisen sairaalan synnytysosastot, Terveyden ja hyvinvoinnin laitos, Kätilöliitto sekä Metropolia Ammattikorkeakoulu. Opinnäytetyö toteutettiin kvantitatiivisena tutkimuksena. Tutkimuksessa käytettiin valmista Kuopio Instrument for Fathers (KIF) -mittaria. Tutkimusaineisto kerättiin kyselylomakkeilla kuudessa eri synnytyssairaalassa kevään ja syksyn välisenä aikana vuonna 2012. Kyselylomakkeita jaettiin sairaaloihin yhteensä 1500 kappaletta. Analyysiin mukaan hyväksyttiin lopulta 947 kyselylomaketta ja vastausprosentti oli 63,1 %. Aineisto analysoitiin IBM SPSS Statistics 21 -tilastointiohjelmalla. Aineiston analysointia varten kyselylomakkeen väittämät ryhmiteltiin summamuuttujiksi, joita ovat fyysinen, emotionaalinen ja tiedollinen tuki sekä varhaiskontaktiin tukeminen. Tulosten perusteella isät kokivat kätilön antaman synnytyksen aikaisen tuen toteutuneen pääasiassa hyvin kuudessa eri sairaalassa. Ensimmäistä kertaa synnytyksessä mukana olleet isät kokivat saaneensa paremmin tukea kuin uudelleen synnytyksessä mukana olleet isät. Kahdessa sairaalassa myös aikaisemman synnytyskokemuksen laadulla havaittiin yhteys tuen kokemiseen. Fyysisen ja emotionaalisen tuen sekä varhaiskontaktin tukemisen osalta löytyi tilastollisesti merkitsevää eroa sairaaloiden välillä. Tiedollisen tuen toteutumisessa ei havaittu merkitsevää eroa sairaaloiden välillä. Isät kokivat lähes kaikissa sairaaloissa tiedollisen tuen toteutuneen parhaiten. Emotionaalinen tuki koettiin heikoiten toteutuneeksi. Isät kokivat vaikeaksi arvioida emotionaalisen tuen toteutumista. Isien emotionaaliseen tukemiseen ja fyysisen hyvinvoinnin huomioimiseen synnytyksen aikana tulisi kiinnittää enemmän huomiota. Imetysohjauksessa tulisi paremmin huomioida isät. Lisäksi uudelleen synnytyksessä mukana olevien isien tuen tarpeet olisi syytä huomioida paremmin ja isien synnytyskokemukseen tulisi kiinnittää enemmän huomiota. Eri sairaaloiden hoitokäytäntöjä olisi synnytyksen aikaisen tuen osalta hyvä yhtenäistää.The purpose of this study was to find out fathers’ experiences about support given by midwives during labour and the effect of fathers’ background information in experiencing the support in six different hospitals. The aim of this study was to bring new information about the topic and to advance evidence-based midwifery. This study is a part of the Good Birth -project. Partners in cooperation were the maternity wards of HUS/Hyvinkää Hospital and Oulu University Hospital, the National Institute for Health and Welfare, Midwife Association and Metropolia University of Applied Sciences. The study was conducted as a quantitative study. We used the Kuopio Instrument for Fathers (KIF) as an instrument. The data was collected with questionnaires in six different hospitals between the summer and autumn of 2012, when 1500 questionnaires were delivered to the hospitals. 947 responses were accepted into the analysis and the response rate was 63,1 %. The data was analysed with IBM SPSS Statistics 21 -statistics programme. Support during labour is divided in this study to physical, emotional and informational support and into support in early interaction with the newborn. According to the results fathers felt that the support given during the labour by the midwife was actualised quite well in all six different hospitals. Fathers taking part for the first time in labour experienced all the different forms of support more positively than fathers who had been in labour before. The quality of the earlier birth experience had a relation to how the different forms of support were felt in two hospitals. There were statistical differences between the six hospitals in physical and emotional support and supporting the early interaction, but there was no statistical difference in informational support. Informational support was the best fulfilled area in all the hospitals. Emotional support was experienced to be the weakest support form. Fathers felt hardest to evaluate actualising of the emotional support. Supporting fathers emotionally and supporting fathers’ physical wellbeing during the labour should be taken more into consideration. Fathers should be taken better into consideration in breastfeeding guidance. The needs of support of fathers who had been in labour before and fathers’ birth experience should also be taken better into consideration. Working methods between different hospitals should be more unified in giving support during the labour

Erityistä tukea tarvitsevien lasten äitien haasteet ja voimavarat

Opinnäytetyön aiheena oli erityistä tukea tarvitsevien lasten äitien haasteet ja voimavarat. Opinnäytetyön tarkoituksena oli tutkia, millaisia haasteita ja voimavaroja erityistä tukea tarvitsevien lasten äidit olivat kohdanneet vanhemmuudessa, läheisissä suhteissa, arjessa, lapsen hoitopolussa, päiväkodin ja koulun toiminnassa, fyysisessä ympäristössä, ympäristön asenteissa ja omassa jaksamisessaan. Opinnäytetyön tavoitteena oli lisätä tietoisuutta erityistä tukea tarvitsevien lasten äitien elämästä. Tieto äitien kokemuksista voisi auttaa ymmärtämään erityistä tukea tarvitsevia lapsia ja heidän perheitään. Tieto voisi auttaa myös tunnistamaan ja kehittämään yhteiskunnan puutteita. Opinnäytetyön yhteistyökumppanina oli Leijonaemot ry, joka tarjoaa vertaistukea erityistä tukea tarvitsevien lasten vanhemmille. Tutkimukseen osallistui yksi erityistä tukea tarvitsevan lapsen äiti. Tutkimus toteutettiin laadullisena tutkimuksena. Tutkimusmenetelmänä käytettiin teemahaastattelua. Teemat muodostettiin aiheen teoriatiedon ja toimintaterapian viitekehyksen, Inhimillisen toiminnan mallin, pohjalta. Aineisto analysoitiin aineistolähtöisellä sisällönanalyysillä. Tulosten perusteella erityistä tukea tarvitsevan lapsen äidin elämässä esiintyi lukuisia haasteita. Nämä haasteet liittyivät äitien jaksamiseen, äitiyteen, arkeen, sosiaaliseen verkostoon, ympäristön esteisiin ja ihmisten asenteisiin. Erityistä tukea tarvitsevan lapsen hoitopolku osoittautui kuormittavaksi ja monimutkaiseksi. Äiti koki, että muun muassa perhe, ystävät, vertaistuki, luonto, positiivinen asenne ja rentoutuminen auttavat jaksamaan haasteellista arkea. Pienen otoksen perusteella tutkimustulokset eivät ole yleistettäviä, mutta niistä on hyötyä erityistä tukea tarvitsevien lasten perheille, heidän verkostoille, palveluiden järjestäjille ja organisaatioille. Tuloksia voisi hyödyntää yhteiskunnallisten ongelmakohtien tunnistamisessa ja toimivampien käytäntöjen kehittämisessä sekä yksilö- että organisaatiotasolla. Tutkimuksen pohjalta voisi lähteä kartoittamaan, kehittämään ja rakentamaan erityistä tukea tarvitsevien lasten vanhempien ja heidän perheidensä tarpeisiin vastaavia tukipalveluita, jotka helpottaisivat arjessa jaksamista.The subject of thesis work was challenges and resources of mothers with a child with special needs. The purpose of thesis work was to study what kind of challenges and resources mothers with a child with special needs were faced with in their parenthood, close relationships, everyday life, child´s care path, daycare and school, physical environment, attitude of environment and her own coping. The goal of the thesis was to spread knowledge about mothers’ life with a child with special needs. The knowledge about mothers’ experiences could help other people to understand children with special needs and their families. The knowledge could also help to recognize and develop shortcomings of society. The partner of the thesis was Leijonaemot ry which offers peer support for parents with a child with special needs. One mother with a a child with special need participated in the research. The research was accomplished as a qualitative research. A theme interview was used as a research method. Themes were formed based on the theoretical knowledge of our subject and the context of occupational therapy, Model of Human Occupation. The material was analyzed by means of a content analysis. On the grounds of our results several challenges occured in the life of a mother with a child with special needs. These challenges were related to mothers’ coping, motherhood, social network, environmental barriers and people attitudes. The care path of a child with special needs turned out to be hard and complicated. The mothers’ experiences were that among other things family, friends, peer support, nature, positive attitude and relaxing helped to manage challenging everyday life. Because the study sample was small, the results can’t be generalized. However, they can be useful for families with children with special needs, their social network, service providers and organizations. The results could be used for recognising shortcomings of society and developing praxis that are working better at an individual and organization level. The research could be a base for charting, developing and creating services which help everyday life of parents and families with a child with special needs