Kuntotarkastajan vahingonkorvausvastuu asunto- ja asuinkiinteistökaupan osapuolia kohtaan

Myydystä asunnosta tai asuinkiinteistöstä voi paljastua laatuvirhe silloin, kun ostaja on tehnyt kaupan puutteellisten tietojen varassa. Myös myyjä on voinut olla tietämätön kaikista kohteen puutteista. Kauppaa varten onkin suositeltavaa teettää kuntotarkastus, jotta merkitykselliset tiedot kaupan kohteesta tulisivat ilmi ennen kauppaa. Jos kuntotarkastetusta kohteesta kuitenkin kaupan jälkeen paljastuu vikoja tai puutteita, herää kysymys, kuka on vastuussa. Tutkielmassa lähdetään siitä, mitä erilaiset asuinrakennuksen kuntoa määrittävät toimeksiannot ovat. Kokonaiskuvan saamiseksi kaikkiin selvitystyyppeihin tutustutaan, mutta pääroolissa tutkielmassa on kuntotarkastus asuntokauppaa varten. Myös muilla selvityksillä saatuja tietoja saatetaan käyttää kaupan yhteydessä. Koska asunnon ja kiinteistön kaupassa ostajalla on ennakkotarkastusvelvollisuus ja myyjällä tiedonantovelvollisuus, tutustutaan aluksi siihen, miten kuntotarkastuksen teettäminen vaikuttaa näihin velvollisuuksiin ja miten nämä velvollisuudet vaikuttavat kuntotarkastajan vastuuseen. Tutkimus rajoittuu yksityishenkilöiden väliseen asunnon ja asuinkiinteistön kauppaan. Kuntotarkastajan toimeksiantajana on yleensä myyjä tai myyjä ja ostaja yhdessä. Kuntotarkastajan huolimattomasta suorituksesta voi kärsiä vahinkoa sekä ostaja että myyjä, mutta vastuu ostajaa ja myyjää kohtaan määräytyy eri säännöstöjen nojalla. Tutkielmassa päädytään siihen, että kuntotarkastajan vastuu toimeksiantajaa kohtaan määräytyy kuluttajansuojalain mukaan. Toimeksiantajan vastapuolta kohtaan vastuun tulisi määräytyä sopimusvastuun yleisten periaatteiden mukaisesti, vaikka myös vahingonkorvauslain mukainen vastuu vaikuttaa nykyisen oikeustilan mukaan mahdolliselta. Vastuun tulisi olla samanlainen siitä riippumatta, kumpi on toimeksiantajana. Kuntotarkastaja vastaa huolimattomuudellaan aiheuttamasta vahingosta. Tutkimuksessa selvitetään, mikä on korvausvastuuseen velvoittava tuottamus kuntotarkastajan toiminnassa, minkälaiset vahingot ovat korvauskelpoisia ja onko kuntotarkastajalla mahdollisuutta rajoittaa vastuutaan kaupan osapuolia kohtaan. Lopuksi luodaan silmäys Ruotsin, Norjan ja Tanskan kuntotarkastukseen, katsotaan tulevaisuuden näkymiä ja kerrataan tiivistetysti tutkielmassa opittu.acceptedVersio

Blood Transfusion and Outcome After Transfemoral Transcatheter Aortic Valve Replacement

Objective: To investigate the prognostic impact of red blood cell (RBC) transfusion on the outcome after transfemoral transcatheter aortic valve replacement (TAVR). Design: Nationwide, retrospective multicenter study. Setting: Five University Hospitals. Participants: The nationwide FinnValve registry included data from 2,130 patients who underwent TAVR for aortic stenosis from 2008 to 2017. After excluding patients who underwent TAVR through nontransfemoral accesses, 1,818 patients were selected for this analysis. Intervention: TAVR with or without coronary revascularization. Measurements and Main Results: RBCs were transfused in 293 patients (16.1%). Time-trend analysis showed that the rates of RBC transfusion decreased significantly from 27.5% in 2012 to 10.0% in 2017 (p <0.0001). Among 281 propensity score matched pairs, RBC transfusion was associated with higher 30-day mortality (7.1% v 0%, p <0.0001), late mortality (at 5-year, 59.1% v 43.3%, p = 0.008), as well as increased risk of acute kidney injury (17.0% v 4.4%, p <0.0001), renal replacement therapy (3.6% v 0.4, p <0.0001) and prolonged hospital stay (mean, 8.5 v 4.7 days, p <0.0001) compared with patients who did not receive blood transfusion. In the overall series, the risk of adverse events increased significantly with the increasing amount of transfused RBC units and when operation for excessive bleeding was necessary. Consistently with these findings, postoperative hemoglobin drop and nadir level were associated with higher early and late mortality. Conclusions: Patients who received blood transfusion after TAVR had an increased risk of early and late adverse events. These adverse effects were particularly evident with increasing amount of RBC transfusion and operations for excessive bleeding. (C) 2019 Elsevier Inc. All rights reserved.Peer reviewe

Comparison of Outcomes After Transcatheter Aortic Valve Replacement vs Surgical Aortic Valve Replacement Among Patients With Aortic Stenosis at Low Operative Risk

IMPORTANCE Transcatheter aortic valve replacement (TAVR) has been shown to be a valid alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk with severe aortic stenosis (AS). However, the evidence of the benefits and harms of TAVR in patients at low operative risk is still scarce. OBJECTIVE To compare the short-term and midterm outcomes after TAVR and SAVR in low-risk patients with AS. DESIGN, SETTING, AND PARTICIPANTS This retrospective comparative effectiveness cohort study used data from the Nationwide Finnish Registry of Transcatheter and Surgical Aortic Valve Replacement for Aortic Valve Stenosis of patients at low operative risk who underwent TAVR or SAVR with a bioprosthesis for severe AS from January 1, 2008, to November 30, 2017. Low operative risk was defined as a Society of Thoracic Surgeons Predicted Risk of Mortality score less than 3% without other comorbidities of clinical relevance. One-to-one propensity score matching was performed to adjust for baseline covariates between the TAVR and SAVR cohorts. EXPOSURES Primary TAVR or SAVR with a bioprosthesis for AS with or without associated coronary revascularization. MAIN OUTCOMES AND MEASURES The primary outcomes were 30-day and 3-year survival. RESULTS Overall, 2841 patients (mean [SD] age, 74.0 [6.2] years; 1560 [54.9%] men) fulfilled the inclusion criteria and were included in the analysis; TAVR was performed in 325 patients and SAVR in 2516 patients. Propensity score matching produced 304 pairs with similar baseline characteristics. Third-generation devices were used in 263 patients (86.5%) who underwent TAVR. Among these matched pairs, 30-day mortality was 1.3% after TAVR and 3.6% after SAVR (P=.12). Three-year survival was similar in the study cohorts (TAVR, 85.7%; SAVR, 87.7%; P=.45). Interaction tests found no differences in terms of 3-year survival between the study cohorts in patients younger than vs older than 80 years or in patients who received recent aortic valve prostheses vs those who did not. CONCLUSIONS AND RELEVANCE Transcatheter aortic valve replacement using mostly third-generation devices achieved similar short- and mid-term survival compared with SAVR in low-risk patients. Further studies are needed to assess the long-term durability of TAVR prostheses before extending their use to low-risk patients.Peer reviewe

Altered hip control during a standing knee-lift test is associated with increased risk of knee injuries

Few prospective studies have investigated hip and pelvic control as a risk factor for lower extremity (LE) injuries. The purpose of this study was to investigate whether deficits in hip and lumbopelvic control during standing knee lift test are associated with increased risk of acute knee and LE injuries in youth team sports. At baseline, 258 basketball and floorball players (aged 12‒21 y.) participated in a standing knee lift test using 3‐dimensional motion analysis. Two trials per leg were recorded from each participant. Peak sagittal plane pelvic tilt and frontal plane pelvic drop/hike were measured. Both continuous and categorical variables were analysed. New non‐contact LE injuries, and match and training exposure, were recorded for 12 months. Seventy acute LE injuries were registered. Of these, 17 were knee injuries (eight ACL ruptures) and 35 ankle injuries. Risk factor analyses showed that increased contralateral pelvic hike was significantly associated with knee injury risk when using categorical variable (HR for high versus low group 4.07; 95% CI 1.32–12.6). Furthermore, significant association was found between high lateral pelvic hike angles and ACL injury risk in female players (HR for high versus low group 9.10; 95% CI 1.10–75.2). Poor combined sensitivity and specificity of the test was observed. In conclusion, increased contralateral pelvic hike is associated with non‐contact knee injury risk among young team sport players as well as non‐contact ACL injuries among female players. More research to determine the role of pelvic control as a risk factor for knee injuries is needed.peerReviewe

Predictors of lower extremity injuries in team sports (PROFITS-study) : a study protocol

Introduction Several intrinsic risk factors for lower extremity injuries have been proposed, including lack of proper knee and body control during landings and cutting manoeuvres, low muscular strength, reduced balance and increased ligament laxity, but there are still many unanswered questions. The overall aim of this research project is to investigate anatomical, biomechanical, neuromuscular, genetic and demographic risk factors for traumatic non-contact lower extremity injuries in young team sport athletes. Furthermore, the research project aims to develop clinically oriented screening tools for predicting future injury risk. Methods Young female and male players (n=508) from nine basketball teams, nine floorball teams, three ice hockey teams, and one volleyball team accepted the invitation to participate in this four-and-half-year prospective follow-up study. The players entered the study either in 2011, 2012 or 2013, and gave blood samples, performed physical tests and completed the baseline questionnaires. Following the start of screening tests, the players will be followed for sports injuries through December 2015. The primary outcome is a traumatic non-contact lower extremity injury. The secondary outcomes are other sports-related injuries. Injury risk is examined on the basis of anatomical, biomechanical, neuromuscular, genetic and other baseline factors. Univariate and multivariate regression models will be used to investigate association between investigated parameters and injury risk.peerReviewe

Comparison of outcomes after transcatheter aortic valve replacement vs surgical aortic valve replacement among patients with aortic stenosis at low operative risk

Abstract Importance: Transcatheter aortic valve replacement (TAVR) has been shown to be a valid alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk with severe aortic stenosis (AS). However, the evidence of the benefits and harms of TAVR in patients at low operative risk is still scarce. Objective: To compare the short-term and midterm outcomes after TAVR and SAVR in low-risk patients with AS. Design, Setting, and Participants: This retrospective comparative effectiveness cohort study used data from the Nationwide Finnish Registry of Transcatheter and Surgical Aortic Valve Replacement for Aortic Valve Stenosis of patients at low operative risk who underwent TAVR or SAVR with a bioprosthesis for severe AS from January 1, 2008, to November 30, 2017. Low operative risk was defined as a Society of Thoracic Surgeons Predicted Risk of Mortality score less than 3% without other comorbidities of clinical relevance. One-to-one propensity score matching was performed to adjust for baseline covariates between the TAVR and SAVR cohorts. Exposures: Primary TAVR or SAVR with a bioprosthesis for AS with or without associated coronary revascularization. Main Outcomes and Measures: The primary outcomes were 30-day and 3-year survival. Results: Overall, 2841 patients (mean [SD] age, 74.0 [6.2] years; 1560 [54.9%] men) fulfilled the inclusion criteria and were included in the analysis; TAVR was performed in 325 patients and SAVR in 2516 patients. Propensity score matching produced 304 pairs with similar baseline characteristics. Third-generation devices were used in 263 patients (86.5%) who underwent TAVR. Among these matched pairs, 30-day mortality was 1.3% after TAVR and 3.6% after SAVR (P = .12). Three-year survival was similar in the study cohorts (TAVR, 85.7%; SAVR, 87.7%; P = .45). Interaction tests found no differences in terms of 3-year survival between the study cohorts in patients younger than vs older than 80 years or in patients who received recent aortic valve prostheses vs those who did not. Conclusions and Relevance: Transcatheter aortic valve replacement using mostly third-generation devices achieved similar short- and mid-term survival compared with SAVR in low-risk patients. Further studies are needed to assess the long-term durability of TAVR prostheses before extending their use to low-risk patients

Lasten ja nuorten liikuntakäyttäytyminen Suomessa : LIITU-tutkimuksen tuloksia 2022

Lasten ja nuorten liikuntakäyttäytyminen Suomessa (LIITU) -tutkimus on kansallinen 7-15-vuotiaiden liikkumista, liikuntakäyttäytymistä ja -kulttuuria laajasti kartoittava seurantatutkimus. Tämä raportti käsittelee kyseisen ikäryhmän lapsilta ja nuorilta maalis-kesäkuussa 2022 sähköisillä kyselyillä (n = 10 098) ja liikemittareilla (n = 1 525) kerättyä aineistoa. Aineiston keruun ajalle ajoittui kolmas korona-aalto (koulujen sulku-uhka), Ukrainan sodan alku sekä opetusalan lakkoja sekä lakonuhkia. Nämä tekijät ovat voineet vaikuttaa tutkimuksen osallistumishalukkuuteen sekä osallistujien liikunta- ja terveyskäyttäytymiseen. Vaikka lähes kaksi kolmesta (61 %) kaikista 7–15-vuotiaista arvioi liikkumisensa lisääntyneen viimeisen 12 kuukauden aikana, vain noin kolmasosa (36 %) raportoi saavuttavansa liikkumissuosituksen, joka on pienempi osuus kuin vuonna 2018 (38 %). Liikemittarilla mitatut tulokset ovat samansuuntaiset; liikkumissuosituksen saavutti mitatusti vuonna 2022 kolmasosa (33 %) lapsista ja nuorista. Mittariaineiston mukaan lasten ja nuorten liikkumisesta suurin osa kertyi 5–10 minuuttia kerrallaan kestäneistä jaksoista. Liikkumisessa on edelleen nähtävillä selvä sukupuoliero; pojat saavuttivat suosituksen kaikissa ikäryhmissä tyttöjä yleisemmin. Iänmukainen liikkumisen väheneminen alkoi tytöillä aikaisempiin LIITU-aineistoihin verrattuna poikia aikaisemmin (9-vuotiaasta alkaen). Samalla sukupuolierot liikkumissuosituksen saavuttaneiden osuuksissa kasvoivat kaikissa ikäryhmissä. Valtaosa lapsista ja nuorista liikkui omatoimisesti ja noin puolet urheiluseuroissa, tosin näin tekevien osuudet olivat pienentyneet kaikissa ikäluokissa. Vuonna 2022 yleisimmin käytettyjä liikuntapaikkoja olivat kevyen liikenteen väylät, oma tai kaverin piha sekä aito luonto. Oma tai kaverin piha lisättiin uutena elementtinä kyselyyn ja se osoittautui yhdeksi eniten käytetyistä liikuntapaikoista. Samalla, luonnossa viikoittain liikkuneiden osuus oli kasvanut merkittävästi vuodesta 2016. Yleisimmät lasten ja nuorten raportoimat vapaa-ajan liikkumismuodot olivat talvella hiihto, jalkapallo, luistelu, jääkiekko ja laskettelu, kesällä jalkapallo, uinti, pyöräily ja frisbeegolf. Vuonna 2018 todettu liikunnan vetovoimaisuuden väheneminen näyttää jatkuneen (2018–2022), muttei yhtä jyrkkänä kuin aiemmin (2014–2018). Merkitysten arvostuksen väheneminen oli tapahtunut erityisesti tyttöjen keskuudessa. Myös liikkumisen esteitä tytöt raportoivat vuonna 2022 useammin kuin vuonna 2018. Urheiluseuratoimintaan osallistuvien lasten ja nuorten osuus oli pienempi vuonna 2022 (58 %) kuin vuonna 2018 (62 %). Vuoteen 2016 verrattuna urheiluseuratoimintaan osallistuminen vähentyi erityisesti 13- ja 15-vuotiaiden ikäryhmissä. Myös kilpailutoimintaan osallistuminen oli pandemian jälkeen vähäisempää. Tässä raportissa esitellään lisäksi tuloksia seuraavilta aihealueilta: liikkumisen seurantalaitteet ja -sovellukset, liikemittareilla mitatun paikallaanolon ja unen määrä, vanhempien ja kavereiden liikunnallinen tuki, liikunnanopetuksen tuntimäärät ja oppilaiden arvosanat, nuorten käsityksiä liikunnanopetuksesta, koulun liikunnallinen toimintakulttuuri, aktiivisesti kuljetut koulumatkat, epäasiallinen kohtelu urheilussa, liikuntavammat, digipelaaminen ja liikkuminen, sekä liikunta, terveys ja terveydenlukutaito. Lisäksi eroja liikuntakäyttäytymisessä tarkastellaan sekä suomen- ja ruotsinkielisten että toimintarajoitteisten lasten ja nuorten ja niiden, joilla ei ole toimintarajoitteita, välillä. Kaikkinensa tämän LIITU-raportin tulosten perusteella voidaan sanoa, että vaikka korona-aikana keskimäärin vähentynyt liikkuminen on alkanut elpymään, ei se ole kaikilla palannut korona-aikaa edeltäneelle tasolle. Liikkumissuositusten mukaan liikkuvien osuudet ovat aiempaa matalammalla tasolla. Vähentymistä oli tapahtunut erityisesti omaehtoisessa liikkumisessa ja seuraharrastamisessa. Erityisen huolestuttavaa on tyttöjen ja poikien välisen eron lisääntyminen useilla eri osa-alueilla. Esimerkiksi, tyttöjen liikkumisaktiivisuus lähtee poikia aiemmin iän myötä laskuun, heillä liikunnan merkitysten arvostus on vähentynyt poikia enemmän, ja tytöt raportoivat enemmän liikkumisen esteitä kuin pojat. Suomessa on edelleen kasvava tarve edistää liikkumista suurimmalla osalla lapsista ja nuorista, erityisesti vanhemmissa ikäryhmissä sekä tytöillä.The Finnish School-aged Physical Activity (F-SPA, LIITU in Finnish) monitoring study provides a comprehensive insight into the physical activity of children and young people aged 7 to 15 in Finland, including the behavioural and cultural aspects. This report presents data collected from children and adolescents between March and June 2022 using online surveys (n = 10,098) and accelerometers (n = 1,525). The data was collected during the third wave of the COVID-19 pandemic (threat of school closures), the start of Russia’s war of aggression in Ukraine, strikes and strike threats in the education sector. These factors may have influenced the willingness of potential participants to take part in the study and the physical activity and health behaviour of those who participated. Although almost two thirds (61%) of all respondents aged 7 to 15 estimated that their physical activity had increased over the past 12 months, only around one in three (36%) reported that they would meet a physical activity (PA) recommendation, showing a reduction from 2018 (38%). The results measured using accelerometers are similar: in 2022, one in three (33%) children and adolescents met the recommendation on physical activity measured. According to the measured data, most physical activity among children and young people took place in periods of 5 to 10 minutes at a time. There is still a clear gender difference in physical activity: boys met the PA recommendation in all age groups more often than girls. The drop-off in physical activity as children get older started earlier among girls than in previous LIITU data (from the age of 9). At the same time, gender differences among those who reached the recommendation on physical activity increased in all age groups. The majority of children and adolescents engaged in independent physical activity and about half of them participated in sports club activities, although the share of both independent PA and club participation had decreased in all age groups. In 2022, the most commonly used sports facilities were pedestrian and bicycle routes, one’s own garden or a friend’s garden, and the natural environment. The respondent’s yard or a friend’s yard was added as a new element to the survey and proved to be one of the most common sports facilities. At the same time, the share of people who moved in a natural environment on a weekly basis had increased significantly since 2016. The most common forms of physical activity reported by children and adolescents were cross-country skiing, football, skating, ice hockey and downhill skiing in winter, and football, swimming, cycling and disc golf in summer. The decrease in the attractiveness of physical activity identified in 2018 seems to have continued (2018–2022), but not as steeply as before (2014–2018). The appreciation of meanings had decreased especially among girls. Girls also reported obstacles to physical activity more often in 2022 than in 2018. The share of children and adolescents participating in sports club activities was smaller in 2022 (58%) than in 2018 (62%). Compared to 2016, participation in sports club activities decreased especially among those aged 13 and 15. Participation in competitions was also less common after the pandemic. In addition to the above, this report presents results in the following areas: use of physical activity monitoring devices and applications, amount of sedentary time and sleep measured using accelerometers, support for physical activity from parents and friends, number of lessons in physical education and students’ school grades, adolescents perceptions concerning physical education, school cultural support related to physical activity, active school travel, inappropriate treatment in sports, sports injuries, digital gaming and physical activity, and physical activity, health and health literacy. In addition, differences in behaviour related to physical activity are examined between both Finnish and Swedish speakers and adolescents with and without disabilities. Based on the results of this F-SPA study, even though the take-up of physical activity, which on average declined during the COVID-19 pandemic, has begun to increase again, it has not returned to its pre-COVID level in all cases. The proportion of those who accumulate the recommended amount of physical activity is lower than before. There had been a particularly steep decline in independent physical activity and club activities. It is particularly alarming that the gap between girls and boys has increased in many areas. For example, girls’ physical activity rates begin to drop off earlier than boys’, their appreciation of meanings of physical activity has decreased more than that of boys, and girls reported more obstacles to physical activity than boys. In Finland, there is still a growing need to promote physical activity among the majority of children and adolescents, especially in older age groups and among girls.nonPeerReviewe