Elpymisliikunta työhyvinvoinnin tukena : Sievin Jalkine Oy:n neulomotyöntekijöille suunnitellut elpymisliikuntaohjelmat

Terve tuki- ja liikuntaelimistö on edellytys hyvälle työ- ja toimintakyvylle. Tuki- ja liikuntaelimistön terveyteen vaikuttavat ikä, perimä, yksilölliset elintavat, terveydentila sekä elin- ja työskentelyolot ja sosioekonominen asema. Tuki- ja liikuntaelimistön kivut ovat erittäin yleisiä työikäisellä väestöllä ja ne ovat yksi yleisimmistä syistä pitkille sairauspoissaoloille. Yleisimpiä työn aiheuttamia oireita ovat niska-hartiavaivat sekä lanne-ristiselän kivut. Työn fyysisiä kuormitustekijöitä voivat olla vaikeat työasennot, ruumiillisesti raskas työ, raskaiden taakkojen käsittely, toistuvat työliikkeet tai jatkuva istuminen. Mitä useammalle fyysiselle kuormitustekijälle työssä altistuu, sitä haitallisempaa se on tuki- ja liikuntaelimistölle. Elpymisliikunnalla ja tauotuksella ehkäistään ylikuormittavan työn aiheuttamia haittoja parantamalla kudosten verenkiertoa. Elpymisliikunnan merkitys korostuu etenkin yksipuolisessa ja staattisessa työssä. Opinnäytetyön tarkoituksena on ehkäistä ja pienentää Sievin Jalkine Oy:n neulo-motyöntekijöiden tuki- ja liikuntaelinongelmien esiintyvyyttä, sekä innostaa ja motivoida heitä työhyvinvoinnin parantamiseen päivittäisen elpymisliikunnan avulla. Tavoitteena oli suunnitella neulomotyöntekijöille kolme erilaista elpymisliikuntaohjelmaa heille tehdyn kyselyn ja havainnoinnin pohjalta. Opinnäytetyö koostui määrällisestä tutkimuksesta sekä elpymisliikuntaohjelmien toteutuksesta. Elpymisliikuntaohjelmat perustuivat neulomotyöntekijöille teetettyyn kysely- ja havainnointitutkimukseen. Kyselytutkimuksella haettiin vastausta työntekijöiden yleisimmistä tuki- ja liikuntaelinongelmista sekä yleisimmät työn fyysisistä kuormitustekijöistä. Havainnoinnilla kerättiin tietoa neulomotyöskentelystä. Neulomotyöntekijöiden yleisimmät tuki- ja liikuntaelinongelmat kohdistuivat niska-hartiaseutuun sekä alaraajoihin. Yleisimmät työn fyysiset kuormitustekijät olivat ranteen/sormien toistoliikkeet sekä yhtäjaksoinen istuminen. Kyselyn tulosten ja havainnoinnin pohjalta suunniteltiin kolme erilaista elpymisliikuntaohjelmaa: perinteinen venyttely- ja lihasvoimaharjoitteita sisältävä ohjelma, nopeatempoinen kiertoharjoitteluohjelma sekä venyttelyohjelma.A healthy musculoskeletal system is necessary for the ability to work and function. Age, genetics, individual lifestyle, health status, living and working conditions and socioeconomic status have an influence on the condition of the musculoskeletal system. Musculoskeletal pain is very common among working population and the pains are one of the most common reasons for the absences from work. Neck-shoulder problems and low-back pain are the most common work-related disorders. Physical work factors are poor work positions, physically heavy work, forceful movements, repetitive work and sedentary work. The more physical load factors people are exposed to at work, the more harmful it is for the musculoskeletal system. Workplace exercises and work breaks can prevent work-related disorders by improving the blood flow to tissues. Workplace exercises are important especially for monotonic and static work. The aim of our study is to prevent and reduce musculoskeletal disorders among the sewing machine operators of Sievin Jalkine Oy and to inspire and motivate them to improve their well-being at work by daily workplace exercises. The objective of our study was to design three different workplace exercise programs based on questionnaire and observation. Our thesis includes quantitative research and workplace exercise programs. The programs were based on questionnaire and observation study which was done for the sewing machine operators. We detected the most common musculoskeletal disorders and most common physical work factors of the operators through the questionnaire. The observation provided information of the sewing work tasks. The most common musculoskeletal disorders of the sewing machine operators were located in the neck-shoulder area and lower limbs. The most common physical work factors were the repetitive movements of the wrist/fingers and sedentary work. We designed three different workplace exercise programs based on questionnaire and observation. The programs are a traditional stretching and strengthening program, a fast-paced circuit training program and a stretching program

Efficacy of the implementation of the National Emergency X-Radiography Utilization Study II decision rule to clinical practice for paediatric head injury patients

Aim To investigate the usefulness of the National Emergency X-Radiography Utilization Study (NEXUS) II head trauma decision rule in clinical practice for paediatric patients in a tertiary university hospital serving as the only paediatric hospital in the area. Methods We compared how doctors evaluated and examined patients with head injury during two time periods, before and after the introduction of NEXUS II decision rule. Multiple implementation strategies were used as follows: education, tutoring and written instructions for the use of NEXUS II. Results Two hundred and forty-four head injury patients visited the hospital before and 385 after the introduction of the NEXUS II decision rule. The number of hospital admissions (56%) and the mean duration of hospitalisation (2.5 days) remained the same during the two periods. In the NEXUS II evaluated group, there was a decrease of 40% in the number of hospital admissions. NEXUS II was applied in only 62 (16%) cases. The number of head imaging procedures remained the same. No patients with a clinically significant head injury were missed with the NEXUS II evaluation. Conclusion NEXUS II was ineffective as our implementation failed. When used, NEXUS II reduced expenses in our study population by decreasing the number of hospital admissions.Peer reviewe

Multi-inflammatory syndrome and Kawasaki disease in children during the COVID-19 pandemic : A nationwide register-based study and time series analysis

Aim We investigated whether the ongoing COVID-19 pandemic was associated with the occurrence of Kawasaki disease or with multi-inflammatory syndrome in children (MIS-C). Methods This national Finnish register-based study was based on laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, MIS-C and Kawasaki disease cases. We performed a time series analysis on the occurrence of Kawasaki disease in 2016-2020. Results In 2020, there were 5170 laboratory-confirmed COVID-19 cases in children under 18 years of age and five fulfilled the MIS-C case definition. The occurrence of MIS-C was 0.97 per 1000 (95% confidence interval: 0.31-2.26) laboratory-confirmed SARS-CoV-2 infections in children. Our time series analysis showed that Kawasaki disease cases decreased during the COVID-19 pandemic. The seasonally adjusted incidence rate ratio was 0.49 (95% confidence interval: 0.32-0.74) when it was compared to pre-pandemic levels. This coincided with a reduced occurrence of respiratory infections, due to social distancing in the population. Conclusion This nationwide register-based study found that MIS-C was a rare complication of the SARS-CoV-2 infection. The occurrence of Kawasaki disease and respiratory infections decreased during the pandemic. This suggests that transmissible microbes may play an important role in Kawasaki disease and social distancing may have a protective effect.Peer reviewe

Donor haplotype B of NK KIR receptor reduces the relapse risk in HLA-icentical sibling hematopoetic stem cell transplantation of AML patients

Creative Commons Attribution License (CC BY 4.0)Successful allogeneic hematopoietic stem cell transplantation (HSCT) depends not only on good HLA match but also on T-cell mediated graft-versus-leukemia (GyL) effect. Natural killer (NK) cells are able to kill malignant cells by receiving activation signal from the killer-cell immunoglobulin-like receptors (KIR) recognizing HLA molecules on a cancer cell. It has been recently reported that the risk of relapse in allogeneic hematopoietic stem cell transplantation (HSCT) is reduced in acute myeloid leukemia (AML) patients whose donors have several activating KIR genes or KIR B-motifs in unrelated donor setting, obviously due to enhanced GyL effect by NK cells. We studied the effect on relapse rate of donor KIR haplotypes in the HLA-identical adult sibling HSCT, done in a single center, in Helsinki University Central Hospital, Helsinki, Finland. Altogether, 134 patients with 6 different diagnoses were identified. Their donors were KIR genotyped using the Luminex and the SSP techniques. The clinical endpoint, that is, occurrence of relapse, was compared with the presence or absence of single KIR genes. Also, time from transplantation to relapse was analyzed. The patients with AML whose donors have KIR2DL2 or KIR2DS2 had statistically significantly longer relapse-free survival (P = 0.015). Our data support previous reports that donors with KIR B-haplotype defining genes have a lower occurrence of relapse in HSCT of AML patients. Determination of donor KIR haplotypes could be a useful addition for a risk assessment of HSCT especially in AML patients.Peer reviewe

Clinically relevant germline variants in allogeneic hematopoietic stem cell transplant recipients

Allogeneic hematopoietic stem cell transplantation (HSCT) provides patients with severe hematologic disease a well-established potential for curation. Incorporation of germline analyses in the workup of HSCT patients is not a common practice. Recognizing rare harmful germline variants may however affect patients' pre-transplantation care, choice of the stem cell donor, and complication risks. We analyzed a population-based series of germline exome data of 432 patients who had undergone HSCT. Our aim was to identify clinically relevant variants that may challenge the outcome of the HSCT. We focused on genes predisposing to hematological diseases, or solid tumors, and genes included in the American College of Medical Genetics secondary findings list v3.0. As population-specific controls, we used GnomAD non-cancer Finns (n = 10,816). We identified in our population-based analysis rare harmful germline variants in disease-predisposing or actionable toxicity-increasing genes in 17.8% of adult and pediatric patients that have undergone HSCT (15.1% and 22.9%, respectively). More than half of the patients with a family member as a donor had not received genetic diagnosis prior to the HSCT. Our results encourage clinicians to incorporate germline genetic testing in the HSCT protocol in the future in order to reach optimal long-term outcome for the patients.Peer reviewe

Multi-inflammatory syndrome and Kawasaki disease in children during the COVID-19 pandemic: A nationwide register-based study and time series analysis

Aim: We investigated whether the ongoing COVID-19 pandemic was associated with the occurrence of Kawasaki disease or with multi-inflammatory syndrome in children (MIS-C). Methods: This national Finnish register-based study was based on laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, MIS-C and Kawasaki disease cases. We performed a time series analysis on the occurrence of Kawasaki disease in 2016-2020. Results: In 2020, there were 5170 laboratory-confirmed COVID-19 cases in children under 18 years of age and five fulfilled the MIS-C case definition. The occurrence of MIS-C was 0.97 per 1000 (95% confidence interval: 0.31-2.26) laboratory-confirmed SARS-CoV-2 infections in children. Our time series analysis showed that Kawasaki disease cases decreased during the COVID-19 pandemic. The seasonally adjusted incidence rate ratio was 0.49 (95% confidence interval: 0.32-0.74) when it was compared to pre-pandemic levels. This coincided with a reduced occurrence of respiratory infections, due to social distancing in the population. Conclusion: This nationwide register-based study found that MIS-C was a rare complication of the SARS-CoV-2 infection. The occurrence of Kawasaki disease and respiratory infections decreased during the pandemic. This suggests that transmissible microbes may play an important role in Kawasaki disease and social distancing may have a protective effect.</p

A nationwide real-world study on dynamic ustekinumab dosing and concomitant medication use among Crohn's disease patients in Finland

Background Real-world evidence to support optimal ustekinumab dosing for refractory Crohn's disease (CD) patients remains limited. Data from a retrospective nationwide chart review study was utilized to explore ustekinumab dosing dynamics and optimization, identify possible clinical predictors of dose intensification, and to evaluate ustekinumab trough concentrations (TCs) and concomitant medication use in Finland. Methods Information gathered from17 Finnish hospitals included clinical chart data from 155 adult CD patients who received intravenous ustekinumab induction during 2017-2018. Data on ustekinumab dosing and TCs, concomitant corticosteroid and immunosuppressant use, and antiustekinumab antibodies were analyzed in a two-year follow-up, subject to availability. Results Among 140 patients onustekinumab maintenance therapy, dose optimization was required in 55(39%) of the patients, and 41/47 dose-intensified patients (87%) persisted on ustekinumab. At baseline, dose-intensified patient group had significantly higher C-reactive protein (CRP) levels, and at week 16, significantly lower ustekinumab TCs than in patients without dose intensification. Irrespective of dose optimization, a statistically significant reduction in the use of corticosteroids was observed at both 16 weeks and one year, coupled with an increased proportion of patients on ustekinumab monotherapy. Antiustekinumab antibodies were undetectable in all 28 samples from 25 patients collected throughout the study period. Conclusions Nearly a third of all CD patients on ustekinumab maintenance therapy, with a history of treatment-refractory and long-standing disease, required dose intensification. These patients persisted on ustekinumab and had significant reduction of corticosteroid use. Increased baseline CRP was identified as the sole indicator of dose intensification.Peer reviewe

Measuring regional eco-efficiency – case Kymenlaakso. Key results of the ECOREG project

Eco-efficiency is one of the means by which sustainable development is sought to be implemented. In the last few years the focus has been, in many ways, placed on the European “regions”, and hence the promotion of their competitiveness – and, by this means, their eco-efficiency – has become a central issue in the regions concerned. The Finnish Environment Institute (SYKE), the Southeast Finland Regional Environment Centre, the Regional Council of Kymenlaakso and the Thule Institute at the University of Oulu conducted (1 September 2002 – 31 December 2004) a LIFE project named “The Ecoefficiency of Regions – Case Kymenlaakso (ECOREG)”. The project was financed by the European Community’s LIFE programme (support obtained from LIFE-Environment) and the Finnish Ministry of the Environment. The goal of this project was to demonstrate the concept of ecoefficiency and eco-efficiency evaluation on a regional scale, taking the Kymenlaakso region located in Southeast Finland as an example. This current report presents the key results of the ECOREG project particularly focusing on the indicators and measuring of regional eco-efficiency (monitoring and evaluation mechanism), the processes and methods utilised in the project as well as reproducibility and transferability of the ECOREG results in other parts of Finland and Europe. The ECOREG project has a website in Finnish and English at http://www.ymparisto.fi/syke/ecoreg, http://www.environment.fi/ syke/ecoreg

Att mäta regional ekoeffektivitet – erfarenheter från Kymmenedalen. ECOREG-projektets viktigaste slutsatser

Ekoeffektivitet är ett verktyg som används i strävandena att nå en hållbar utveckling. När de europeiska ”regionerna” under de senaste åren på många sätt har blivit föremål för uppmärksamhet, har också frågan om deras konkurrensförmåga – och därmed också deras ekoeffektivitet – blivit viktig i regionerna. Finlands miljöcentral (SYKE), Sydöstra Finlands miljöcentral, Kymmenedalens förbund och Thule-Institutet vid Uleåborgs universitet genomförde under tiden 1.9.2002-31.12.2004 Lifeprojektet ”Regional ekoeffektivitet – fallet Kymmenedalen (ECOREG)” Målet för projektet ECOREG var att ge en demonstration av begreppet ekoeffektivitet och mätning av ekoeffektivitet i regional skala. Till fallstudieregion valdes landskapet Kymmenedalen i sydöstra Finland. Den här rapporten presenterar projektets viktigaste resultat med särskild betoning på indikatorer för och mätning av regional ekoeffektivitet (uppföljnings- och bedömningssystemet), på de processer och metoder som användes i projektet samt på möjligheterna att tillämpa dessa förfaranden i andra delar av Finland och Europa. Projektet har www-sidor på finska och engelska: http:/ /www.ymparisto.fi/syke/ecoreg, http://www.environment.fi/syke/ecoreg