Terveys, toimintakyky ja estettömyyden haasteet selkäydinvammaisten joukossa Suomessa: FinSCI-tutkimuksen protokolla

Background and purpose: The purpose of the Finnish Spinal Cord Injury Study (FinSCI) is to identify factors related to the health and functioning of people with spinal cord injury, their challenges with accessibility, and how such factors are interconnected. The International Classification of Functioning, Disability and Health (ICF) is used as a structured framework in the study. Design: Protocol of mixed methods study. Results: Study participants were recruited from all 3 spinal cord injury outpatient clinics in Finland. The final target group consists of 1,789 subjects with spinal cord injury. The final questionnaire was formed from 5 different patient-reported instruments. The spinal cord injury-specified instruments are the Spinal Cord Injury Secondary Condition Scale, the Spinal Cord Independence Measure, and the Nottwil Environmental Factors Inventory Short Form. In addition, questions from the following generic instruments were chosen after a selection process: the Patient-Reported Outcomes Measurement Information System, PROM'S (R), and the National Study of Health, Well-being and Service, FinSote. Altogether, the final questionnaire covers 64 ICF categories and consists of 151 ICF-linked questions. Conclusion: The formulated questionnaire covers widely different aspects of health, functioning and accessibility. The questionnaire results and subsequent interviews will help in developing care and rehabilitation policies and services for people with spinal cord injury.Peer reviewe

Prevalence of comorbidities and secondary health conditions among the Finnish population with spinal cord injury

Study design A cross-sectional study. Objectives To explore the prevalence of comorbidities, secondary health conditions (SHCs), and multimorbidity in the Finnish population with spinal cord injury (SCI). Setting The data were collected from the Finnish Spinal Cord Injury Study (FinSCI). Participants were identified from three SCI outpatient clinics responsible for the lifelong follow-up of persons with SCI in Finland, (n = 884 participants, response rate; 50%). Methods The FinSCI-questionnaire included a question from the National Study of Health, Well-being, and Service (FinSote) for screening 12 comorbidities. The reference data of the general population for that question were received from the Finnish Institute for Health and Welfare. The Spinal Cord Injury Secondary Condition Scale (SCI-SCS) was used to screen 16 SHCs. The data were analysed with univariate testing and multivariable negative binomial regression modelling. Results The most common comorbidities were high blood pressure/hypertension (38%), back problems (28%), and high cholesterol (22%). The most common SHCs were joint and muscle pain (81%), muscle spasms (74%), chronic pain (71%), and bowel problems (71%). The prevalence of comorbidities was highest among persons aged >= 76 years (mean; 2.0; scale range; 0-12). The prevalence of SHCs was highest in the severity of SCI group C1-4 AIS A, B, and C (mean; 8.9; scale range; 0-16). Conclusions Further research on geriatrics in SCI, non-traumatic SCI, and knowledge of the needs of persons with cervical lesion AIS A, B, or C is required, due to the fact that the prevalence of multimorbidity is high in these groups.Peer reviewe

Health-related factors for work participation in persons with spinal cord injury in Finland

Objective: To explore work participation and the health-related factors affecting work participation among the Finnish Spinal Cord injury (FinSCI) study population (n = 884). Methods: A cross-sectional explorative observational study in the FinSCI community survey applying Patient-Reported Outcomes Measurement Information System (PROMIS®) forms on Social Health and Global Health. Analyses of socio-demographic and injury-related data were performed. Results: Employment among the study population (n = 452) was 26.5%. Physical, Mental, Social and General Health were better in the employed group compared with work-age persons not working. Logistic regression showed that work participation was related to all health domains, but Physical Health and Ability to Participate in Social Roles and Activities in Social Health were the strongest indicators of likelihood of being at work. Paraplegia and young age were associated with increased likelihood of work participation. Conclusion: The first national survey among people with spinal cord injury in Finland shows low level of employment. The results suggest that pain, physical function, and ability to participate in social roles should be monitored by health and vocational professionals when assessing a person's likelihood of being in work.Peer reviewe

Puhdistamolietteen ja lietevalmisteiden käyttö maataloudessa. Hygienia ja riskitutkimus (pilottihanke LIVAKE-2000)

Raportoitavan pilottihankkeen tavoitteena oli kartoittaa, eläinten ja ihmisen sekä kasvien taudinaiheuttajien esiintymistä maatalous- ja viherrakentamiskäyttöön menevässä puhdistamolietteessä, stabiloidussa lietteessä, lietevalmisteissa. Tavoitteena oli myös kehittää laadunvalvontaan tarvittavia analyysimenetelmiä ja saada taustatietoa mahdollisille hallinnollisille päätöksille ja säädösten muutostyöhön. Giardia- ja Cryptosporidium-alkueläinten, kalikivirusten, enterokokkien, salmonellojen, Listeria monocytogenes- ja Escherichia coli O157:H7-bakteerien sekä mykobakteerien esiintymistä kartoitettiin 12 puhdistamon lietteissä ja niistä tehdyissä erilaisissa ja eri-ikäisissä lietevalmisteissa. Lisäksi kartoitettiin peruna-ankeroisen esiintymistä perunateollisuuden lietteissä ja lietekomposteissa. Alkueläinten kestomuotojen analysointiin puhdistamolietteistä kehitettiin projektin yhteydessä IMS-PCR-pohjainen menetelmä. Myös kalikivirusten ja mykobakteerien määritysmenetelmiä kehitettiin hankkeen yhteydessä. Tutkituissa lietteissä esiintyi puhdistamotyypistä riippumatta yleisesti tutkittuja taudinaiheuttajia, lukuun ottamatta E.coli O157:H7-bakteeria, jota ei lietteistä eikä lietevalmisteista tavattu. Lietteen stabilointi joko kalkkikäsittelyllä tai mädättämällä ei riittänyt tutkituilla puhdistamoilla tuhoamaan kartoitettuja taudinaiheuttajia lietteestä. Tutkimuksessa oli mukana kolme mädätystä käyttävää puhdistamoa, niistä kahdesta ei salmonellaa eikä enterokokkeja tavattu, mutta alkueläinten kestomuotoja sekä kalikivirusta löytyi edelleen. Tutkimuksessa mukana ollut kalkkistabilointilaitos osoittautui huonosti toimivaksi, taudinaiheuttajien määrä ei käsittelyssä vähentynyt, päinvastoin. Kompostointi mädätyksen jälkeisenä toimenpiteenä näytti riittävän kuudessa kuukaudessa tuhoamaan salmonellat, enterokokit ja listeriat. Samaan tulokseen päästiin tulosten mukaan joillakin puhdistamoilla pelkästään kompostoimalla, mutta joissakin tapauksissa listeriaa ja yhdessä tapauksessa myös kalikivirusta löytyi vielä kuudenkin kuukauden kompostoinnin jälkeen, vaikkei muita taudinaiheuttajia enää todettu. Komposteista ja lieteseoksista ei ollut mahdollista tutkia alkueläinten esiintymistä. Perunateollisuuden jätevesilietteistä ja lietekomposteista ei löytynyt peruna-ankeroisten kystia, mutta yhden tutkitun teollisuuslaitoksen lietenäytteistä (3 positiivista näytettä) löytyi Heterodera-suvun ankeroisten kystia. Tähän sukuun kuuluu mm. merkittävä sokerijuurikkaan tuholainen, juurikasankeroinen (H. schachtii). Kartoituksen tulokset osoittavat lietteiden ja lietevalmisteiden käyttöön maanviljelyssä sisältyvän riskin - sekä zoonoottisten taudinaiheuttajien osalta että kasvitautien osalta. Tässä hankkeessa toteutetussa laajuudessa ei aiemmin ole kartoitettu taudinaiheuttajia puhdistamolietteistä eikä niistä valmistetuista lietevalmisteista

High-Density SNP Mapping of the HLA Region Identifies Multiple Independent Susceptibility Loci Associated with Selective IgA Deficiency

Selective IgA deficiency (IgAD; serum IgA<0.07 g/l) is the most common form of human primary immune deficiency, affecting approximately 1∶600 individuals in populations of Northern European ancestry. The polygenic nature of IgAD is underscored by the recent identification of several new risk genes in a genome-wide association study. Among the characterized susceptibility loci, the association with specific HLA haplotypes represents the major genetic risk factor for IgAD. Despite the robust association, the nature and location of the causal variants in the HLA region remains unknown. To better characterize the association signal in this region, we performed a high-density SNP mapping of the HLA locus and imputed the genotypes of common HLA-B, -DRB1, and -DQB1 alleles in a combined sample of 772 IgAD patients and 1,976 matched controls from 3 independent European populations. We confirmed the complex nature of the association with the HLA locus, which is the result of multiple effects spanning the entire HLA region. The primary association signal mapped to the HLA-DQB1*02 allele in the HLA Class II region (combined P = 7.69×10−57; OR = 2.80) resulting from the combined independent effects of the HLA-B*0801-DRB1*0301-DQB1*02 and -DRB1*0701-DQB1*02 haplotypes, while additional secondary signals were associated with the DRB1*0102 (combined P = 5.86×10−17; OR = 4.28) and the DRB1*1501 (combined P = 2.24×10−35; OR = 0.13) alleles. Despite the strong population-specific frequencies of HLA alleles, we found a remarkable conservation of these effects regardless of the ethnic background, which supports the use of large multi-ethnic populations to characterize shared genetic association signals in the HLA region. We also provide evidence for the location of association signals within the specific extended haplotypes, which will guide future sequencing studies aimed at characterizing the precise functional variants contributing to disease pathogenesis

Facilitators and barriers in the rehabilitation process described by persons with spinal cord injury: a deductive-inductive analysis from the Finnish spinal cord injury study

AbstractBackground This study aimed to determine the factors that promote and facilitate rehabilitation as well as challenges and possible barriers perceived by people with spinal cord injury (SCI).Materials and Methods This study was part of a larger, mixed-method Finnish Spinal Cord Injury (FinSCI) study. We interviewed 45 persons with SCI representing participants from the FinSCI study and used a qualitative approach and a deductive-inductive content analysis to analyse the data.Results We identified 28 facilitators and 19 barriers in the rehabilitation process. The majority of the facilitators and barriers were related to the rehabilitation planning phase. There were more barriers than facilitators in applying for and accessing treatment or rehabilitation and during the implementation of rehabilitation. Facilitators consisted of successful, realized, or planned treatments or rehabilitation events; clear goals; multidisciplinary teamwork; support and monitoring in various changing situations; and the rehabilitees’ own capabilities and activities, among other things. The barriers included delays, challenges and deficiencies in the planning and implementation of treatment or rehabilitation; the lack of different skills; and resources of rehabilitation professionals; and different personal factors, which made the rehabilitation process cumbersome.Conclusions Good communication and interaction between stakeholders are crucial for the progress of rehabilitation