13 research outputs found
Krooniline köha lapsel
Krooniline köha vĂ”ib olla iseparaneva haiguse sĂŒmptomiks, aga ka tĂ”sise haiguse vĂ€ljendus. Kahjuks puudub laste kroonilise köha kohta konsensusdefinitsioon, kuid rahvusvaheliselt aktsepteerituim on igapĂ€evane köha kestusega ĂŒle 4 nĂ€dala. Krooniline köha jaotatakse spetsiifiliseks, kui köhaga kaasnevad pĂ”hihaigusele viitavad sĂŒmptomid, ja mittespetsiifiliseks, kui esineb ainult isoleeritud kuiv köha. Enamikul mittespetsiifilise isoleeritud köhaga lastel ei esine astmat, vaid soodsa prognoosiga respiratoorne infektsioon. Mittespetsiifilise kroonilise köha puhul on soovitatav nn oota-vaata-kontrolli taktika. Postinfektsioosne köha paraneb ise. VĂ€ga oluline on köha provotseerivate tegurite nagu tubakasuitsu ja teiste Ă€rritajate vĂ€ltimine ning lastevanemate nĂ”ustamine.
Eesti Arst 2009; 88(7â8):522â52
Bronhiaalastma kui vÀikeste hingamisteede haigus
TĂ€napĂ€eval kĂ€sitletakse bronhiaalastmat kui pĂ”letikulist haigust, kusjuures pĂ”letikuline protsess lokaliseerub nii tsentraalsetes hingamisteedes kui ka vĂ€ikestes bronhides ja kopsu parenhĂŒĂŒmis. Viimastel aastatel tehtud uuringud nĂ€itavad, et pĂ”letik perifeersetes hingamisteedes on astma patogeneesi tĂ€htsaimaks lĂŒliks, pĂ”hjustades vĂ€ikeste bronhide limaskesta kahjustust ja obstruktsiooni. SeetĂ”ttu tuleb astma varajane ravi suunata pĂ”letikureaktsiooni pĂ€rssimisele kogu hingamisteede ulatuses. Artiklis on tutvustatud lĂ€hemalt vĂ€ikeste hingamisteede funktsionaalse uurimise vĂ”imalusi ja uusi ravistrateegiaid astma korral.
Eesti Arst 2002; 81 (12): 804â81
Hingamistakistused II. Hingamistakistuse mÔÔtmine vÀikelastel
Paljudel hingamiskaebustega patsientidel esineb hingamisteede valendiku ahenemine, millega kaasneb voolutakistuse suurenemine. Forsseeritud hingamise voolu-mahu lingu abil on vÔimalik kaudselt hinnata hingamisteede takistuse muutusi, kuid seda uuringut saab nÔuetekohaselt teha alles alates 6. vÔi 7. eluaastast. Artiklis on kirjeldatud kaht meetodit, mis sobivad hingamisteede takistuse mÔÔtmiseks juba ka vÀikestel lastel ning mille kasutusele vÔtmisega paranevad mÀrkimisvÀÀrselt just eelkooliealiste laste kopsuhaiguste diagnoosimise ja ravi efektiivsuse hindamise vÔimalused.
Eesti Arst 2005; 84 (8): 563â56
Electoral Reform and the Centralisation of the New Zealand National Party
Political party organisations respond to the challenges of their environments. Different organisational structures have different capabilities and capacities and, therefore, some organisations are better suited to some environments. What happened to party organisations when New Zealand changed from a first-past-the-post to a mixed member proportional electoral system? Did all parties have the same capacities to meet the challenges raised by this new environment? This paper addresses these questions by examining the organisational responses of the New Zealand National Party to the introduction of the mixed member proportional electoral system after 1993. The National Party was constructed to operate in a first-past-the-post electoral system and it did so successfully, winning twelve of the nineteen elections it contested. In response to the challenges of the first-past-the-post environment, National decentralised both candidate selection and campaign structure. National's decentralised organisation proved to be a liability for National under the new mixed member proportional environment however. Mixed member proportional demanded the construction of a nationwide list and a coherent campaign for the nationwide party vote. With its existing organisational structure, National was unable to meet either of these demands and suffered the electoral repercussions of that failure. After four consecutive elections in which National lost vote share, the National Party centralised its organisation in 2003. This paper analyses the centralisation of the National Party's organisation and the reasons for it by examining the Party's efforts to reform candidate selection and management of campaigns. The two organisational structures which National used for selecting candidates and managing campaigns under mixed member proportional produced different results. The candidate pools for 1996, 1999 and 2002 failed to provide nationwide appeal and produced incentive for electorate candidates to ignore the party vote element. Further, the campaign structure for these three elections allowed electorate committees significant control and the ability to undermine the nationwide party vote campaign. In the 2005 election, however, candidate selection and campaign management showed significant changes. The candidate selection process provided incentives for electorate candidates to seek both electorate and party votes, although it arguably still failed to produce a nationally appealing party list. The management of the campaign was also significantly different. It demonstrated the benefit of central campaign control in a mixed member proportional electoral system. The 2003 centralisation gave National elites significant control and allowed National to almost double its 2002 result in the 2005 election. This thesis demonstrates that a mixed member proportional electoral system gave National strong incentives to centralise its party organisation
Astma diagnoosimine ja ravi lastel: ĂŒlevaade PRACTALL konsensusaruandest
Enamikus tööstusriikides on astma las­te seas kĂ”ige levinum krooniline haigus, kuid vaatamata sellele on tĂ”enduspĂ”hi­seid andmeid selle haiguse kohta vĂ€he. Viimasel kĂŒmnel aastal ei ole avaldatud ĂŒhtegi eranditult laste astmale keskendu­nud rahvusvahelist ravijuhendit. SeetĂ”t­tu moodustasid Euroopa Allergoloogia ja Kliinilise Immunoloogia Akadeemia (EAACI) ning Ameerika Allergoloo­gia, Astma ja Immunoloogia Akadee­mia (AAAAI) eksperdirĂŒhma, kes töö­tas vĂ€lja laste astma ravijuhendi, mida saaks kasutada nii Euroopa kui ka PĂ”hja-Ameerika kliinilises praktikas. KĂ”ne­aluses konsensusaruandes PRACTALL (PRACTicing ALLergology) antakse soovitusi farmakoloogiliseks raviks, al­lergeenide ja haigushoogude vĂ€ltimiseks ning astmaalaseks teavitustööks.
Eesti Arst 2 008; 87(10):748â75
Astma ja teiste allergiahaiguste sÔeluuring Eesti kooliÔpilastel
KĂ€esolevas uuringus hinnati astma ja teiste allergiliste haiguste levimust laste-allergoloogilise arstiabita linnade kooliĂ”pilaste hulgas ning analĂŒĂŒsiti allergiahaigustesse haigestumist Eesti erinevates piirkondades. 2003. aasta 1. mĂ€rtsist 8. maini toimunud uuringus osalesid PĂ€rnu ĂhisgĂŒmnaasiumi, VĂ”ru Kreutzwaldi GĂŒmnaasiumi, Elva GĂŒmnaasiumi ja Narva Vene Kesklinna GĂŒmnaasiumi 5.â12. klassi Ă”pilased. SĂ”el uuringu pĂ”hjal vĂ”ib vĂ€ita, et astmasse haigestumine on Eesti kooliĂ”pilastel sagenenud (4,8%) ja allergiahaiguste levimus on paikkonniti erinev. 40%-l astmaga lastest diagnoositi haigus uuringu kĂ€igus esimest korda ning see viitab selgelt haiguse ala diagnoosi misele keskustest kaugemal elavatel kooliĂ”pilastel
TsĂŒstiline fibroos 5aastasel poisil: haigusjuhu kirjeldus
TsĂŒstiline fibroos ehk mukovistsidoos (TF) on valge rassi hulgas esinev kĂ”ige sagedasem geneetiline haigus. Tegemist on autosoom-retsessiivse haigusega, mille tagajĂ€rjel tekib eksokriinnÀÀrmete dĂŒsfunktsioon. Kliiniliselt vĂ”ib haiguspilt olla vĂ€ga erinev, kuid klassikalistel juhtudel esineb progresseeruv obstruktiivne kopsuhaigus, pankrease eksokriinne puudulikkus ja klooriioonide kontsentratsiooni suurenemine higis.
Nina polĂŒpoosi esineb 26â56%-l TF-haigetel. Kui lapsel leitakse ninapolĂŒĂŒbid, on vajalik edasine uurimine tsĂŒstilise fibroosi suhtes isegi siis, kui patsiendil muid kaebusi ei ole. Artiklis on kirjeldatud haigusjuhtu, kus diagnoositi tsĂŒstiline fibroos 5 aasta vanusel polĂŒĂŒpidega poisslapsel.
Eesti Arst 2007; 86 (5): 348â35
TsĂŒstiline fibroos â Eesti patsientide kliinilised andmed 2011. aastal
Uuringu eesmĂ€rk. TsĂŒstiline fibroos (TF) on kĂ”ige sagedasem eluiga lĂŒhendavatest autosoom-retsessiivsetest pĂ€rilikest haigustest valgel rassil. Uurimuse eesmĂ€rgiks oli analĂŒĂŒsida Eesti TFi-patsientide kliinilisi andmeid 31.12.2011. aasta seisuga ning vĂ”rrelda neid varasemate Eesti ja Euroopa andmetega. Uuritavad ja metoodika. Retrospektiivne uuring hĂ”lmas lapseeas diagnoositud ja elus oleva 46 TFi-patsiendi andmeid. Kliinilised andmed olid olemas 40 patsiendi kohta, kes olid arsti jĂ€lgimisel 2011. aastal. Tulemused. VĂ”rreldes 1993. aastaga oli patsientide keskmine vanus suurenenud ligi kaks korda (8,16 vs. 15,9 aastat). Mediaanvanus diagnoosimisel oli 1,5 aastat, mis on suurem kui Euroopa Liidus keskmiselt. Viiendikul patsientidest vastas toitumus rahvusvaheliselt soovitatavale. Kopsufunktsioon oli oluliselt halvem alatoitunud taiskasvanutel (p P. aeruginosa kolonisatsiooniga patsientidel (p = 0,005). P. aeruginosa kolonisatsiooniga patsientidel oli vĂ€iksem KMI (p JĂ€reldused. TĂ€nu uute nĂŒĂŒdisaegsete ravimite kasutamisele, ravi regulaarsusele ning erialaarstide ja mitmete spetsialistide meeskonnatööle on viimase 10 aastaga Eesti TFipatsientide keskmine vanus suurenenud, suremus kahanenud ning elulemus paranenud. Endiselt pĂŒsib kĂ”rge patsientide mediaanvanus haiguse esmasel diagnoosimisel.
Eesti Arst 2013; 92(4):186â19
Association analysis of class II cytokine and receptor genes in vitiligo patients
The loss of melanocytes in vitiligo is mainly attributed to defective autoimmune mechanisms and lately autoinflammatory mediators have become more emphasized. Among these, a number of class II cytokines and their receptors have displayed altered expression patterns in vitiligo. Thus, we selected 30 SNPs from the regions of respective genes to be genotyped in Estonian case-control sample (109 and 328 individuals, respectively). For more precise analyses, patients were divided into subgroups based on vitiligo progression activity, age of onset, sex, occurrence of vitiligo among relatives, extent of depigmented areas, appearance of Köbnerâs phenomenon, existence of halo nevi, occurrence of spontaneous repigmentation, and amount of thyroid peroxidase antibodies. No associations appeared in whole vitiligo group. In subgroups, several allelic and haplotype associations were found. The strongest involved SNPs rs12301088 (near IL26 gene), that was associated with familial vitiligo and existence of halo nevi, and rs2257167 (IFNAR1 gene), that was associated with female vitiligo. Additionally, haplotypes consisting of rs12301088 and rs12321603 alleles (IL26âIL22 genes), that were associated with familial vitiligo and existence of halo nevi. In conclusion, several genetic associations with vitiligo subphenotypes were revealed and functional explanations to these remain to be determined in respective studies
Seclusion Management in an Acute In-Patient Unit
Trends in modern day mental health facilities have been towards the least restrictive
environment with emphasis on patientsâ rights, but these rights have to be balanced
against the safety of both the patients themselves and anyone else in the immediate
environment. One way of restricting a personâs movement is through the use of
seclusion, a means of isolating a person in a locked room with minimal stimulus and
from where that person cannot freely exit.
This study was developed to explore the use of seclusion in an acute in-patient unit
for people with mental illnesses. Investigation into this issue was considered
important due to an identified large increase in seclusion use over the previous two
years.
The study used a qualitative research methodology with a descriptive and
interpretive approach. Data collection included a retrospective file audit of patients
who had been secluded over the past seven years, and one-to-one staff interviews. I
also included some personal reflections of seclusion events.
The principle reason for using seclusion was violence and aggression in the context
of mental illness. It was also used for people who were at risk of, or who had
previously absconded from the unit. A recovery approach and the use of the
strengths model was fundamental to nursesâ way of working with patients in the unit.
Nurses believed that the strengths process should be adapted to the personâs level of
acuity and to their ability to engage in this approach in a real and tangible way.
Seclusion continues to be a clinical management option in the unit that is the subject
of this study. It is used when a person is so unwell that they cannot be managed in
any other identified way. However, in many circumstances there are other options
that could be explored so that the utmost consideration is given to the dignity,
privacy and safety of that person