Raskaana olevien mielipiteitä sikiöseulonnoista saamistaan tiedoista

Sikiöseulonnoista on säädetty seulonta-asetus (1339/2006), jonka perusteella kuntien sikiöseulontoja yhtenäistettiin vuoden 2010 alussa. Asetuksen mukaan kuntien tulee tarjota raskaana oleville tasavertaisesti sikiön poikkeavuuksien seulontoja ja tarvittaessa jatkotutkimuksia. Uudistettuihin sikiöseulontakäytäntöihin kuuluu varhaisraskauden ultraääni raskausviikolla (rv) 10+0-13+6, varhaisraskauden yhdistelmäseulonta, rakenneultraäänitutkimus raskausviikolla 18+0-21+6 tai raskausviikon 24 jälkeen. Opinnäytetyössämme on tarkoitus kartoittaa raskaana olevien mielipiteitä tiedoista, joita he ovat saaneet sikiöseulonnoista. Opinnäytetyömme tavoitteena on antaa sikiöseulontoja tekeville tietoa raskaana olevien mielipiteistä sikiöseulonnoista saamistaan tiedoista, jotta he voivat näiden pohjalta kehittää omaa työtänsä. Tutkimustehtävät: 1. Millaista tietoa raskaana olevat ovat saaneet sikiöseulonnoista? 2. Millaista tietoa raskaana olevat olisivat tarvinneet sikiöseulonnoista? 3. Mistä raskaana olevat ovat saaneet tietoa sikiöseulonnoista? Opinnäytetyössä on käytetty sekä määrällisen että laadullisen tutkimusmenetelmän piirteitä. Uudelleensynnyttäjiä oli 59 % (n=56) kaikista vastanneista (n=95). Ensisynnyttäjiä oli 41 % (n=39) kaikista vastanneista. Uudelleensynnyttäjillä on tulosten mukaan ollut paremmat ja kattavammat tiedot seulontoihin mennessä kuin ensisynnyttäjillä. Avoimen kysymyksen kolmeksi pääteemaksi nousi: riittävä tiedon saanti, tiedon lähde ja kehitettävät osa-alueet. Suurimmat puutteet tiedon saannissa ja sen riittävyydessä koskivat sikiöseulontojen sisältöä sekä luotettavuutta. Ensisynnyttäjät kokivat saaneensa vähemmän tietoa kuin uudelleensynnyttäjät. Suurin osa vastanneista oli saanut sikiöseulontoja koskevat tiedot neuvolasta, synnytysosastolta ja Internetistä. Aiempien tutkimusten mukaan nykykäytännöllä raskaana olevat eivät tiedä seulonnasta riittävästi voidakseen tehdä päätöksensä siihen osallistumisesta tietoisina ja asian ymmärtäneinä. Tulostemme perusteella suurimmalla osalla vastaajista on riittävästi tietoa seulontoihin tullessaan. Näin ollen Kainuussa raskaana olevat saavat mielestään riittävästi tietoa ennen sikiöseulontoihin osallistumista. Jatkotutkimusaiheita omalle opinnäytetyöllemme voisi olla tutkimuksen toistaminen esimerkiksi toisessa si-kiöseulontoja tekevässä sairaalassa. Vastaavan tutkimuksen voisi tehdä myös neuvolan terveydenhoitajille. Esimerkiksi millaisena he kokevat tiedon antamisen sikiöseulonnoista ja sen riittävyydestä.Prenatal screenings are enacted in the screening statute (1339/2006) on the basis of which the practices for prenatal screenings provided by municipalities were unified in 2010. According to the statute, municipalities must offer pregnant women an equal opportunity to screening for fetal abnormalities. The revised practices include a first trimester ultrasound examination in weeks 10+0-13+6, a combined first trimester screening and a supplementary ultrasound examination in weeks 18+0-21+6 or after week 24. Quantitative and qualitative research methods were used in this thesis. The purpose of this thesis was to chart pregnant women’s opinions of the information which they had received about prenatal screening. The objective of this thesis was to give information to health professionals who perform prenatal screenings about what kind of information pregnant women had got about screenings. The research questions were to chart firstly what kind of information pregnant women had got about prenatal screening, secondly where pregnant women had got the information, and thirdly what kind of information they would have needed. 59 % (n=56) of the respondents (n=95) were reparturient mothers and 41 % (n=39) primipara mothers. According to the results, reparturient mothers had received better and wider information than primipara mothers before they went to screenings. The three main themes to the open question were access to information, source of information and areas to be developed. As far as access to information and insufficient information were concerned, both primipara and reparturient mothers named the content and the reliability of prenatal screenings as having most shortcomings. Most respondents had got the information about prenatal screenings from the maternity clinic, maternity ward and internet. Previous researches have shown that nowadays pregnant women do not know sufficiently about prenatal screenings to make a conscious and knowledgeable decision on participation. According to the results of this thesis, most respondents have sufficient information, when they come to prenatal screening. Also, pregnant women in Kainuu think that they receive sufficient information before prenatal screening. Further research could focus on performing a similar research, for example, in another hospital where prenatal screenings are made or on studying how public health nurses feel about giving information about prenatal screenings and the adequacy of the information

Alarming development of dual snus and cigarette usage among young Finnish males

Abstract Background The consumption of tobacco products has evolved to include more complex combinations of different products. We investigated the tobacco habits of a representative population of young Finnish male conscripts in order to evaluate the prevalence of dual use of cigarettes and snus as well as the transition from one tobacco product to another. In addition, we evaluated the correlation between the level of education and the use of cigarettes and snus. Methods A questionnaire-based survey was carried out in three out of 17 garrisons among conscripts during their first week of service in 2014. A total of 1971 male conscripts were selected by simple random sampling of the 9013 males in the selected garrisons. Of them 1916 participated and filled in the questionnaire. The response rate was 97.2%. The questionnaire consisted of 25 questions including age, gender, basic education, use of tobacco products as well as questions assessing nicotine dependency. Results The amount of dual users of cigarettes and snus was 21%. There was a higher probability of dual use of cigarettes and snus among smokers compared to snus users (p < 0.001). One third (35%) of former smokers reported daily snus use and over 40% of the former snus users smoked daily. One third (34%) of the participants reported snus usage and 14% of the study subjects used snus daily. 40% of the study population were smokers and over 25% smoked daily. Of the participants with basic educational background 57% smoked daily (p < 0.001), however, no association between snus and level of education was found (p = 0.69). Conclusions This study provides better understanding of the complex tobacco habits of young adult males. The simultaneous usage of multiple tobacco products as well as the high tendency to transition from one tobacco product to another should be taken into consideration when planning cessation interventions in health care settings and tobacco control policies at societal levels

Alarming development of dual snus and cigarette usage among young Finnish males

Background The consumption of tobacco products has evolved to include more complex combinations of different products. We investigated the tobacco habits of a representative population of young Finnish male conscripts in order to evaluate the prevalence of dual use of cigarettes and snus as well as the transition from one tobacco product to another. In addition, we evaluated the correlation between the level of education and the use of cigarettes and snus. Methods A questionnaire-based survey was carried out in three out of 17 garrisons among conscripts during their first week of service in 2014. A total of 1971 male conscripts were selected by simple random sampling of the 9013 males in the selected garrisons. Of them 1916 participated and filled in the questionnaire. The response rate was 97.2%. The questionnaire consisted of 25 questions including age, gender, basic education, use of tobacco products as well as questions assessing nicotine dependency. Results The amount of dual users of cigarettes and snus was 21%. There was a higher probability of dual use of cigarettes and snus among smokers compared to snus users (p <0.001). One third (35%) of former smokers reported daily snus use and over 40% of the former snus users smoked daily. One third (34%) of the participants reported snus usage and 14% of the study subjects used snus daily. 40% of the study population were smokers and over 25% smoked daily. Of the participants with basic educational background 57% smoked daily (p <0.001), however, no association between snus and level of education was found (p = 0.69). Conclusions This study provides better understanding of the complex tobacco habits of young adult males. The simultaneous usage of multiple tobacco products as well as the high tendency to transition from one tobacco product to another should be taken into consideration when planning cessation interventions in health care settings and tobacco control policies at societal levels.Peer reviewe

Prevalence, duration of exposure and predicting factors for snus use among young Finnish men: a cross-sectional study

ObjectiveThe health hazards of tobacco products depend on the level of exposure, but little is known about the characteristics of snus use. The aim of this study was to investigate the duration of daily exposure to snus among occasional and daily users and its associated predictive factors among young Finnish men.DesignCross-sectional questionnaire study.SettingThree out of 16 Finnish Defence Forces units.Participants1280 young Finnish male conscripts starting their military service in 2016 chosen by simple random sampling.Primary and secondary measuresThe prevalence, duration of use and the amount of daily usage of snus and cigarettes were investigated. The attitudes towards perceived harmfulness of snus and the predictive factors affecting the total time of snus consumption were examined.ResultsAlmost a fifth (19.5%) of the conscripts reported daily snus use, and a further 16% reported occasional use. Daily snus use was associated with an earlier starting age, longer duration of use and higher daily exposure time compared with occasional use. On average, daily snus users consumed 10 portions and occasional users three portions per day (pConclusionSnus use was very common among young Finnish men. High snus exposure duration was associated with an earlier starting age, a longer history of use and a careless attitude to its health hazards. A higher education level was a protective factor for total exposure time. Studies of the long-term health effects and dependency profile of snus use are needed.Data availability statementData are available on reasonable request. The datasets generated and/or analysed during the current study are not publicly available due to unpublished material that will be used in the future publications but are available from the corresponding author on reasonable request.</p

Daily standing time, dietary fiber, and intake of unsaturated fatty acids are beneficially associated with hepatic insulin sensitivity in adults with metabolic syndrome

BackgroundObesity is associated with impaired glucose metabolism and hepatic insulin resistance. The aim was to investigate the associations of hepatic glucose uptake (HGU) and endogenous glucose production (EGP) to sedentary behavior (SB), physical activity (PA), cardiorespiratory fitness, dietary factors, and metabolic risk markers.MethodsForty-four adults with metabolic syndrome (mean age 58 [SD 7] years, BMI ranging from 25–40kg/; 25 females) were included. HGU was measured by positron emission tomography during the hyperinsulinemic-euglycemic clamp. EGP was calculated by subtracting the glucose infusion rate during clamp from the glucose rate of disappearance. SB and PA were measured with hip-worn accelerometers (26 [SD3] days). Fitness was assessed by maximal bicycle ergometry with respiratory gas measurements and dietary intake of nutrients by 4-day food diaries.ResultsHGU was not associated with fitness or any of the SB or PA measures. When adjusted for sex, age, and body fat-%, HGU was associated with whole-body insulin sensitivity (β=0.58), water-insoluble dietary fiber (β=0.29), energy percent (E%) of carbohydrates (β=-0.32), saccharose (β=-0.32), mono- and polyunsaturated fatty acids (β=0.35, β=0.41, respectively). EGP was associated with whole-body insulin sensitivity (β=-0.53), and low-density lipoprotein cholesterol [β=-0.31], and when further adjusted for accelerometry wear time, EGP was associated with standing [β=-0.43]. (p-value for all&lt; 0.05).ConclusionsStanding more, consuming a diet rich in fiber and unsaturated fatty acids, and a lower intake of carbohydrates, especially sugar, associate beneficially with hepatic insulin sensitivity. Habitual SB, PA, or fitness may not be the primary modulators of HGU and EGP. However, these associations need to be confirmed with intervention studies

Standing is associated with insulin sensitivity in adults with metabolic syndrome

AbstractObjectivesTo determine how components of accelerometer-measured sedentary behavior (SB) and physical activity (PA), and fitness are associated with insulin sensitivity in adults with metabolic syndrome.DesignCross-sectional.MethodsTarget population was middle-aged (40–65 years) sedentary adults with metabolic syndrome. SB, breaks in SB, standing, and PA were measured for four weeks with hip-worn accelerometers. VO2max (ml/min/kg) was measured with maximal cycle ergometry. Insulin sensitivity was determined by hyperinsulinaemic-euglycaemic clamp (M-value) and fasting blood sampling (HOMA-IR, insulin). Multivariable regression was used for analyses.ResultsSixty-four participants (37 women; 58.3 [SD 6.8] years) were included. Participants spent 10.0 (1.0) h sedentary, 1.8 (0.6) h standing, and 2.7 (0.6) h in PA and took 5149 (1825) steps and 29 (8) breaks daily. In sex-, age- and accelerometer wear time-adjusted model SB, standing, steps and VO2max were associated with M-value (β = −0.384; β = 0.400; β = 0.350; β = 0.609, respectively), HOMA-IR (β = 0.420; β = −0.548; β = −0.252; β = −0.449), and insulin (β = 0.433; β = −0.541; β = −0.252; β = −0.453); all p-values ConclusionsStanding is associated with insulin sensitivity markers. The association with HOMA-IR and insulin is independent of adiposity, PA, SB and fitness. Further studies are warranted, but these findings encourage replacing sitting with standing for potential improvements in insulin sensitivity in adults at increased type 2 diabetes risk.AbbreviationsAPEangle for posture estimation; BPblood pressure; FFMfat free mass; HOMA-IRhomeostatic model assessment of insulin resistance; LPAlight physical activity; MADmean amplitude deviation; METmetabolic equivalent; MetSmetabolic syndrome; MVPAmoderate-to-vigorous physical activity; NEFAnon-esterified fatty acids; PAphysical activity; SBsedentary behavior; T2Dtype 2 diabetes; WCwaist circumference</p

Relationship between liver fat content and lifestyle factors in adults with metabolic syndrome

The aim of this study was to investigate the associations between liver fat content (LFC), sedentary behaviour (SB), physical activity (PA), fitness, diet, body composition, and cardiometabolic risk factors in adults with metabolic syndrome. A total of 44 sedentary adults (mean age 58 [SD 7] years; 25 women) with overweight or obesity participated. LFC was assessed with magnetic resonance spectroscopy and imaging, SB and PA with hip-worn accelerometers (26 [SD 3] days), fitness by maximal bicycle ergometry, body composition by air displacement plethysmography and nutrient intake by 4-day food diaries. LFC was not independently associated with SB, PA or fitness. Adjusted for sex and age, LFC was associated with body fat%, body mass index, waist circumference, triglycerides, alanine aminotransferase, and with insulin resistance markers. There was and inverse association between LFC and daily protein intake, which persisted after further adjusment with body fat%. LFC is positively associated with body adiposity and cardiometabolic risk factors, and inversely with daily protein intake. SB, habitual PA or fitness are not independent modulators of LFC. However, as PA is an essential component of healthy lifestyle, it may contribute to liver health indirectly through its effects on body composition in adults with metabolic syndrome.publishedVersionPeer reviewe

Effects of reduced sedentary time on resting, exercise and post-exercise blood pressure in inactive adults with metabolic syndrome : a six-month exploratory RCT

Evidence on the long-term effects of reducing sedentary behaviour (SB) on blood pressure (BP) is scarce. Therefore, we performed a sub-analysis of the BP effects of a six-month intervention that aimed at reducing SB by 1 h/day and replacing it with non-exercise activities. Sixty-four physically inactive and sedentary adults with metabolic syndrome (58% female, 58 [SD 7] years, BP 143/88 [16/9] mmHg, SB 10 [1] h/day) were randomised into intervention (INT, n = 33) and control (CON, n = 31) groups. Resting BP and BP at each stage during and after a graded maximal bicycle ergometer test were measured before and after the intervention. SB, standing, moderate-to-vigorous physical activity (MVPA), and light physical activity (LPA) were measured in six-second intervals at baseline and during the whole six-month intervention using hip-worn accelerometers. The analyses were adjusted for BP medication status. The intervention resulted in a 40 min/day reduction in SB and concomitant 20 min/day increase in MVPA. Resting systolic BP was lower in the CON group before and after the intervention. No group x time interactions were observed in resting BP or BP during exercise at submaximal or maximal intensities, or during recovery. The changes in LPA and MVPA were inversely correlated with the changes in BP during light-to-moderate intensity exercise. An intervention that resulted in a 40 min/day reduction in SB for six months was not sufficient at influencing BP at rest, during or after exercise in adults with metabolic syndrome. However, successfully increasing LPA or MVPA might lower BP during light-to-moderate-intensity activities.Peer reviewe

Effects of reducing sedentary behavior on cardiorespiratory fitness in adults with metabolic syndrome : A 6-month RCT

Introduction: Poor cardiorespiratory fitness (CRF) is associated with adverse health outcomes. Previous observational and cross-sectional studies have suggested that reducing sedentary behavior (SB) might improve CRF. Therefore, we investigated the effects of a 6-month intervention of reducing SB on CRF in 64 sedentary inactive adults with metabolic syndrome in a non-blind randomized controlled trial. Materials and Methods: In the intervention group (INT, n = 33), the aim was to reduce SB by 1 h/day for 6 months without increasing exercise training. Control group (CON, n = 31) was instructed to maintain their habitual SB and physical activity. Maximal oxygen uptake (VO2max) was measured by maximal graded bicycle ergometer test with respiratory gas measurements. Physical activity and SB were measured during the whole intervention using accelerometers. Results: Reduction in SB did not improve VO2max statistically significantly (group × time p > 0.05). Maximal absolute power output (Wmax) did not improve significantly but increased in INT compared to CON when scaled to fat free mass (FFM) (at 6 months INT 1.54 [95% CI: 1.41, 1.67] vs. CON 1.45 [1.32, 1.59] Wmax/kgFFM, p = 0.036). Finally, the changes in daily step count correlated positively with the changes in VO2max scaled to body mass and FFM (r = 0.31 and 0.30, respectively, p < 0.05). Discussion: Reducing SB without adding exercise training does not seem to improve VO2max in adults with metabolic syndrome. However, succeeding in increasing daily step count may increase VO2max.publishedVersionPeer reviewe

Associations of sedentary time, physical activity, and fitness with muscle glucose uptake in adults with metabolic syndrome

publishedVersionPeer reviewe