Suoran vatsalihaksen erkauma ja alaselkäkipu fysioterapian näkökulmasta tarkasteltuna

Suoran vatsalihaksen erkaumalla tarkoitetaan vatsalihasten keskilinjassa kulkevan linea alban venyttymistä ja ohenemista sekä suoran vatsalihaksen vasemman ja oikean osan erkaantumista lateraalisesti. Suoran vatsalihaksen erkaumaan voi vaikuttaa mm. raskaushormonit, vatsaontelon sisäinen rasva tai liiallinen vatsalihasten harjoittelu. Fysioterapiassa erkauma tutkitaan havainnoimalla, palpoimalla ja mittaamalla sormin, mittareilla tai ultraäänen avulla. Erkauman fysioterapia sisältää erkauman aiheuttamien toimintahäiriöiden ja erkaantuman palauttamista terapeuttisen harjoittelun keinoin. Suoran vatsalihaksen erkaumaa on tutkittu jo jonkin verran ja se on hyvin yleinen syy hakeutua fysioterapiaan. Erkauman yhteyttä selkäkipuun on sen sijaan tutkittu vielä melko vähän. Tämä tutkimus on kuvaileva kirjallisuuskatsaus, joka on tehty yhteistyössä Pohjois-Pohjanmaan sairaanhoitopiirin (PPSHP) kanssa. Tämän tutkimuksen tavoitteena on selvittää suoran vatsalihaksen erkauman yhteyttä alaselkäkipuun ja tarkastella sitä fysioterapian näkökulmasta. Aineistonhaku tehtiin seuraaviin tietokantoihin: Ebsco, PEDro - Physiotherapy Evidence Database, Sage journals, Elsevier Science Direct, PubMed, Cochrane, Medic ja Google Scholar. Tiedonhaussa valittiin sisäänottokriteerien perusteella 15 tutkimusta. Tutkimukset analysoitiin käyttäen aineistolähtöistä sisällönanalyysiä. Kirjallisuuskatsauksen tulokset ovat ristiriitaiset. Kolmessa tutkimuksessa ei löytynyt selkeää yhteyttä suoran vatsalihaksen erkauman ja alaselkäkivun välillä. Puolestaan 12 tutkimuksessa erkaumasta kärsivillä havaittiin enemmän alaselkäkipua. Tutkimuksia, joista löytyi yhteys erkauman ja alaselkäkivun välillä, yhdisti se, että niissä alaselkäkipu oli suurimmaksi osaksi mitattu toimintakykyä laaja-alaisesti arvioivalla mittarilla muihin tutkimuksiin verrattuna. Lisäksi näissä tutkimuksissa tutkimusten kohdejoukko koostui suurimmalta osin synnyttäneistä naisista, joiden iän keskiarvo oli korkeampi muihin tutkimuksiin verrattuna. Kyseisissä tutkimuksissa oli raportoitu erkauman lisäksi myös muita toimintahäiriöitä. Sen sijaan tutkimuksia, joista ei löytynyt yhteyttä erkauman ja selkäkivun välillä, yhdisti se, että selkäkivun mittaamiseen oli käytetty kapea-alaista mittaria. Lisäksi kyseisissä tutkimuksissa kohdejoukkona olivat raskaana olevat naiset ja kohdejoukon iän keskiarvo oli huomattavasti muihin tutkimuksiin verrattuna matalampi. Tutkimuksissa, joissa erkauma hoidettiin kirurgisesti, selkäkipu väheni merkittävästi operaation jälkeen. Suurimmat erot tutkimuksissa löytyi erkauman mittaustavoissa, sekä selkäkivun mittaamiseen käytetyissä mittareissa. Fysioterapian osuus tutkimuksissa oli vähäistä. Fysioterapeutteja oli tutkimuksissa mukana joko tutkijan roolissa tai osana työryhmää kliinikkona.Diastasis of the rectus abdominis (DRA) is a common condition to seek for physical therapy and there is a quite good amount of research at hand. As for the connection of DRA and low back pain (LBP), there is only a small amount of research available. The aim of this study is to determine the connection between DRA and LBP, and to examine the connection from the physical therapy's point of view. This study is a descriptive literary survey made in cooperation with Oulu University Hospital. The material was searched in the following databases: Ebsco, PEDro - Physiotherapy Evidence Database, Sage journals, Elsevier Science Direct, PubMed, Cochrane, Medic and Google Scholar. The search includes 15 articles, and they were analyzed using material based content analysis. The results are inconsistent. In some of the studies there was no clear connection found. On the other hand, in most of the studies people with DRA suffered more from LBP. In the studies that had the connection between DRA and LBP, back pain was mostly measured with integrated measuring methods. In addition, the target group in these studies was mostly women who have had at least one child, and who had a higher mean age. The target group also had other functional disorders besides low back pain. In the studies that did not find connection between DRA and LBP measuring methods for back pain were subjective. The target group consisted of pregnant or younger women. In all of the studies that reported surgical DRA treatment, LBP diminished substantially. Measuring methods for LBP and DRA varied a great deal. The connection to physical therapy was scant. In some studies physical therapists were included as researchers or as a part of the crew, performing measurements, for example. Physical therapists should examine DRA when evaluating LBP causes. Therapists should also continue to rehabilitate the condition in spite of the inconsistent results of this study. The field should standardize their measurement methods for evaluating DRA and use integrated measuring methods when evaluating LBP for more reliable results and for the benefit of the patient

Metsistä ja soilta tuleva vesistökuormitus 2020

Metsätalouden osuus metsistä ja soilta tulevasta typen kokonaiskuormituksesta on uuden arvion mukaan 16 % (7 300 tonnia/v), fosforikuormituksesta 25 % (440 tonnia/v) ja orgaanisen hiilen kuormituksesta 78 000 tonnia/v. Uusissa typpi- ja fosforikuormitusarvioissa näkyy selvästi metsäojitusten vaikutus. Metsätalouden osuus kaikesta ihmistoiminnan aiheuttamasta typpikuormituksesta nousee 6 %:sta 12 %:iin ja fosforikuormituksesta vastaavasti 8 %:sta 14 %:iin. Vuosittaiseksi metsistä ja soilta tulevaksi typen kokonaiskuormitukseksi arvioidaan 44 600 tonnia, fosforin kokonaiskuormitukseksi 1 760 tonnia ja orgaanisen hiilen kokonaiskuormitukseksi 1,8 miljoonaa tonnia. Luonnonhuuhtouma on suurinta Etelä-Suomessa. Metsätalouden aiheuttama ravinnekuormitus on puolestaan suurinta Pohjanmaalla ja Kainuussa, missä on paljon ojitettuja soita. Aiemmin metsäojituksen on oletettu aiheuttavan ravinnekuormitusta 10 vuoden ajan. Uusien tulosten mukaan kuormitus jatkuu pidempään. Hankkeen tulosten mukaan metsistä tuleva fosforikuormitus on vähentynyt viime vuosiin asti. Valumaveden typen- ja orgaanisen hiilen pitoisuuksissa havaittiin nousevia trendejä vuosina 1978–2018. Samanaikaisesti ilman lämpötilassa, hydrologiassa ja happamassa laskeuma on tapahtunut muutoksia, jotka voivat selittää kuormitusta. Tutkijoiden mukaan typen ja orgaanisen hiilen kuormituksen hallintaan tulisi kehittää uusia menetelmiä erityisesti turvemaille. MetsäVesi-hankkeen tulokset tulisi sisällyttää vesienhoidossa käytettävään VEMALA-mallijärjestelmään, ja ne tulisi jatkossa huomioida myös virallisissa raportoinneissa. MetsäVesi-hanke toteutettiin vuoden 2019 aikana yhteistyössä Luonnonvarakeskuksen (Luke), Suomen ympäristökeskuksen (SYKE), Tapio Oy:n ja Oulun yliopiston tutkijoiden kanssa. Työssä hyödynnettiin laajoja valtakunnallisia veden laadun ja virtaaman seuranta-aineistoja

Towards an operationalisation of nature-based solutions for natural hazards

Nature-based solutions (NBS) are being promoted as adaptive measures against predicted increasing hydrometeorological hazards (HMHs), such as heatwaves and floods which have already caused significant loss of life and economic damage across the globe. However, the underpinning factors such as policy framework, end-users' interests and participation for NBS design and operationalisation are yet to be established. We discuss the operationalisation and implementation processes of NBS by means of a novel concept of Open-Air Laboratories (OAL) for its wider acceptance. The design and implementation of environmentally, economically, technically and socio-culturally sustainable NBS require inter- and transdisciplinary approaches which could be achieved by fostering co-creation processes by engaging stakeholders across various sectors and levels, inspiring more effective use of skills, diverse knowledge, manpower and resources, and connecting and harmonising the adaptation aims. The OAL serves as a benchmark for NBS upscaling, replication and exploitation in policy-making process through monitoring by field measurement, evaluation by key performance indicators and building solid evidence on their short- and long-term multiple benefits in different climatic, environmental and socio-economic conditions, thereby alleviating the challenges of political resistance, financial barriers and lack of knowledge. We conclude that holistic management of HMHs by effective use of NBS can be achieved with standard compliant data for replicating and monitoring NBS in OALs, knowledge about policy silos and interaction between research communities and end-users. Further research is needed for multi-risk analysis of HMHs and inclusion of NBS into policy frameworks, adaptable at local, regional and national scales leading to modification in the prevalent guidelines related to HMHs. The findings of this work can be used for developing synergies between current policy frameworks, scientific research and practical implementation of NBS in Europe and beyond for its wider acceptance

Towards operationalisation of nature-based solutions for natural hazards

Nature-based solutions (NBS) are being promoted as adaptive measures against predicted increasing hydrometeorological hazards (HMHs), such as heatwaves and floods which have already caused significant loss of life and economic damage across the globe. However, the underpinning factors such as policy framework, end-users' interests and participation for NBS design and operationalisation are yet to be established. We discuss the operationalisation and implementation processes of NBS by means of a novel concept of Open-Air Laboratories (OAL) for its wider acceptance. The design and implementation of environmentally, economically, technically and socio-culturally sustainable NBS require inter- and transdisciplinary approaches which could be achieved by fostering co-creation processes by engaging stakeholders across various sectors and levels, inspiring more effective use of skills, diverse knowledge, manpower and resources, and connecting and harmonising the adaptation aims. The OAL serves as a benchmark for NBS upscaling, replication and exploitation in policy-making process through monitoring by field measurement, evaluation by key performance indicators and building solid evidence on their short- and long-term multiple benefits in different climatic, environmental and socio-economic conditions, thereby alleviating the challenges of political resistance, financial barriers and lack of knowledge. We conclude that holistic management of HMHs by effective use of NBS can be achieved with standard compliant data for replicating and monitoring NBS in OALs, knowledge about policy silos and interaction between research communities and end-users. Further research is needed for multi-risk analysis of HMHs and inclusion of NBS into policy frameworks, adaptable at local, regional and national scales leading to modification in the prevalent guidelines related to HMHs. The findings of this work can be used for developing synergies between current policy frameworks, scientific research and practical implementation of NBS in Europe and beyond for its wider acceptance

Sleep-related breathing disorder in non-infectious pulmonary complications after pediatric allogeneic stem cell transplantation

Background Chronic lung problems are a rare but serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). We studied clinical phenotypes and polysomnography appearance of breathing abnormality in late onset non-infectious pulmonary complications (NIPS). Methods We reviewed Finnish national reference database between the years 1999 and 2016. We identified 12 children with most severely decreased pulmonary function and performed polysomnography and 24 aged-matched controls out of 325 performed pediatric allogeneic HSCTs. Results All patients with NIPS had severely decreased pulmonary function already at 6 months post HSCT with median FEV1 value 42% (interquartile range (IQR) 30-52%) of predicted normal values. Seven children had obstructive and five children more restrictive lung function. Children with obstructive lung function showed laborious breathing (7/7), decreased oxygenation and ventilation-to-perfusion mismatch (6/7), or REM-sleep-related hypoventilation (4/7) on polysomnography. Children with restrictive lung function (5/12) did not show sleep-related breathing disorder. Conclusions Children going through allogeneic HSCT who develop severe chronic obstructive lung function are more likely to present with sleep-related hypoxia and hypoventilation than children with restrictive lung function. Impact Children with severe obstructive lung function and chronic lung graft-versus-host disease following hematopoietic stem cell transplantation are more likely to present with sleep-related mild hypoxia and hypoventilation than children with restrictive lung disease. To our knowledge there are no reports on sleep-related breathing disorders and ventilatory function measured by polysomnography in children with pulmonary complications after allogeneic HSCT. Polysomnography may add to the differential diagnostics between patients with BOS and other non-infectious pulmonary complications.Peer reviewe

Metsätalouden vesistökuormituksen arviointimenetelmiä on kehitettävä

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Sleep-related breathing disorder in non-infectious pulmonary complications after pediatric allogeneic stem cell transplantation

Abstract Background: Chronic lung problems are a rare but serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). We studied clinical phenotypes and polysomnography appearance of breathing abnormality in late onset non-infectious pulmonary complications (NIPS). Methods: We reviewed Finnish national reference database between the years 1999 and 2016. We identified 12 children with most severely decreased pulmonary function and performed polysomnography and 24 aged-matched controls out of 325 performed pediatric allogeneic HSCTs. Results: All patients with NIPS had severely decreased pulmonary function already at 6 months post HSCT with median FEV1 value 42% (interquartile range (IQR) 30–52%) of predicted normal values. Seven children had obstructive and five children more restrictive lung function. Children with obstructive lung function showed laborious breathing (7/7), decreased oxygenation and ventilation-to-perfusion mismatch (6/7), or REM-sleep-related hypoventilation (4/7) on polysomnography. Children with restrictive lung function (5/12) did not show sleep-related breathing disorder. Conclusions: Children going through allogeneic HSCT who develop severe chronic obstructive lung function are more likely to present with sleep-related hypoxia and hypoventilation than children with restrictive lung function. Impact: Children with severe obstructive lung function and chronic lung graft-versus-host disease following hematopoietic stem cell transplantation are more likely to present with sleep-related mild hypoxia and hypoventilation than children with restrictive lung disease. To our knowledge there are no reports on sleep-related breathing disorders and ventilatory function measured by polysomnography in children with pulmonary complications after allogeneic HSCT. Polysomnography may add to the differential diagnostics between patients with BOS and other non-infectious pulmonary complications

Metsistä ja soilta tuleva vesistökuormitus 2020 – MetsäVesi-hankkeen loppuraportti

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Drainage for forestry increases N, P and TOC export to boreal surface waters

Highlights • N, P and TOC export from forests to streams needs more reliable assessments. • Long-term data were used to assess export at different spatial scales in Finland. • N, P and TOC concentrations increased with temperature sum, i.e. from north to south. • Long-term impacts of forest drainage are much bigger than previously estimated. • Drained areas of forests are hotspots for the export of N, P and TOC.More reliable assessments of nutrient export to surface waters and the Baltic Sea are required to achieve good ecological status of all water bodies. Previous nutrient export estimates have recently been questioned since they did not include the long-term impacts of drainage for forestry. We made new estimates of the total nitrogen (N), total phosphorus (P) and total organic carbon (TOC) export from forests to surface waters at different spatial scales in Finland. This was done by formulating statistical equations between streamwater concentrations and climate, soil, forest management and runoff variables and spatial data on catchment characteristics. The equations were based on a large, long-term runoff and streamwater quality dataset, which was collected from 28 pristine and 61 managed boreal forest catchments located around Finland. We found that the concentrations increased with temperature sum (TS), i.e. from north to south. Nitrogen, P and TOC concentrations increased with the proportion of drained areas in the catchment; those of N and TOC also increased with the proportion of peatlands. In contrast, with the increasing concentrations of N and TOC with time, P concentrations showed a decreasing trend over the last few decades. According to our estimates, altogether 47,300 Mg of N, 1780 Mg of P and 1814 Gg of TOC is transported from forest areas to surface waters in Finland. Forest management contributes 17% of the N export, 35% of the P export and 12% of the TOC export. Our new forest management export estimates for N and P are more than two times higher than the old estimates used by the environment authorities. The differences may be explained by the long-term impact of forest drainage. The spatial results indicate that peatland forests are hotspots for N, P and TOC export, especially in the river basins draining to the Gulf of Bothnia

Metsätalouden vesistökuormituksesta uudet arviot

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