Sosiaalisen toimintakyvyn arviointi ja mittaaminen väestötutkimuksessa

TOIMIA-suositu

Long-term health-related quality of life in persons diagnosed with an insulinoma in Finland 1980-2010

Objective Insulinomas are rare pancreatic neoplasms, which can usually be cured by surgery. As the diagnostic delay is often long and the prolonged hyperinsulinemia may have long-term effects on health and the quality of life, we studied the long-term health-related quality of life (HRQoL) in insulinoma patients. Design, patients and measurements The HRQoL of adults diagnosed with an insulinoma in Finland in 1980-2010 was studied with the 15D instrument, and the results were compared to those of an age- and gender-matched sample of the general population. The minimum clinically important difference in the total 15D score has been defined as +/- 0.015. The clinical characteristics, details of insulinoma diagnosis and treatment, and the current health status of the subjects were examined to specify the possible determinants of long-term HRQoL. Results Thirty-eight insulinoma patients participated in the HRQoL survey (response rate 75%). All had undergone surgery with a curative aim, a median of 13 (min 7, max 34) years before the survey. The insulinoma patients had a clinically importantly and statistically significantly better mean 15D score compared with the controls (0.930 +/- 0.072 vs 0.903 +/- 0.039, P = .046) and were significantly better off regarding mobility, usual activities and eating. Among the insulinoma patients, younger age at the time of survey, higher level of education and smaller number of chronic diseases were associated with better overall HRQoL. Conclusions In the long term, the overall HRQoL of insulinoma patients is slightly better than that of the general population.Peer reviewe

Characteristics and Outcomes of 79 Patients with an Insulinoma : A Nationwide Retrospective Study in Finland

Objective. Insulinomas are rare pancreatic tumours. Population-based data on their incidence, clinical picture, diagnosis, and treatment are almost nonexistent. The aim of this study was to clarify these aspects in a nationwide cohort of insulinoma patients diagnosed during three decades. Design and Methods. Retrospective analysis on all adult patients diagnosed with insulinoma in Finland during 1980-2010. Results. Seventy-nine patients were diagnosed with insulinoma over the research period. The median follow-up from diagnosis to last control visit was one (min 0, max 31) year. The incidence increased from 0.5/million/year in the 1980s to 0.9/million/year in the 2000s (p = 0 002). The median diagnostic delay was 13 months and did not change over the study period. The mean age at diagnosis was 52 (SD 16) years. The overall imaging sensitivity improved from 39% in the 1980s to 98% in the 2000s (p <0 001). Seventy- one (90%) of the patients underwent surgery with a curative aim, two (3%) had palliative surgery, and 6 (8%) were inoperable. There were no significant differences in the types of surgical procedures between the 1980s, 1990s, and 2000s; tumour enucleations comprised 43% of the operations, distal pancreatic resections 45%, and pancreaticoduodenectomies 12%, over the whole study period. Of the patients who underwent surgery with a curative aim, 89% had a full recovery. Postoperative complications occurred in half of the patients, but postoperative mortality was rare. Conclusions. The incidence of insulinomas has increased during the past three decades. Despite the improved diagnostic options, diagnostic delay has remained unchanged. To shorten the delay, clinicians should be informed and alert to consider the possibility of hypoglycemia and insulinoma, when symptomatic attacks are investigated in different sectors of the healthcare system. Developing the surgical treatment is another major target, in order to lower the overall complication rate, without compromising the high cure rate of insulinomas.Peer reviewe

Response to letter on use of functional imaging by 11C-metomidate PET for primary aldosteronism subtyping

Non peer reviewe

Long-term morbidity and mortality in patients diagnosed with an insulinoma

Objective: Insulinomas are rare functional pancreatic neuroendocrine tumours. As previous data on the long-term prognosis of insulinoma patients are scarce, we studied the morbidity and mortality in the Finnish insulinoma cohort. Design: Retrospective cohort study. Methods: Incidence of endocrine, cardiovascular, gastrointestinal and psychiatric disorders, and cancers was compared in all the patients diagnosed with an insulinoma in Finland during 1980-2010 (n = 79, including two patients with multiple endocrine neoplasia type 1 syndrome), vs 316 matched controls, using the Mantel-Haenszel method. Overall survival was analysed with Kaplan-Meier and Cox regression analyses. Results: The median length of follow-up was 10.7 years for the patients and 12.2 years for the controls. The long-term incidence of atrial fibrillation (rate ratio (RR): 2.07 (95% CI: 1.02-4.22)), intestinal obstruction (18.65 (2.09-166.86)), and possibly breast (4.46 (1.29-15.39) and kidney cancers (RR not applicable) was increased among insulinoma patients vs controls, P < 0.05 for all comparisons. Endocrine disorders and pancreatic diseases were more frequent in the patients during the first year after insulinoma diagnosis, but not later on. The survival of patients with a non-metastatic insulinoma (n = 70) was similar to that of controls, but for patients with distant metastases (n = 9), the survival was significantly impaired (median 3.4 years). Conclusions: The long-term prognosis of patients with a non-metastatic insulinoma is similar to the general population, except for an increased incidence of atrial fibrillation, intestinal obstruction, and possibly breast and kidney cancers. These results need to be confirmed in future studies. Metastatic insulinomas entail a markedly decreased survival.publishedVersionPeer reviewe

Characteristics and Outcomes of 79 Patients with an Insulinoma: A Nationwide Retrospective Study in Finland

Objective. Insulinomas are rare pancreatic tumours. Population-based data on their incidence, clinical picture, diagnosis, and treatment are almost nonexistent. The aim of this study was to clarify these aspects in a nationwide cohort of insulinoma patients diagnosed during three decades. Design and Methods. Retrospective analysis on all adult patients diagnosed with insulinoma in Finland during 1980-2010. Results. Seventy-nine patients were diagnosed with insulinoma over the research period. The median follow-up from diagnosis to last control visit was one (min 0, max 31) year. The incidence increased from 0.5/million/year in the 1980s to 0.9/million/year in the 2000s (p = 0 002). The median diagnostic delay was 13 months and did not change over the study period. The mean age at diagnosis was 52 (SD 16) years. The overall imaging sensitivity improved from 39% in the 1980s to 98% in the 2000s (p < 0 001). Seventy- one (90%) of the patients underwent surgery with a curative aim, two (3%) had palliative surgery, and 6 (8%) were inoperable. There were no significant differences in the types of surgical procedures between the 1980s, 1990s, and 2000s; tumour enucleations comprised 43% of the operations, distal pancreatic resections 45%, and pancreaticoduodenectomies 12%, over the whole study period. Of the patients who underwent surgery with a curative aim, 89% had a full recovery. Postoperative complications occurred in half of the patients, but postoperative mortality was rare. Conclusions. The incidence of insulinomas has increased during the past three decades. Despite the improved diagnostic options, diagnostic delay has remained unchanged. To shorten the delay, clinicians should be informed and alert to consider the possibility of hypoglycemia and insulinoma, when symptomatic attacks are investigated in different sectors of the healthcare system. Developing the surgical treatment is another major target, in order to lower the overall complication rate, without compromising the high cure rate of insulinomas

Vanhuusiän yksinäisyys : seuruututkimus emotionaalista ja sosiaalista yksinäisyyttä määrittävistä tekijöistä

The first purpose of this study was to examine perceived loneliness among elderly persons aged 80 at the baseline and stability and changes in loneliness over a 5-year follow-up. In addition, the extent to which different factors are associated with and predict loneliness was explored. The second purpose was to study the structure and stability and the predictors of perceived togetherness in men and women over the 5-year period. The overall aim was to identify the determinants of loneliness in old age. The target population of this study comprised all persons born in 1910 and 1914 and living in Jyväskylä. At age 80, 91.1 % (n = 512) of those eligible participated in the home-interviews and 70.5% (n=396) in the laboratory tests. The corresponding figures at age 85 were 88.7% (n = 306) and 57.7% (n =199). The interviews and laboratory tests dealt with sociodemographic and economic factors, social ties, health and functional status. Loneliness was measured with the question “Do you suffer from loneliness?” and perceived togetherness with the Social Provision Scale. In the cross-sectional and longitudinal material about 10% of the participants experienced loneliness often or almost always. The proportion of those who said they felt lonely increased during the follow-up, but changes also occurred in the other direction, lonely to non-lonely. The determinants of perceived loneliness were widowhood, living alone, depressiveness, poor self-rated health and difficulties in ADL functioning. The explanatory power of perceived togetherness was rather low. Perceived togetherness was differentiated into the factors of emotional and social togetherness; the structure remained unchanged during the 5-year follow-up. Perceived togetherness decreased with increasing age. The results showed some gender differences in the predictors of both perceived emotional and perceived social togetherness. Moreover, there appeared to be two subgroups of women and men; these were labeled Socially embedded, Socially isolated, Socially active and Solitary. The best determinants of emotional togetherness were less depressiveness, more contacts with friends and education level and of social togetherness friends and IADL functioning. The results also showed that loneliness could be decomposed into emotional and social loneliness. Emotional loneliness was best described by negative feelings associated with widowhood and poor functioning, and social loneliness was best described by dissatisfaction with friendships and poor ADL functioning. The results show that changes and losses occurring in the domains of health, functional capacity and social relations may lead to loneliness with increasing age. Special attention should be paid to the two different dimensions of loneliness and to individual factors when developing interventions. The concept of loneliness is not clear and requires further investigation. In particular, we need more longitudinal research on long-term changes in loneliness, also in younger groups of the elderly80- ja 85-vuotiaista lähes kolmasosa kokee jossain määrin yksinäisyyttä. Yhdellä kymmenestä vanhuksesta yksinäisyyden tunteita on usein tai lähes aina.Nämä tiedot selviävät Pirjo Tiikkaisen väitöskirjasta, jossa hän tutki 80-vuotiaiden jyväskyläläisten kokemaa yksinäisyyttä ja sen muutosta viiden vuoden aikana.Yksinäiseksi itsensä kokevien osuus lisääntyi viiden vuoden seuruun aikana, mutta joillakin vanhuksilla muutosta tapahtui myös myönteiseen suuntaan.Tiikkainen tutki myös, miten sosiodemografiset, vuorovaikutussuhteita ja terveyttä ja toimintakykyä kuvaavat tekijät ovat yhteydessä yksinäisyyteen ja ennustavat yksinäisyyttä.Vanhuusiän yksinäisyydessä erottuu kaksi ulottuvuutta, emotionaalinen ja sosiaalinen yksinäisyys. Vanhuksen itsensä ilmaisema yksinäisyyden tunne heijastaa emotionaalista yksinäisyyttä, johon liittyy erilaisia kielteisiä tunteita kuten masentuneisuutta. Tärkeimmät emotionaalista yksinäisyyttä määrittävät tekijät masentuneisuuden lisäksi ovat leskeys, yksin asuminen, huonoksi koettu terveys ja alentunut toimintakyky.Sosiaalinen yksinäisyys ilmenee puutteellisiksi koettuina vuorovaikutussuhteina. Siihen johtavat erityisesti vähäiset ystäväkontaktit sekä mielialaongelmat ja huono toimintakyky, jotka vaikeuttavat kontaktien ylläpitämistä. Parempi koulutustaso vähentää sosiaalista yksinäisyyttä.Terveyden ja toimintakyvyn heikkeneminen ja ihmissuhteiden menetykset aiheuttavat yksinäisyyden tunteita vanhuusiässä. Vanhuksen itsensä ilmaisemaan yksinäisyyden tunteeseen sosiaalisilla suhteilla on vähäinen merkitys erityisesti vanhemmalla iällä. Auttamiskeinoja kehitettäessä tulee ottaa huomioon yksinäisyyden emotionaalinen ja sosiaalinen ulottuvuus, koska niihin molempiin eivät välttämättä sovellu samat hoitokeinot. Soveltuvien auttamismenetelmien löytyminen emotionaalisesta yksinäisyydestä kärsiville vanhuksille voi olla haastavampaa kuin sosiaalisesta yksinäisyydestä kärsiville, joille erilaisista sosiaalisista interventioista kuten ystävä- ja vertaisryhmistä voi löytyä apua. Emotionaalisesta yksinäisyydestä kärsiville taas masentuneisuuden tunnistaminen ja siihen johtaneiden syiden hoitaminen on ensisijaista

Kukoistava kotihoito : Kotihoidon työntekijöiden itsearvioitu osaaminen

Asiakaslähtöisen kotihoidon kehittäminen maakunnissa vaatii henkilökunnalta monipuolista osaamista. Keski-Suomen Kukoistava kotihoito-hankkeessa kartoitettiin koko kotihoidon henkilöstön osaaminen tarkoituksena kuvata osaamisen nykyinen taso sekä tunnistaa kehittämistarpeet. Osaamiskartoituksen tavoitteena oli suunnata kotihoidon työntekijöitä pohtimaan, miten he soveltavat omaa osaamistaan ja mikä on heidän roolinsa asiakkaan tarpeisiin vastaamisessa yhteistyössä muiden ammattilaisten kanssa asiakaslähtöisesti. Osaamisen itsearviointi toteutettiin sähköisenä lokakuussa 2017 ydinosaamisen pohjalta laaditulla mittarilla. Osaamiskartoituksen tuloksia voidaan hyödyntää osaamisen vahvistamisessa, ammattiryhmäkohtaisten osaamiskarttojen laatimisessa ja maakunnan sähköisen osaamisen tietokannan kehittämisessä. Näin olemassa oleva osaaminen pystytään tunnistamaan ja hyödyntämään mahdollisimman optimaalisesti. Osaamiskartoitus oli laaja, jotta sen pohjalta saatiin mahdollisimman monipuolinen kuva kotihoidossa jo olemassa olevasta osaamisesta ja tietoa tulevaisuuden osaamisen kehittämistarpeista. Tässä julkaisussa kuvataan kotihoidon ydinosaaminen, itsearviointimittarin laatiminen sekä osaamiskartoituksen tulokset. Lopuksi annetaan kehittämisehdotuksia kotihoidon osaamisen kehittämiseen.Developing person-centered home care in provinces requires versatile competence from the staff. Central Finland’s Flourishing Home Care Project studied the entire expertise of the home care staff in order to describe the current level of competence and to identify development needs. The goal of the home care competence survey was to direct the home care staff to reflect on how they apply their skills and what their role is in responding to their clients’ needs in co-operation with other professionals using personcentered orientation. The self-assessment of competence was carried out electronically in October 2017 using an assessment tool based on core competences. The results of the competence survey can be used in strengthening competence, developing competence maps for various professional groups and developing province’s e-competence database. Thus, existing expertise can be identified and utilized as optimally as possible. The competence survey was extensive in order to provide the most versatile picture of the existing competence in home care and information on the future development needs. This paper describes the core competence of home care, the selfassessment tool and the results of the competence survey. Finally, development suggestions are provided in order to develop home care competence