Erilaisina, ihmisinä Hokkaidolla

Kirjoittajat vierailivat Hokkaidon yliopistolla Sapporossa 14.1.–17.2.2023. Kutsujana oli yliopiston yksikkö Global Station for Indigenous Studies and Cultural Diversity (GSI). Tässä matkakertomuksessa esittelemme kokemuksiamme ensikertalaisina Japanissa ja kerromme, mitä opimme Japanin ainoasta alkuperäiskansasta ainuista

Provision of intrauterine contraception in association with first trimester induced abortion reduces the need of repeat abortion : first-year results of a randomized controlled trial

Correction: Volume: 34 Issue: 3 Pages: 587-588 DOI: 10.1093/humrep/dey376 Published: MAR 2019 Accession Number: WOS:000461140700021STUDY QUESTION: Can the need of subsequent abortion be reduced by providing intrauterine contraception as a part of the abortion service? SUMMARY ANSWER: Provision of intrauterine devices (IUDs) in association with first trimester abortion more than halved the incidence of repeat abortion during the first year of follow-up. WHAT IS KNOWN ALREADY: Following abortion, the incidence of subsequent abortion is high, up to 30-40%. In cohort studies, intrauterine contraception has reduced the need of repeat abortion by 60-70%. STUDY DESIGN, SIZE, DURATION: A randomized controlled trial. The main outcome measure was the incidence of subsequent induced abortions during the follow-up. Altogether 751 women seeking first trimester induced abortion were recruited and randomized into two groups. Randomization was accomplished by computer-assisted permuted-block randomization with random block sizes of four to six. The investigators did not participate in randomization, which was done before commencing the study. The participants were recruited between 18 October 2010 and 21 January 2013. PARTICIPANTS, SETTINGS, METHODS: The inclusion criteria were age >= 18 years, duration of pregnancy This study was conducted in collaboration between the Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, and Centralized family planning of the City of Helsinki. The intervention group (n = 375) was provided with intrauterine contraception (either the levonorgestrel-releasing intrauterine system or copper-releasing intrauterine device) immediately following surgical abortion (18.1%) or at a follow-up 2-4 weeks after medical abortion (81.9%). Women in the control group were prescribed oral contraceptives and advised to contact their primary healthcare unit for a follow-up visit and further contraceptive services according to national guidelines. The women were followed-up to 28 February 2014 by using the Finnish National Abortion Registry, Helsinki University Hospital electronic database and clinical follow-up visit at 1 year. MAIN RESULTS AND THE ROLE OF CHANCE: The median age of the whole study group was 27 years and 44% had a history of induced abortion(s). During the follow-up year the number of women requesting subsequent abortion was significantly lower in the intervention than in the control group (9/375 [2.4%] versus 20/373 [5.4%], difference -3.0 [95% CI -6.0 to -0.2] percentage points, P = 0.038, according to intention-to-treat analysis and 5/346 [1.4%] versus 20/357 [5.6%], difference -4.2(-7.2 to -1.4) percentage points, P = 0.003, according toper-protocol analysis, respectively). Provision of intrauterine contraception was safe with rate of infection and expulsion similar to those reported previously. LIMITATIONS, REASONS FOR CAUTION: The powercalculation was calculated for a 5-year follow-up. However, significant differences between the two groups were already seen after 1 year. The present study was performed in a single clinic, where, similar to 15% of all abortions in Finland are performed. WIDER IMPLICATIONS OF THE FINDINGS: In order to decrease the need of subsequent abortions, IUDs should be provided at the time of abortion.Peer reviewe

Evaluation of Residual Stresses and Their Influence on Cavitation Erosion Resistance of High Kinetic HVOF and HVAF-Sprayed WC-CoCr Coatings

Thermal spray processes have been developing toward lower particle temperature and higher velocity. Latest generation high-velocity oxygen-fuel (HVOF) and high-velocity air-fuel (HVAF) can produce very dense coating structures due to the higher kinetic energy typical for these thermal spray processes. Thermally sprayed coatings usually contain residual stresses, which are formed by a superposition of thermal mismatch, quenching and, in case of high kinetic energy technologies, peening stresses. These stresses may have a significant role on the mechanical response and fatigue behavior of the coating. Understanding these effects is mandatory for damage tolerant coating design and wear performance. For instance, wear-resistant WC-CoCr coatings having high compressive stresses show improved cavitation erosion performance. In this study, comparison of residual stresses in coatings sprayed by various thermal spray systems HVOF (Thermico CJS and Oerlikon Metco DJ Hybrid) and HVAF (Kermetico AcuKote) was made. Residual stresses were determined through thickness by utilizing Tsui and Clyne analytical model. The real temperature and deposition stress data were collected in the coating process by in situ technique. That data were used for the model to represent realistic residual stress state of the coating. The cavitation erosion and abrasion wear resistance of the coatings were tested, and relationships between residual stresses and wear resistance were discussed.publishedVersionPeer reviewe

Laki raskaudenkeskeytyksestä tarvitsee päivitystä

Laki edellyttää perustetta ennen 12. raskausviikkoa tehtävälle keskeytykselle, kahden lääkärin hyväksyntää naisen päätökselle sekä keskeytysten hoidon keskittämistä sairaaloihin. Nämä ¬vaatimukset ovat nykytilanteessa tarpeettomia ja ne pitäisi poistaa

Early provision of intrauterine contraception as part of abortion care-5-year results of a randomised controlled trial

STUDY QUESTION: Can the incidence of subsequent termination of pregnancy (TOP) be reduced by providing intrauterine contraception as part of the abortion service? SUMMARY ANSWER: Provision of an intrauterine device (IUD) as part of TOP services reduced the need for subsequent TOP but the effect was limited to the first 3 years of the 5-year follow-up. WHAT IS KNOWN ALREADY: An IUD is highly effective in preventing subsequent TOP. Prompt initiation of IUD use leads to a higher usage rate during follow-up, as compliance with post-TOP IUD insertion visits is low. STUDY DESIGN, SIZE, DURATION: The objective of this randomised controlled trial was to assess the effect of early comprehensive provision of intrauterine contraception after TOP, with primary outcome being the incidence of subsequent TOP during the 5 years of follow-up after the index abortion. This study was conducted at a tertiary care centre between 18 October 2010 and 21 January 2013. Altogether, 748 women undergoing a first trimester TOP were recruited and randomised into two groups. The intervention group (n = 375) was provided with an IUD during surgical TOP or 1-4 weeks following medical TOP at the hospital providing the abortion care. Women in the control group (n = 373) were advised to contact primary health care for follow-up and IUD insertion. Subsequent TOPs during the 5-year follow-up were identified from the Finnish Register on induced abortions. PARTICIPANTS/MATERIALS, SETTING, METHODS: The inclusion criteria were age >= 18 years, duration of gestation MAIN RESULTS AND THE ROLE OF CHANCE: The overall numbers of subsequent TOPs were 50 in the intervention and 72 in the control group (26.7 versus 38.6/1000 years of follow-up, P = 0.027), and those of requested TOPs, including TOPs and early pregnancy failures, were 58 and 76, respectively (30.9 versus 40.8/1000, P = 0.080). Altogether 40 (10.7%) women in the intervention and 63 (16.9%) in the control group underwent one or several subsequent TOPs (hazard ratio 1.67 [95% CI 1.13 to 2.49], P = 0.011). The number of TOPs was reduced by the intervention during years 0-3 (22.2 versus 46.5/1000, P = 0.035), but not during years 4-5 (33.3 versus 26.8/1000, P = 0.631). LIMITATIONS, REASONS FOR CAUTION: Both medical and surgical TOP were used. This may be seen as a limitation, but it also reflects the contemporary practice of abortion care. The immediate post-TOP care was provided by two different organizations, allowing us to compare two different ways of contraceptive service provision following TOP. WIDER IMPLICATIONS OF THE FINDINGS: Providing TOP and IUD insertion comprehensively in the same heath care unit leads to significantly higher rates of attendance, IUD use and a significantly lower risk of subsequent TOP.Peer reviewe

Comparison of rates of adverse events in adolescent and adult women undergoing medical abortion: population register based study

Objective To determine the risks of short term adverse events in adolescent and older women undergoing medical abortion

Needs for Open Interfaces in Personal Health Record Systems and Citizen eServices – Results from a National Survey

Electronic services for supporting self-care, personal wellbeing management, communication between citizens and service providers, and citizen-centric care processes are developed in many countries and initiatives. Interoperability between these services and between them and information systems for service provision is increasingly needed. Open and standardized interfaces to support such interoperability must be selected or specified according to the needs of stakeholders in each project and environment. We report the results of a national survey related to the needs of open interfaces for self-care, citizen services and personal health records. The survey was performed using a web-based questionnaire focusing on the needs for open interface specifications. Interface needs were classified in nine categories. Respondents (n=23) represented health care solution providers / vendors, health service providers and research organizations. The majority of answers regarding the interface needs were in the category “great need for open interface specifications”. Most highly ranked were the interfaces for personal health record (PHR) information exchange and various needs related to identity and access management and care processes. The results are used as one basis for selecting topics for national collaboration related to open interfaces for self-care, personal health records and citizen-centric care pathways