Työikäisten niskakipupotilaiden fysioterapia Suomessa : osa 3 : hoitokäytännöt fysiatrian poliklinikoilla

Tämän opinnäytetyön tarkoituksena oli selvittää epäspesifin niskakivun fysioterapian hoitokäytäntöjä työikäisillä potilailla Suomessa. Niskakivun hoidosta on olemassa tutkittua tietoa, ja tässä työssä pohdimme kuinka hyvin näyttöön perustuva fysioterapia toteutuu fysiatrian poliklinikoilla. Työ on osa laajempaa tutkimusta, joka kattaa yhteensä neljä eri sektoria, joista muut osat keskittyivät terveyskeskuksiin (osa 1), yksityiseen sektoriin (osa 2) sekä kuntoutuslaitoksiin (osa 4). Opinnäytetyössä käytettiin internetissä täytettävää kyselylomaketta, jonka avulla fysioterapeutit vastasivat hoitokäytännöistä viimeisimmän niskakipupotilaansa kohdalla. Kysely toteutettiin 19 sairaanhoitopiirin alueella sijaitsevissa fysiatrian poliklinikoissa, joista vastauksia saatiin viidestä eri sairaanhoitopiiristä. Pienen vastausprosentin vuoksi tulosten analyysissä keskityttiin nostamaan esille vastauksien keskuudessa toisistaan eriäviä ja keskenään samanlaisia fysioterapiakäytäntöjä. Näitä käytäntöjä arvioidaan tutkittuun tietoon perustaen. Vastausten perusteella fysioterapeutit ovat käyttäneet monipuolisesti eri harjoitusvälineitä, joista vastuskuminauha oli eniten hyödynnetty väline. Myös ohjauksessa on käytetty monia eri menetelmiä, kuten verbaalista ohjausta, demonstrointia ja fasilitointia. Suuri osa fysioterapeuteista ohjeisti harjoitteita jokaisella käyntikerralla. Työssä ilmeni kehitystarpeita, joita olivat erityisesti korkean intensiteetin harjoitteiden ohjauksen vähäisyys, hoidon seurantakäyntien vähyys sekä liian lyhyet hoitojaksot. Johtopäätöksenä todetaan, että ainoastaan pieni osa vastaajista ohjasi potilailleen korkean intensiteetin niskalihasharjoitteita, vaikka niiden vaikuttavuus on tutkitusti tehokkaampaa kuin matalan intensiteetin harjoitteet. Hoidon seurantaa hyödynnettiin melko vähän sekä hoitojakson pituus jäi yleisesti liian lyhyeksi.The purpose of this Bachelor’s thesis was to examine clinical practices of non-specific neck pain in working age patients in Finland. There are several studies about treatment for neck pain and in this thesis we reflect on how well physiotherapy treatments base on different studies in physiatrics clinics. This study is part of a larger survey which includes a total of four different sectors, focusing on health care centres (1), the private sector (2) and rehabilitation centres (4), number three being physiatrics clinics reported in this paper. We interviewed physiotherapists by using an internet questionnaire in which they answered questions concerning their most recent neck pain patient. The survey was implemented in a total of 19 different health care districts, out of which five districts participated. Due to the small number of responses instead of using quantitative methods to analyze the data we decided to reflect on themes that appeared to be the most significant in the questionnaire. In conclusion, we aimed to speculate different physiotherapy conventions used in the treatment of neck pain patients based on previous studies. Based on the answers in the questionnaires, all of the physiotherapists used a wide variety of training equipment, mainly elastic bands, in the treatment of their most recent neck pain patients. Several methods such as verbal guidance, demonstration and facilitation were applied during treatment periods and the majority of the physiotherapists instructed their patients on every visit. However, we discovered that there were deficiencies in high intensity training, the amount of follow-ups and the length of the treatment period. High intensity training was only applied in a minority of the physiotherapists exercise therapies although it has been proven to be more efficient than low intensity training. In addition, the number of follow-ups after the treatment period was generally low and the treatment periods themselves were often short

Single-Molecule Sequencing Revealing the Presence of Distinct JC Polyomavirus Populations in Patients With Progressive Multifocal Leukoencephalopathy

Background. Progressive multifocal leukoencephalopathy (PML) is a fatal disease caused by reactivation of JC polyomavirus (JCPyV) in immunosuppressed individuals and lytic infection by neurotropic JCPyV in glial cells. The exact content of neurotropic mutations within individual JCPyV strains has not been studied to our knowledge. Methods. We exploited the capacity of single-molecule real-time sequencing technology to determine the sequence of complete JCPyV genomes in single reads. The method was used to precisely characterize individual neurotropic JCPyV strains of 3 patients with PML without the bias caused by assembly of short sequence reads. Results. In the cerebrospinal fluid sample of a 73-year-old woman with rapid PML onset, 3 distinct JCPyV populations could be identified. All viral populations were characterized by rearrangements within the noncoding regulatory region (NCCR) and 1 point mutation, S267L in the VP1 gene, suggestive of neurotropic strains. One patient with PML had a single neurotropic strain with rearranged NCCR, and 1 patient had a single strain with small NCCR alterations. Conclusions. We report here, for the first time, full characterization of individual neurotropic JCPyV strains in the cerebrospinal fluid of patients with PML. It remains to be established whether PML pathogenesis is driven by one or several neurotropic strains in an individual.Peer reviewe

Relationship between Fried's frailty phenotype and oral frailty in long-term care residents

Background: oral frailty (OFr) may be called a syndrome lacking a consensus on its definition. Objective: the aim was to prove the relationship between OFr to the phenotype of frailty, general health and nutrition in long-term care. Design: the FINnish ORAL Health Study in Long-Term Care study is a cross-sectional clinical research comprising findings on oral and general health and nutrition. Setting: participants were divided into groups according to the number of OFr signs: Group 1 (0-1 sign), Group 2 (2-4 signs) and Group 3 (5-6 signs). Subjects: the study includes data on 349 older residents of long-term care facilities in Helsinki, Finland. Methods: frailty status was defined according to Fried's frailty phenotype. OFr was evaluated with six signs: dry mouth, diet of pureed or soft food, residue of food on oral surfaces, unclear speech, inability to keep mouth open during the clinical oral examination and pain expression during the examination. Results: a significant linear relationship across the OFr groups with Fried's frailty phenotype was found (P for linearity = 0.008, adjusted by gender and age). A linear trend existed between OFr groups and general health; prevalence of dementia and malnutrition increased from Group 1 to Group 3. The need for help with eating and oral hygiene procedures increased from Group 1 to Group 3. Moreover, OFr had a linear relationship with chewing and swallowing difficulties. Conclusions: OFr is related to Fried's frailty phenotype, general health, nutrition and need for help with daily activities.Peer reviewe

Oral hygiene and health-related quality of life in institutionalized older people

Purpose We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. Methods This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants' background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. Results Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. Conclusions Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents' oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups. Key summary pointsAim We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities. Findings Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL. Message Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.Peer reviewe

Burning roots : Stakeholder arguments and media representations on the sustainability of tree stump extraction in Finland

Highlights • Bioenergy is an important part of renewable energy portfolio. • Sustainability of forest-based bioenergy is debated. • The arguments in the media and among experts adhere to different framings. • Climate impacts stand out in the media discussion of stump energy use. • The results show that science contributes to public discussion and concern.The sustainable use of forest resources is an intensively debated topic, raising environmental, socio-cultural and economic concerns. The debate culminates around forest bioenergy. The bioenergy debate has been characterized by a strong polarisation between different perspectives on environmental impacts. In particular, the claims about carbon sequestration have been contrasted with other ecological impacts. This article focuses on the debate over the use of tree stumps as a relatively novel source of forest bioenergy. To shed light on the constellation of the different arguments and actors in the debate on the sustainability of forest bioenergy, we conducted an empirical qualitative analysis of Finnish argumentation on tree stump removal, using media and interview data and relating the emerging sustainability arguments to the dimensions debated in the EU biofuel sustainability policy. The analysis shows the variation of views across Finnish expert stakeholders and the fora where the arguments are made. Climate impacts dominate the media discussion, while other sustainability dimensions are covered in expert discussion. Our findings have implications for the interpretation and use of scientific arguments in energy debates, in particular regarding environmental sustainability

Dietary fat intake and quality in long-term care residents in two cohorts assessed 10 years apart

Purpose To describe and compare detailed dietary fat intake, fat quality and associative factors between two measuring points 10 years apart of residents living in long-term care facilities, and to reflect how fat composition and fat quality corresponds to current nutrition recommendations. Methods In 2007 long-term care residents (n = 374) of 25 assisted-living facilities and nursing homes and in 2017-18 long-term care residents (n = 486) of 17 respective facilities in Helsinki metropolitan area were recruited for this study. Information on the residents' heights, demographic information and use of calcium and vitamin D supplementation were retrieved from medical records. Residents' clinical assessment included Clinical Dementia Rating (CDR), the Mini Nutritional Assessment (MNA) and questionnaire related to nutrition care. Participants' energy and fat intake were determined from 1--2-day food diaries kept by the ward nurses, and fat quality indicators calculated. Results Age, gender distribution, MNA score or body mass index did not differ between the two cohorts. Residents' cognitive status, subjective health and mobility were poorer in 2017 compared to 2007. Total fat and saturated fatty acid (SFA) intakes were higher and fat quality indicators lower in the 2017 cohort residents than in the 2007 cohort residents. Sugar intake, male gender, eating independently, eating larger amounts and not having dry mouth predicted higher SFA intake in the 2017 cohort. Conclusions The fat quality in long-term care residents in our study worsened in spite of official recommendations between the two measurement points.Peer reviewe

Long-term follow up of families with pathogenic NFKB1 variants reveals incomplete penetrance and frequent inflammatory sequelae

Publisher Copyright: © 2022 The AuthorsNuclear factor κ light-chain enhancer of activated B cells (NF-κB) family of evolutionarily conserved transcription factors are involved in key cellular signaling pathways. Previously, hypogammaglobulinemia and common variable immunodeficiency (CVID)-like phenotypes have been associated with NFKB1 variants and loss-of-function NFKB1 variants have been reported as the most common monogenic cause for CVID among Europeans. Here, we describe a Finnish cohort of NFKB1 carriers consisting of 31 living subjects in six different families carrying five distinct heterozygous variants. In contrast to previous reports, the clinical penetrance was not complete even with advancing age and the prevalence of CVID/hypogammaglobulinemia was significantly lower, whereas (auto)inflammatory manifestations were more common (42% of the total cohort). At current stage of knowledge, routine genetic screening of asymptomatic individuals is not recommended, but counseling of potential adult carriers seems necessary.Peer reviewe

Antiviral Properties of Chemical Inhibitors of Cellular Anti-Apoptotic Bcl-2 Proteins

Viral diseases remain serious threats to public health because of the shortage of effective means of control. To combat the surge of viral diseases, new treatments are urgently needed. Here we show that small-molecules, which inhibit cellular anti-apoptotic Bcl-2 proteins (Bcl-2i), induced the premature death of cells infected with different RNA or DNA viruses, whereas, at the same concentrations, no toxicity was observed in mock-infected cells. Moreover, these compounds limited viral replication and spread. Surprisingly, Bcl-2i also induced the premature apoptosis of cells transfected with viral RNA or plasmid DNA but not of mock-transfected cells. These results suggest that Bcl-2i sensitizes cells containing foreign RNA or DNA to apoptosis. A comparison of the toxicity, antiviral activity, and side effects of six Bcl-2i allowed us to select A-1155463 as an antiviral lead candidate. Thus, our results pave the way for the further development of Bcl-2i for the prevention and treatment of viral diseases.Peer reviewe

Antiviral properties of chemical inhibitors of cellular anti-apoptotic Bcl-2 proteins

Viral diseases remain serious threats to public health because of the shortage of effective means of control. To combat the surge of viral diseases, new treatments are urgently needed. Here we show that small-molecules, which inhibit cellular anti-apoptotic Bcl-2 proteins (Bcl-2i), induced the premature death of cells infected with different RNA or DNA viruses, whereas, at the same concentrations, no toxicity was observed in mock-infected cells. Moreover, these compounds limited viral replication and spread. Surprisingly, Bcl-2i also induced the premature apoptosis of cells transfected with viral RNA or plasmid DNA but not of mock-transfected cells. These results suggest that Bcl-2i sensitizes cells containing foreign RNA or DNA to apoptosis. A comparison of the toxicity, antiviral activity, and side effects of six Bcl-2i allowed us to select A-1155463 as an antiviral lead candidate. Thus, our results pave the way for the further development of Bcl-2i for the prevention and treatment of viral diseases.</p