Lapsen äkillisen välikorvatulehduksen hoidon ohjaus ja kotihoito-ohje vanhemmille

Toiminnallisen opinnäytetyömme tarkoituksena oli laatia vanhemmille kirjallinen kotihoito-ohje lasten äkillisen välikorvatulehduksen kotihoidosta sekä jälkitarkastuksesta Tikkurilan terveysasemalle. Lisäksi tarkoituksena oli kuvata opinnäytetyön teoreettisessa viitekehyksessä lasten äkillisen välikorvatulehduksen hoitoa ja lapsiperheen ohjaamista avovastaanotolla. Opinnäytetyön tavoitteena oli tuottaa hoitajien ohjauksen tueksi kotihoito-ohje lasten äkillisen välikorvatulehduksen kotihoidosta ja jälkitarkastuksesta. Opinnäytetyön teoreettinen viitekehys välikorvatulehduksesta ja sen hoidosta sekä viitekehyksen pohjalta laadittu kotihoito-ohje on laadittu ennen syyskuussa 2017 laadittuja uusia Käypä hoito -suosituksia. Äkillinen välikorvatulehdus on yksi lapsuusiän yleisimmistä infektioista. Suurimmillaan sen ilmaantuvuus on 0,5-2-vuotiailla lapsilla. Suomessa lapsilla diagnosoidaan arviolta 500 000 äkillistä välikorvatulehdusta vuosittain. Suurin osa niistä hoidetaan mikrobi- ja kipulääkkeillä kotona. Tämän vuoksi vanhempien riittävällä tiedolla lapsen äkillisestä välikorvatulehduksesta on suuri rooli hoidon onnistumisen näkökulmasta. Vastuu tiedon ja ohjauksen antamisesta on perhettä hoitavalla hoitohenkilökunnalla.The purpose of this functional thesis was to provide parents with home care instructions for children’s acute otitis media and post infection review guidance at Tikkurila Health Center. The theoretical framework of the thesis also discusses the treatment of children acute otitis media and family guidance on an open practice unit. The goal of this thesis was to develop home care instructions and post infection review practices for children acute otitis media which health care nurses can use while counseling parents. The theoretical framework of this thesis deals with acute otitis media and its treatment as well as the home care instructions that have been written before September 2017 when the Current Care Guidelines (Käypä hoito) were developed. Acute otitis media is one of the most common infections in childhood. At its highest, its incidence is in children aged 0.5-2 years. Approximately 500,000 acute otitis media are diagnosed in children every year in Finland. Most of them are treated with microbial- and analgesic medicine at home. Therefore, with sufficient information for the parents, the child´s acute otitis media plays a major role in the success of the treatment. The responsibility to provide information and guidance for families is borne by health care nurses

Retinal Temperature Determination Based on Photopic Porcine Electroretinogram

Objective: Subthreshold retinal laser therapy (SLT) is a treatment modality where the temperature of the retinal pigment epithelium (RPE) is briefly elevated to trigger the therapeutic benefits of sublethal heat shock. However, the temperature elevation induced by a laser exposure varies between patients due to individual differences in RPE pigmentation and choroidal perfusion. This study describes an electroretinography (ERG)-based method for controlling the temperature elevation during SLT. Methods: The temperature dependence of the photopic ERG response kinetics were investigated both ex vivo with isolated pig retinas and in vivo with anesthetized pigs by altering the temperature of the subject and recording ERG in different temperatures. A model was created for ERG-based temperature estimation and the feasibility of the model for controlling SLT was assessed through computational simulations. Results: The kinetics of the photopic in vivo flash ERG signaling accelerated between 3.6 and 4.7%/degrees C, depending on the strength of the stimulus. The temperature dependence was 5.0%/degrees C in the entire investigated range of 33 to 44 degrees C in ex vivo ERG. The simulations showed that the method is suitable for determining the steady-state temperature elevation in SLT treatments with a sufficiently long laser exposure and large spot size, e.g., during > 30 s laser exposures with > 3 mm stimulus spot diameter. Conclusions: The described ERG-based temperature estimation model could be used to control SLT treatments such as transpupillary thermotherapy. Significance: The introduced ERG-based method for controlling SLT could improve the repeatability, safety, and efficacy of the treatment of various retinal disorders.Peer reviewe

Psychotherapy and change in mental health-related work disability : a prospective Finnish population-level register-based study with a quasi-experimental design

Background Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability. Methods We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied. Results The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group. Conclusions This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.Peer reviewe

Polar Northern Hemisphere Middle Atmospheric Influence due to Energetic Particle Precipitation in January 2005

Solar eruptions and geomagnetic activity led to energetic particle precipitation in early 2005, primarily during the January 16-21 period. Production of OH and destruction of ozone have been documented due to the enhanced energetic solar proton flux in January 2005 [e.g., Verronen et al., Geophys. Res. Lett.,33,L24811,doi:10.1029/2006GL028115, 2006; Seppala et al., Geophys. Res. Lett.,33,L07804, doi:10.1029/2005GL025571,2006]. These solar protons as well as precipitating electrons also led to the production of NO(x) (NO, NO2). Our simulations with the Whole Atmosphere Community Climate Model (WACCM) show that NO(x) is enhanced by 20-50 ppbv in the polar Northern Hemisphere middle mesosphere (approx.60-70 km) by January 18. Both the SCISAT-1 Atmospheric Chemistry Experiment (ACE) NO(x) measurements and Envisat Michelson Interferometer for Passive Atmospheric Sounding (MIP AS) nighttime NO2 observations show large increases during this period, in reasonable agreement with WACCM predictions. Such enhancements are considerable for the mesosphere and led to simulated increases in polar Northern Hemisphere upper stratospheric odd nitrogen (NO(y)) of2-5 ppbv into February 2005. The largest ground level enhancement (GLE) of solar cycle 23 occurred on January 20, 2005 with a neutron monitor increase of about 270 percent [Gopalswamy et al., 29th International Cosmic Ray Conference, Pune,00,101-104,2005]. We found that protons of energies 300 to 20,000 MeV, not normally included in our computations, led to enhanced stratospheric NO(y) of less than 1 percent as a result of this GLE. The atmospheric impact of precipitating middle energy electrons (30-2,500 keV) during the January 16-21, 2005 period is also of interest, and an effort is ongoing to include these in WACCM computations. This presentation will show both short- and longer-term changes due to the January 2005 energetic particle precipitation

Effects of intramuscular vatinoxan (MK-467), co-administered with medetomidine and butorphanol, on cardiopulmonary and anaesthetic effects of intravenous ketamine in dogs

Objective To investigate the impact of intramuscular (IM) co-administration of the peripheral alpha(2)-adrenoceptor agonist vatinoxan (MK-467) with medetomidine and butorphanol prior to intravenous (IV) ketamine on the cardiopulmonary and anaesthetic effects in dogs, followed by atipamezole reversal. Study design Randomized, masked crossover study. Animals A total of eight purpose-bred Beagle dogs aged 3 years. Methods Each dog was instrumented and administered two treatments 2 weeks apart: medetomidine (20 mu g kg(-1)) and butorphanol (100 mu g kg(-1)) premedication with vatinoxan (500 mu g kg(-1); treatment MVB) or without vatinoxan (treatment MB) IM 20 minutes before IV ketamine (4 mg kg(-1)). Atipamezole (100 mu g kg(-1)) was administered IM 60 minutes after ketamine. Heart rate (HR), mean arterial (MAP) and central venous (CVP) pressures and cardiac output (CO) were measured; cardiac (CI) and systemic vascular resistance (SVRI) indices were calculated before and 10 minutes after MVB or MB, and 10, 25, 40, 55, 70 and 100 minutes after ketamine. Data were analysed with repeated measures analysis of covariance models. A p-value Results At most time points, HR and CI were significantly higher, and SVRI and CVP significantly lower with MVB than with MB. With both treatments, SVRI and MAP decreased after ketamine, whereas HR and CI increased. MAP was significantly lower with MVB than with MB; mild hypotension (57-59 mmHg) was recorded in two dogs with MVB prior to atipamezole administration. Sedation, induction, intubation and recovery scores were not different between treatments, but intolerance to the endotracheal tube was observed earlier with MVB. Conclusions and clinical relevance Haemodynamic performance was improved by vatinoxan co-administration with medetomidine-butorphanol, before and after ketamine administration. However, vatinoxan was associated with mild hypotension after ketamine with the dose used in this study. Vatinoxan shortened the duration of anaesthesia.Peer reviewe

Labor Market Participation Before and After Long-Term Part-Time Sickness Absence in Finland A Population-Based Cohort Study

Objective: To examine trends in labor market participation among those with long-term part-time or long-term full-time sickness absence. Methods: Finnish population-based cohort study including 3406 individuals with greater than 30-day part-time sickness absence in 2011 and 42,944 individuals with greater than 30-day full-time sickness absence in 2011. Results: Compared to previous years, the rates of sickness absence and vocational rehabilitation increased after 2011 in both groups. Sickness absence rate was higher in 2012 in the full-time sickness absence group than in the part-time sickness absence group. An increasing trend in unemployment after 2011 was observed in both groups, but the absolute level of unemployment was higher in the full-time sickness absence group. Conclusion: Long-term part-time sickness absence seems to mark a decline in labor market participation, but the decline is smaller than that in employees with full-time sickness absence.Peer reviewe

Distinct fatty acid signatures in infrapatellar fat pad and synovial fluid of patients with osteoarthritis versus rheumatoid arthritis

Background: Infrapatellar fat pad (IFP) has recently emerged as a potential source of inflammation in knee arthropathies. It has been proposed to be one source of adipocytokines, fatty acids (FA), and FA-derived lipid mediators that could contribute to the pathophysiological processes in the knee joint. Alterations in synovial fluid (SF) lipid composition have been linked to both osteoarthritis (OA) and rheumatoid arthritis (RA). The aim of the present study was to compare the FA signatures in the IFP and SF of RA and OA patients. Methods: Pairs of IFP and SF samples were collected from the same knees of RA (n=10) and OA patients (n=10) undergoing total joint replacement surgery. Control SF samples (n=6) were harvested during diagnostic or therapeutic arthroscopic knee surgery unrelated to RA or OA. The FA composition in the total lipids of IFP and SF was determined by gas chromatography with flame ionization and mass spectrometric detection. Results: Arthropathies resulted in a significant reduction in the SF proportions of n-6 polyunsaturated FA (PUFA), more pronouncedly in OA than in RA. OA was also characterized with reduced percentages of 22:6n-3 and lower product/precursor ratios of n-3 PUFA. The proportions of total monounsaturated FA increased in both RA and OA SF. Regarding IFP, RA patients had lower proportions of 20:4n-6, total n-6 PUFA, and 22:6n-3, as well as lower product/precursor ratios of n-3 PUFA compared to OA patients. The average chain length of SF FA decreased in both diagnoses and the double bond index in OA. Conclusions: The observed complex alterations in the FA signatures could have both contributed to but also limited the inflammatory processes and cartilage destruction in the RA and OA knees.Peer reviewe

Työkyvyn tuen vaikuttavuus Tutkimuskatsaus työkyvyn tukitoimien työkyky- ja kustannusvaikutuksista

Katsauksen tavoitteena oli tunnistaa yksilö-, työpaikka- ja yhteiskuntatason työkyvyttömyyttä ehkäiseviä ja varhaisen työkyvyn tuen toimenpiteitä sekä selvittää, miten niiden vaikutuksia on mitattu ja mitä vaikutuksista tiedetään. Tutkimuksissa työkykyä arvioitiin useimmiten työkyvyttömyyden, sairauden tai oirehtimisen näkökulmista. Eniten tutkimusta oli yksilötason toimenpiteistä. Vahvinta näyttöä löytyi elintapainterventioiden, yksilölähtöisen stressinhallinnan, korvaavan työn mallin ja työn muokkauksen, osasairauspäivärahan ja yksilöpsykoterapian myönteisistä vaikutuksista. Kohtuullista näyttöä löytyi työuravalmennuksen, työkykykoordinaattoritoiminnan, psykososiaalisen työympäristön ja fyysisen ergonomian kehittämisen myönteisistä vaikutuksista. Erilaisten toimenpiteiden yhdistäminen todettiin usein vaikuttavaksi. Elintapainterventiot, yksilölähtöinen stressinhallinta, fyysisen ergonomian kehittäminen ja osasairauspäiväraha sekä jotkut psykoterapiamuodot voivat tuottaa myönteisiä kustannusvaikutuksia. Näytön puuttuminen ei tarkoita vaikutusten puuttumista. Lisää tutkimusta tarvitaan työyhteisö- ja yhteiskuntatason toimenpiteistä, työkykyjohtamisen kokonaisuuden, työelämän joustojen ja sairauspoissaolojen omailmoituskäytäntöjen vaikuttavuudesta.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä