Severe intimate partner violence affecting both young and elderly patients of both sexes

Background Intimate partner violence (IPV) affects 25-35 % of women and men in Western countries. Despite the high prevalence of IPV among trauma patients, very little is known about the associated injuries. Most previous studies excluded male victims and IPV is often limited to violence against women. Few reports on IPV among elderly patients exist. Methods We examined self-reports of IPV among patients at two major trauma centers of the Helsinki Central Hospital in Finland. Based on previous studies, we hypothesized that we would find the most severe injuries among young and middle-aged women. Results We identified 29 patients with a total of 105 injuries; patients typically presented with multiple injuries. Half of all patients required hospitalization or surgery. Contrary to previous studies, 17 % of our cohort were male, while 17 % of patients were 65 years or older. We found that 40 % of male victims presented with a New Injury Severity Score (NISS) over 15, indicating severe trauma. Two elderly patients presented with an NISS of 27, the highest in our study. Conclusions IPV leads to severe injury across all age groups among both male and female patients. The injury mechanism should be clearly defined for all trauma patients, keeping IPV in mind as a potential cause despite patient age or gender.Peer reviewe

Manipulating host resistance structure reveals impact of pathogen dispersal and environmental heterogeneity on epidemics

Understanding how variation in hosts, parasites, and the environment shapes patterns of disease is key to predicting ecological and evolutionary outcomes of epidemics. Yet in spatially structured populations, variation in host resistance may be spatially confounded with variation in parasite dispersal and environmental factors that affect disease processes. To tease apart these disease drivers, we paired surveys of natural epidemics with experiments manipulating spatial variation in host susceptibility to infection. We mapped epidemics of the wind-dispersed powdery mildew pathogen Podosphaera plantaginis in five populations of its plant host, Plantago lanceolata. At 15 replicate sites within each population, we deployed groups of healthy potted 'sentinel' plants from five allopatric host lines. By tracking which sentinels became infected in the field and measuring pathogen connectivity and microclimate at those sites, we could test how variation in these factors affected disease when spatial variation in host resistance and soil conditions was minimized. We found that the prevalence and severity of sentinel infection varied over small spatial scales in the field populations, largely due to heterogeneity in pathogen prevalence on wild plants and unmeasured environmental factors. Microclimate was critical for disease spread only at the onset of epidemics, where humidity increased infection risk. Sentinels were more likely to become infected than initially healthy wild plants at a given field site. However, in a follow-up laboratory inoculation study we detected no significant differences between wild and sentinel plant lines in their qualitative susceptibility to pathogen isolates from the field populations, suggesting that primarily non-genetic differences between sentinel and wild hosts drove their differential infection rates in the field. Our study leverages a multi-faceted experimental approach to disentangle important biotic and abiotic drivers of disease patterns within wild populations.Peer reviewe

Self-reported reasons for on-duty sleepiness among commercial airline pilots

Experimental and epidemiological research has shown that human sleepiness is determined especially by the circadian and homeostatic processes. The present field study examined which work-related factors airline pilots perceive as causing on-duty sleepiness during short-haul and long-haul flights. In addition, the association between the perceived reasons for sleepiness and actual sleepiness levels was examined, as well as the association between reporting inadequate sleep causing sleepiness and actual sleep-wake history. The study sample consisted of 29 long-haul (LH) pilots, 28 short-haul (SH) pilots, and 29 mixed fleet pilots (flying both SH and LH flights), each of whom participated in a 2-month field measurement period, yielding a total of 765 SH and 494 LH flight duty periods (FDPs) for analyses (FDP, a period between the start of a duty and the end of the last flight of that duty). The self-reports of sleepiness inducers were collected at the end of each FDP by an electronic select menu. On-duty sleepiness was rated at each flight phase by the Karolinska Sleepiness Scale (KSS). The sleep-wake data was collected by a diary and actigraph. The results showed that "FDP timing" and "inadequate sleep" were the most frequently reported reasons for on-duty sleepiness out of the seven options provided, regardless of FDP type (SH, LH). Reporting these reasons significantly increased the odds of increased on-duty sleepiness (KSS >= 7), except for reporting "inadequate sleep" during LH FDPs. Reporting "inadequate sleep" was also associated with increased odds of a reduced sleep-wake ratio (total sleep time/amount of wakefulnessPeer reviewe

Kohti yhteisiä tavoitteita : GAS-koulutuksen arviointihankkeen loppuraportti

Goal Attaiment Scaling eli GAS on tavoiteasetannan menetelmä, jonka avulla pyritään ottamaan asiakkaan arki kuntoutuksen lähtökohdaksi. GAS-koulutusta avokuntoutuksen ammattihenkilöille on toteutettu 15 ammattikorkeakoulussa eri puolilla Suomea vuodesta 2011 alkaen. Tämän arviointitutkimuksen tarkoituksena oli selvittää, miten koulutuksen suorittaneet ammattilaiset käyttävät GAS-menetelmää ja minkälaisena he kokevat sen käytettävyyden ja hyödynnettävyyden. Lisäksi haluttiin kartoittaa sekä koulutuksiin osallistuneiden että kouluttajien näkemyksiä GAS-menetelmästä ja -koulutuksesta ja sen kehittämistarpeista. Tutkimuksen aineisto koottiin GAS-koulutukseen osallistuneille kuntoutusammattilaisille kohdennetulla sähköisellä kyselyllä ja GAS-kouluttajien haastatteluilla. Kyselyn vastaajista (n = 178) suurin osa ilmoitti kuntoutujien osallistuvan tavoitteiden asettamiseen ja yli puolet vastaajista koki menetelmän parantaneen kuntoutujien kuntoutusmotivaatiota. Yhteistyö hoitovastuutahon kanssa GAStavoitteiden suunnittelussa ja asettamisessa on vastausten perusteella melko vähäistä. Vajaa puolet vastaajista arvioi GAS-menetelmän käyttöönoton lisänneen tai syventäneen moniammatillista yhteistyötä. Tarkasteltaessa GAS-menetelmän hallintaa havaittiin, että koulutukseen osallistuneilla näyttäisi olevan vaikeuksia lähtö- ja tavoitetason määrittelyssä, indikaattorien sanallistamisessa sekä T-scoren ymmärtämisessä. Noin kaksi kolmasosaa vastaajista arvioi GAS-koulutuksen vastanneen odotuksia, mutta kaiken kaikkiaan koulutustyytyväisyyden suhteen ammattikorkeakoulukohtaiset erot olivat suuria tilastollisesti merkitsevällä tasolla. Avoimissa vastauksissa teemoiksi nousivat moniammatillisuus ja ammattikohtaisuus koulutuksen toteutuksessa, kuntoutujiin liittyvät haasteet sekä kouluttajien GAS-osaaminen. Kouluttajien haastatteluissa esille nousivat koulutukseen osallistuneiden vastustavat ennakkoasenteet, moniammatillisen työskentelyn puute arjessa, totutuista rooleista poisoppiminen, vaikeus asettaa arkielämälähtöisiä ja tarkoituksenmukaisia tavoitteita sekä se, että kuntoutukselta puuttuu usein kokonaistavoite. Kouluttajat olivat syventäneet ja laajentaneet koulutussisältöjä ja muokanneet välitehtäviä kukin omalla tavallaan ja omien ryhmiensä tarpeista lähtien, joten GAS-koulutuksen yhdenmukaisuudesta ei voitane puhua. Raportin yhteenvetona kuvataan hyvän GAS-koulutuskäytännön elementit

Slow and Steady: Readiness, Pretreatment Weekly Strengthening Activity, and Pediatric Weight Management Program Completion

Background: Pediatric weight management programs have substantial attrition rates, which have led to recommendations to assess readiness prior to enrollment. Both pretreatment readiness scales and behaviors, such as exercise, have been theorized to predict subsequent program completion. The purpose of this study was to explore the role of self-reported pretreatment exercise in adolescents on completion of a pediatric weight management program and to explore the predictive ability of standard readiness scales. Methods: A total of 146 obese (BMI≥95th percentile) pediatric (ages 11?18) participants joined a 6-month multidisciplinary weight management program between March, 2007, and July, 2010. Completers were compared retrospectively to noncompleters on demographic, readiness, and pretreatment exercise practices from clinic-developed intake questionnaires using univariate analyses. Regression analyses specified the degree to which these variables predicted program completion. Results: The 6-month completion rate was 53%. There was no relationship between self-reported readiness and program completion. Self-reported pretreatment weekly strengthening activity (SA) was significantly associated with program completion, compared to those who performed SA either never [univariate odds ratio (OR) 3.18, 95% confidence interval (CI) 1.51?6.68, p=0.002; multivariate OR 2.43, 95% CI 1.06?5.58, p=0.036] or daily (univariate OR 4.90, 95% CI 1.74?13.77, p=0.002; multivariate OR 4.69, 95% CI 1.45?15.14, p=0.010). No relationship was found between other forms of exercise and program completion. Conclusions: Self-reported pretreatment weekly SA, but not standard readiness scales, predicted pediatric weight management program completion.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140330/1/chi.2013.0006.pd

Outcomes of High-Frequency Gastric Electric Stimulation for the Treatment of Severe, Medically Refractory Gastroparesis in Finland

Background and Aims: Severe, medically uncontrollable gastroparesis is a rare entity, which can be treated using a high-frequency gastric electric stimulator implanted surgically. Previous follow-ups have proven positive outcomes with gastric electric stimulator in patients with gastroparesis. The aim of this study was to evaluate the efficacy and safety of gastric electric stimulator in patients, in whom gastroparesis could not be controlled by conservative means in our country. Materials and Methods: This is a retrospective multi-center cohort comprising all patients who had been implanted gastric electric stimulator for severe, medically refractory gastroparesis during 2007-2015 in Finland. Results: Fourteen patients underwent implantation of gastric electrical stimulator without any postoperative complications. Laparoscopic approach was used in 13 patients (93%). Prior implantation, all patients needed frequent hospitalization for parenteral feeding, 13 had severe nausea, 11 had severe vomiting, 10 had notable weight loss, and 6 had frequent abdominal pain. After operation, none of the patients required parenteral feeding, 11 patients (79%) gained median of 5.1 kg in weight (P <0.01), and symptoms were relieved markedly in 8 and partially in 3 patients (79%). Of partial responders, two continued to experience occasional vomiting and one mild nausea. Five patients needed medication for gastroparesis after the operation. One patient did not get any relief of symptoms, but gained 6 kg in weight. No major late complications occurred. Conclusion: Gastric electrical stimulator seems to improve the nutritional status and give clear relief of the symptoms of severe, medically uncontrollable gastroparesis. Given the low number of operations, gastric electrical stimulator seems to be underused in Finland.Peer reviewe

Stoma reversal after Hartmann's procedure for acute diverticulitis

Background: Hartmann's procedure is a treatment option for perforated acute diverticulitis, especially when organ dysfunction(s) are present. Its use has been criticized mostly out of fear of high permanent stoma rate. The aim of this study was to investigate the rate of stoma reversal, reasons behind non-reversal, and safety of reversal surgery. Methods: This was a single-center retrospective study of patients undergoing urgent Hartmann's pro-cedure due to acute diverticulitis between the years 2006 and 2017 with follow-up until March 2021. Results: A total of 3,319 episodes of diverticulitis in 2,932 patients were screened. The Hartmann's procedure was performed on 218 patients, of whom 157 (72%) had peritonitis (48 (22%) with organ dysfunction). At 2-years, 76 (34.9%) patients had died with stoma, 42 (19.3%) were alive with stoma, and 100 (45.9%) had undergone stoma reversal. The survival of patients with and without reversal were 100% and 42.7% at 1-year, 96.0% and 35.0% at 2-years and 88.9% and 20.7% at 5-years, respectively. The risk factors for nonreversal were old age, a need for outside assistance, low HElsinki Staging for Acute Diverticulitis stage, and higher C-reactive protein level upon hospital admission. The most common reasons for nonreversal in surviving patients were patient not willing to have the operation 18 (41%) and dementia 10 (23%). Twelve (12%) patients had a major complication after reversal (Clavien-Dindo IIIb-IV) and 90-day mortality after reversal was 0%. Conclusion: After the Hartmann's procedure for acute diverticulitis, one-third died, half underwent stoma reversal, and one-fifth did not undergo stoma reversal within 2 years. Patients who survive with stoma are either not willing to have reversal or have severe comorbidities excluding elective surgery. The Hartmann's procedure remains a viable option for high-risk patients with perforated acute diverticulitis. (c) 2022 The Author(s). Published by Elsevier Inc.Peer reviewe

Prolonged sleep restriction induces changes in pathways involved in cholesterol metabolism and inflammatory responses

Sleep loss and insufficient sleep are risk factors for cardiometabolic diseases, but data on how insufficient sleep contributes to these diseases are scarce. These questions were addressed using two approaches: an experimental, partial sleep restriction study (14 cases and 7 control subjects) with objective verification of sleep amount, and two independent epidemiological cohorts (altogether 2739 individuals) with questions of sleep insufficiency. In both approaches, blood transcriptome and serum metabolome were analysed. Sleep loss decreased the expression of genes encoding cholesterol transporters and increased expression in pathways involved in inflammatory responses in both paradigms. Metabolomic analyses revealed lower circulating large HDL in the population cohorts among subjects reporting insufficient sleep, while circulating LDL decreased in the experimental sleep restriction study. These findings suggest that prolonged sleep deprivation modifies inflammatory and cholesterol pathways at the level of gene expression and serum lipoproteins, inducing changes toward potentially higher risk for cardiometabolic diseases