Congenital lower limb deficiencies in Finland : Risk factors, prevalence, associated anomalies and treatment

In the 1950’s congenital limb deficiencies became well-recognized birth defect because of the use of thalidomide treating morning sickness in pregnant women. Despite of many studies the causation of many congenital limb deficiencies is mainly unknown. Upper and lower limb develop simultaneously during the organogenetic phase in early pregnancy (fourth to eight weeks of gestation). This is rapidly differentiating phase and therefore it is the phase most sensitive to teratogens causing major birth defects. Congenital lower limb reductions are rare but they are usually visible at birth and thus are well documented by registries. There are just a few population-based studies about the epidemiology of lower limb deficiencies. There are no population-based studies about the burden of hospital care of lower limb deficiencies to the healthcare system. The aim of this study was to describe risk factors for congenital limb reduction defects and also explore maternal medication use just before pregnancy and during the first trimester. The purpose was to find out features of congenital lower limb reduction defects and to determine the prevalence of congenital lower limb deficiencies and associated mortality and to identify patterns of associated anomalies. The aim was also to explore the impact, that children with lower limb reduction pose to health-care system. The data is based on registries maintained by the Finnish institute for health and welfare. We found that maternal pregestational diabetes, nulliparity and young and old maternal age increased the risk of congenital limb deficiencies. The use of progesterone and antiepileptics before pregnancy and during the first trimester had impact on the risk of congenital limb reductions. The total prevalence of congenital lower limb deficiencies was 2.8 per 10 000 births and the perinatal mortality was 78 per 1000 births. Almost half the cases with lower limb reductions had associated major anomalies The need of hospital care and the number of orthopedic procedures was markedly increased in the patients with congenital lower limb deficiency compared to whole pediatric population.  1950-luvulla alettiin käyttää raskaudenaikaiseen pahoinvointiin talidomidia, jonka seurauksena syntyi pahasti vaurioituneita lapsia, joilla oli mm. raajapuutoksia. Raajapuutoksien riskitekijöistä on tehty paljon tutkimuksia, mutta suurimmassa osassa tapauksia syy jää epäselväksi. Ylä- ja alaraajat muodostuvat raskauden aikana samanaikaisesti ns. organogeneettisen vaiheen aikana. Siinä vaiheessa tapahtuu nopeaa elinten erilaistumista, ja tämä vaihe on herkin erilaisten teratogeenien vaikutukselle. Teratogeenit ovat tekijöitä, jotka aiheuttavat synnynnäisiä poikkeavuuksia. Synnynnäiset alaraajapuutokset ovat harvinaisia, mutta usein ne ovat helposti tunnistettavia syntymän jälkeen. Niiden rekisteritiedot ovat luotettavia. On olemassa vain muutamia väestöpohjaisia tutkimuksia alaraajapuutosten epidemiologiasta. Kirjallisuudessa ei tunneta synnynnäisten alaraajapuutosten hoidon tarvetta eikä vaikutusta terveydenhuollolle. Tämän tutkimuksen tavoite oli selvittää synnynnäisten raajapuutosten liittyviä riskitekijöitä. Lisäksi selvitettiin äidin lääkkeiden käyttöä ennen raskautta ja raskauden ensimmäisen kolmanneksen aikana. Tutkimuksessa kartoitettiin myös synnynnäisten alaraajapuutosten tyypit, esiintyvyys, mortaliteetti sekä liitännäisanomaliat. Tavoitteena oli myös selvittää synnynnäisten alaraajapuutospotilaiden sairaalahoidon sekä kirurgisen hoidon tarve. Aineisto perustuu Terveyden- ja hyvinvoinnin laitoksen rekistereihin. Äidin ennen raskautta todettu diabetes, ensiraskaus ja äidin nuori, sekä korkea ikä lisäsivät raajapuutosten riskiä. Lisäksi äidin käyttämä progesteroni sekä epilepsialääkkeet nostivat raajapuutosten riskiä. Alaraajapuutosten kokonaisesiintyvyys oli 2.8 per 10 000 syntynyttä ja perinataalikuolleisuus 78 per 1000 syntynyttä. Melkein puolella alaraajapuutospotilaista todettiin jokin muu merkittävä synnynnäinen anomalia kuin raajapuutos. Alaraajapuutospotilaiden sairaalahoidon tarve ja ortopedisten toimenpiteiden määrä oli merkittävästi korkeampi verrattuna muuhun lapsipopulaatioon

Transformational Leadership in High Performing Product Development and Products Organisation

Today's world is changing even faster, and companies must find new, more efficient ways and methods to get their products to market even faster. High-performance organisations are one method of improving competitiveness in this changing environment. The foundation for high-performance organisations is created by a high-performance culture, self-directed and competent personnel, a transformational leadership model, and an agile organisation. A high-performance culture reflects how the organization behaves, performs, and lives in the operating environment. It is not easy to achieve a competent self-directed organisation, when establishing a completely new organisation there is a big risk in hiring people, because the people do not necessarily adapt to the team or the team's competences do not complement each other in the desired way. The development of already existing teams into competent and self-directed teams can be achieved by coaching, training, and motivating them to independently take on greater responsibility and grow into a high-performance team. In both cases, leadership plays a big role in success and failure. Among several different leadership models, transformational leadership is considered the most capable model to achieve a high-performance organisation. In the transformational leadership model, teams are given responsibilities and authority to make the necessary decisions efficiently and at the right time. The teams themselves also have the necessary information and competence to make a decision. The organisation and team sizes should be planned so that communication and cooperation within and between teams is as efficient as possible. The ideal team size is 7 people, in which case the mutual interactions of all team members are still continuous events. If the size of the team grows larger than this, the communication and information flow within the team is no longer as effective. One of the best ways is to create competence matrix resource pools, from which project groups of 7 people are created. According to the input-mediator-output model, the efficiency and effectiveness of teams is the output of inputs and mediators. In which the inputs are all members, teams matters and organisation matters, which are then processed according to the processes and the emergent states. The emergent state describes the organisation's behaviour, the team's learning, and information about who can and knows what in the organisation. The research was carried out using the analytical hierarchy model in one global organisation. The goal of the study was to find out the organisation's leadership model in product development and product management, and to give ideas for improving high-performance. The research confirmed the current state of the organisation's leadership model well, and the results were in line with the interviews conducted

DMLS and Manufacturing

Direct Metal Laser Sintering (DMLS) has been used for manufacturing prototypes, functional metal components and prototype tools for more than 10 years. During this period the technology has advanced to a level where direct production of complex metallic parts for various applications is everyday life and manufacturing with its various challenges is its main target. The shift from prototyping to production requires changes in the technology and also in the organizations taking part in the shift. This paper presents the latest status of the DMLS technology and materials development trends for different application areas using EOSINT M270 laser sintering machine. Commercially launched materials include presently biomedical materials like Titanium and Cobalt Chrome alloys, ultra high strength Maraging Steel alloy, Stainless Steels and other high-end engineering materials. In addition, there are many materials which have been developed for evaluation purposes, waiting for industrial applications.Mechanical Engineerin

Ankle-brachial index, high-sensitivity C-reactive protein and endothelial function in a cardiovascular risk population

Atherosclerotic vascular disease is the leading cause of death in the Western world. Its main three manifestations are coronary heart disease, cerebrovascular disease, and peripheral arterial disease. Asymptomatic peripheral arterial disease is usually diagnosed using the ankle brachial index, and values ≤ 0.90 are used to determine the diagnosis. The classical risk factors of peripheral arterial disease, such as smoking and diabetes, are well known and early interventions are mandatory to improve the prognosis. What is not well known is the role of inflammation as a risk factor. Yet, a novel approach to cardiovascular diseases is the measurement of endothelial function. In this thesis, we studied the ankle-brachial index, C-reactive protein and endothelial function in a cardiovascular risk population. A total of 2856 subjects were invited to the study and 2085 (73%) responded. From these subjects, a cohort of 1756 risk persons was screened. We excluded the subjects with previously known cardiovascular disease or diabetes, because they were already under systematic follow-up. Out of the study subjects, 983 (56%) were women and 773 (44%) men. The ankle brachial index and high-sensitivity C-reactive protein were measured from 1047 subjects. Endothelial function was assessed by measuring reactive hyperemia pulse amplitude tonometry from 66 subjects with borderline peripheral arterial disease. In this study, smoking was a crucial risk factor for peripheral arterial disease. Subclinical peripheral arterial disease seems to be more common in hypertensive patients even without comorbidities. The measurement of the ankle brachial index is an efficient method to identify patients at an increased cardiovascular risk. High-sensitivity C-reactive protein did not correlate with the ankle brachial index or peripheral arterial disease. Instead, it correlated with measures of obesity. In a cardiovascular risk population with borderline peripheral arterial disease, nearly every fourth subject had endothelial dysfunction. This might point out a subgroup of individuals in need of more intensive treatment for their risk factors.Siirretty Doriast

Vertebral Body Tethering: Indications, Surgical Technique, and a Systematic Review of Published Results

Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth on the growth plates. VBT was designed to modulate spinal growth of vertebral bodies and hence, the term ‘growth modulation’ has also been used. This review describes the indications and surgical technique of VBT. Further, a systematic review of published studies was conducted to critically evaluate the results and complications of this technique. In a total of 23 included studies on 843 patients, the preoperative main thoracic curve corrected from 49 to 23 degrees in a minimum 2 year follow-up. The complication rate of VBT was 18%. The results showed that 15% of VBT patients required reoperations for pulmonary or tether-related issues (10%) and less than 5% required conversion to spinal fusion. While the reported median-term results of VBT appear promising, long-term results of this technique are currently lacking

The Trail, 1962-02-13

https://soundideas.pugetsound.edu/thetrail_all/1840/thumbnail.jp

Vertebral Body Tethering: Indications, Surgical Technique, and a Systematic Review of Published Results

Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth on the growth plates. VBT was designed to modulate spinal growth of vertebral bodies and hence, the term ‘growth modulation’ has also been used. This review describes the indications and surgical technique of VBT. Further, a systematic review of published studies was conducted to critically evaluate the results and complications of this technique. In a total of 23 included studies on 843 patients, the preoperative main thoracic curve corrected from 49 to 23 degrees in a minimum 2 year follow-up. The complication rate of VBT was 18%. The results showed that 15% of VBT patients required reoperations for pulmonary or tether-related issues (10%) and less than 5% required conversion to spinal fusion. While the reported median-term results of VBT appear promising, long-term results of this technique are currently lacking

Vertebral Body Tethering : Indications, Surgical Technique, and a Systematic Review of Published Results

Vertebral body tethering (VBT) represents a new surgical technique to correct idiopathic scoliosis using an anterior approach, spinal instrumentation with vertebral body screws, and a cable compressing the convexity of the curve. According to the Hueter-Volkmann principle, compression reduces and distraction increases growth on the growth plates. VBT was designed to modulate spinal growth of vertebral bodies and hence, the term 'growth modulation' has also been used. This review describes the indications and surgical technique of VBT. Further, a systematic review of published studies was conducted to critically evaluate the results and complications of this technique. In a total of 23 included studies on 843 patients, the preoperative main thoracic curve corrected from 49 to 23 degrees in a minimum 2 year follow-up. The complication rate of VBT was 18%. The results showed that 15% of VBT patients required reoperations for pulmonary or tether-related issues (10%) and less than 5% required conversion to spinal fusion. While the reported median-term results of VBT appear promising, long-term results of this technique are currently lacking.Peer reviewe

Challenges and Needs for Support in Managing Occupational Health and Safety from Managers’ Viewpoints

Proper working conditions and successful occupational health and safety (OHS) management help organizations achieve their targets and support the quality of working life and performance. Work-related stress, conflicts, work ability issues, ill health, and other challenging OHS situations in the workplace may impede the well-being and productivity of employees. According to OHS legislation, employers are responsible for managing risks and solving problems in the work community. Challenging situations can be viewed from the perspective of efficiency, since their economic effects may be remarkable. The objective of this study is to describe the challenging OHS situations managers encounter and the support they require in these situations. The results are based on thematic interviews and inquiries with top, middle, and front-line managers in three Finnish public sector service organizations. The most challenging OHS management situations are related to the administration of work under high economic pressure and constant changes in the work community, managing employee workload and time pressures, providing feedback, facilitating collaboration, and managing conflict. The managers’ own understandings, competences, and resources, as well as organizational supports, have an effect on successful resolutions of challenging OHS management situations

Distal Femoral Focal Deficiency

Distal femoral focal deficiency is an extremely rare type of congenital femoral deficiency that comprises hypoplasia of the distal femur, with a normally developed hip. We represent a unique case of distal femoral hypoplasia and deficiency of knee extensors, childhood follow-up and final treatment with exarticulation, and a comparison with previous literature.Peer reviewe