Health service use and costs among migrants in an irregular situation : Cross-sectional register-based study from a voluntary-based clinic

Background As few data based on actual demand for healthcare services in vulnerable migrant populations exist, we studied service use and healthcare costs in a cohort of migrants in an irregular situation. Methods In this single-centre retrospective register study, we examined the reasons for encounter, diagnoses, service use and costs of healthcare among patients at a voluntary clinic for migrants in an irregular situation in Helsinki, Finland. ICPC-2 classification and national unit costs for primary healthcare were used for the cost estimation. Results A total of 546 patient visits accounted for 620 ICPC-2 coded reasons for encounter, diagnoses and process codes. The most common health problems were teeth/gum disease (10%), acute upper respiratory infection (5%) and oesophageal disease (3%). Visits seldom led to complementary investigations (2%), follow-up visits (5%) or referrals (11%). The total cost of treatment, excluding dental health costs, was 71 euros per visit. Conclusions Migrants in an irregular situation present with a variety of health concerns, the majority of which can be treated in a basic primary healthcare facility at a relatively low cost. This encourages research to evaluate the health and cost effects of extending public healthcare for migrants in an irregular situation beyond emergency care.Peer reviewe

Biokemiallisia muutoksia aineenvaihdunnan synnynnäisissä ja hankituissa häiriötiloissa

Normal human metabolism is a well-coordinated process involving the whole organism. It can be disturbed in true inborn errors of metabolism or, alternatively, in acquired situations where inappropriate nutrition and impaired energy production compromise normal metabolic control. These situations may share common pathophysiological mechanisms and metabolic markers. Their closer knowledge could provide new approaches for treatment or diagnosis. This thesis had two objectives, both dealing with biochemical changes in situations where significant metabolic perturbations occur. (1) To study thiol metabolism in children with several inborn errors of metabolism (n = 36) and in cell culture models, where similar metabolic conditions are created. Thiol levels and thiol redox status, serving multiple metabolic and regulatory purposes, could be affected in inborn errors of metabolism following inappropriate nutrition and compromised energy metabolism. Changes in thiol status could have an important role in the development of complications and even offer therapeutic potential in these diseases, as thiol levels can be influenced by diet or medication. (2) To investigate end products of metabolism in infants with cow s milk allergy (CMA; n = 35) as metabolic markers of inadequate nutrition in early childhood and altered intestinal microbial metabolism. Eventually, these changes could provide a novel diagnostic tool. Plasma and erythrocyte non-protein thiols (glutathione and cysteine) as well as thiols in cultured human fibroblasts, HEPG2 and 293T cells were measured with a liquid chromatography based method. Mass spectrometry was used for quantification of urinary excretion of end products of metabolism in CMA patients. Activities of enzymes related to thiol metabolism in human erythrocytes were studied in spectrophotometric assays. Patients with inborn errors of energy and nutrient metabolism had altered levels of plasma non-protein thiols glutathione and cysteine. Their plasma thiol redox status was indicative of oxidative stress, which thus seems to play a role in the pathophysiology of complications of these diseases. With further research, the changes in thiol status could have therapeutic implications. CMA is associated with measurable changes in urinary levels of end products of metabolism, which may be seen as markers of inadequate nutrition or altered intestinal bacterial metabolism. If confirmed in future studies, these changes could provide an innovative new approach to the diagnosis of CMA.Normaali aineenvaihdunta on tarkkaan säädeltyjen yhtäaikaisten kemiallisten reaktioiden sarja. Aineenvaihdunta ylläpitää elimistössä tasapainotilaa energian ja ravintoaineiden saannin, kulutuksen ja varastoinnin välillä. Aineenvaihdunnan häiriötiloja tavataan sekä synnynnäisissä aineenvaihduntasairauksissa että hankituissa tilanteissa, joissa esimerkiksi epäsopiva ravitsemus tai riittämätön energiantuotanto johtaa aineenvaihdunnan säätelyn häiriintymiseen. Näillä tilanteilla voi olla yhteisiä taustoja ja mekanismeja, joiden tarkempi tuntemus voisi lisätä ymmärrystä aineenvaihdunnan häiriötilojen kehittymisestä ja edelleen tarjota uusia hoito- ja diagnoosivaihtoehtoja. Väitöskirjatyössä tutkittiin tioliaineenvaihduntaa (glutationin ja kysteiinin pitoisuuksia ja niiden hapettumis-pelkistymisastetta sekä tämän säätelyyn osallistuvien entsyymien toimintaa) lapsipotilailla, jotka kärsivät energia-ja ravintoaineiden aineenvaihdunnan synnynnäisistä sairauksista. Tioleita esiintyy kaikissa solutyypeissä ja niillä on laaja-alaisia vaikutuksia solujen aineenvaihdunnan ja hyvinvoinnin säätelyyn; tioleista glutationi on myös tärkeä solunsisäinen antioksidantteja. Tioliaineenvaihdunnalla on läheinen yhteys energia-aineenvaihdunnan ja ravitsemuksen kanssa; on siis perusteltua olettaa, että puutteet energian tai ravintoaineiden saannissa näkyisivät poikkeavuuksina tiolitasoissa. Lisäksi väitöskirjatyössä tutkittiin lehmänmaitoallergisilla lapsilla virtsaan erittyviä aineenvaihdunnan lopputuotteita esimerkkinä huonosti sopivan ravinnon aineenvaihdunnallisista vaikutuksista. Synnynnäisiä aineenvaihduntasairauksia sairastavilla lapsilla oli terveistä verrokeista poikkeavat plasman tiolipitoisuudet, ja heillä mitattu tiolien hapettumis-pelkistymisaste viittasi oksidatiivisen stressin lisääntymiseen. Vaikuttaakin siltä, että oksidatiivisella stressillä ja alentuneilla tioliantioksidanttitasoilla on osansa aineenvaihduntasairauksiin liittyvien liitännäisongelmien kehittymisessä. On mahdollista, että näitä tuloksia voitaisiin jatkossa hyödyntää joidenkin aineenvaihduntasairauksien hoidossa. Maitoallergisilla potilailla puolestaan havaittiin lisääntyneitä määriä aineenvaihdunnan lopputuotteita virtsassa. Tämä ilmentänee vääränlaisen ja huonosti sopivan ravitsemuksen aineenvaihdunnallisia vaikutuksia, ja taustalla saattavat myös olla maitoallergiaan liittyvän poikkeavan suoliston bakteerikannan aineenvaihduntavaikutukset. Tällaisilla mitattavilla muutoksilla voisi myöhemmin olla myös käyttöä yleisen ja vaikeasti diagnosoitavan ruoka-aineallergian diagnostiikassa

Väestö muuttuu – osaammeko huolehtia maahanmuuttajalasten terveydestä?

Suomen väestörakenteen nopea muutos luo painetta palvelujärjestelmän kehittämiselle. Kokonaiskuva maahanmuuttajalasten terveydestä suhteessa muuhun väestöön on edelleen epäselvä. Maahanmuuttajalasten terveys -tutkimushanke pyrkii selvittämään, onko väestöryhmien terveydessä ja palvelunkäytössä eroja, ja missä määrin mahdolliset erot ovat selitettävissä sosioekonomisilla taustatekijöillä

Helium-oxygen in bronchiolitis-A systematic review and meta-analysis

Introduction Bronchiolitis is common reason for infant hospitalization. The aim of our systematic review and meta-analysis was to evaluate helium-oxygen (heliox) in bronchiolitis. Methods We screened 463 studies, assessed 22 of them, and included six randomized controlled trials. Primary outcomes were the need for continuous positive airway pressure (CPAP) or intubation, hospitalization duration, and change in the modified Woods Clinical Asthma Scale (M-WCAS). We calculated mean differences with 95% confidence intervals (CIs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Results Six studies (five double- and one single-blinded) with 560 infants were included. The risk of bias was high in one, moderate in four, and low in one. The RR for the need for CPAP (three studies) was 0.87 (CI: 0.56-1.35), and for intubation (four studies) was 1.39 (CI: 0.53-3.63), heliox compared to air-oxygen. The hospital stay (four studies) was 0.25 days longer (CI: -0.22 to 0.71) in the heliox group. The mean decrease in M-WCAS from the baseline (three studies) was 1.90 points (CI: 1.46-2.34) greater in the heliox group. Conclusion We found low-quality evidence that heliox does not reduce the need for CPAP, intubation, or length of hospitalization for bronchiolitis. Based on the M-WCAS scores, heliox seems to relieve respiratory distress symptoms rapidly after its initiation. The included studies had high heterogeneity in their methods and included relatively mild cases of bronchiolitis. A larger randomized controlled trial with more severe cases of bronchiolitis with enough power to analyze the need for intubation is needed in the future.Peer reviewe

Tietokannoista tulkintoihin: digitaalisen historiantutkimuksen käytäntöjä

Johdanto erikoisnumeroon teemalla Digitaalinen historiantutkimus verkkolehteen Ennen ja nyt 2/201. </p

Why do infants need out-of-hospital emergency medical services? A retrospective, population-based study

BackgroundThe challenges encountered in emergency medical services (EMS) contacts with children are likely most pronounced in infants, but little is known about their out-of-hospital care. Our primary aim was to describe the characteristics of EMS contacts with infants. The secondary aims were to examine the symptom-based dispatch system for nonverbal infants, and to observe the association of unfavorable patient outcomes with patient and EMS mission characteristics.MethodsIn a population-based 5-year retrospective cohort of all 1712 EMS responses for infants (agePeer reviewe

Overlooking the Obvious during the COVID-19 Pandemic : Dyspnoea with Asymmetric Breath Sounds in a Toddler

Background. Paediatric healthcare specialists are concerned about the secondary effects of the COVID-19 pandemic on children. We report a case of acute respiratory distress in a healthy toddler whose healthcare providers were sidetracked from the correct diagnosis by suspicion of COVID-19. Case Presentation. The patient was a 20-month-old healthy boy. In the morning, he had coughed while drinking milk. He was asymptomatic for the day but presented with acute respiratory distress when lying down in the evening. An ambulance was called, and he was taken to a tertiary hospital's paediatric emergency department, where his condition and oxygen saturation fluctuated. He had mildly elevated temperature and petechiae on his trunk, showed asymmetrical radiographic and auscultatory pulmonary findings, and did not tolerate any exertion. Pneumonia was suspected, SARS-CoV-2 was considered as potential causative agent, and the child was admitted to a Paediatric Intensive Care Unit. As the patient did not show clear signs of infection or bronchial obstruction, the events were thoroughly rediscussed with the caregiver next morning. It was then found out that the child had also been eating cashew nuts. Multiple pieces of cashew nuts were removed from the left bronchial tree in a bronchoscopy. After the procedure, all symptoms promptly resolved. Foreign body aspiration-an obvious cause of acute respiratory distress in our patient's age group-was overlooked by experienced emergency medical care providers and paediatric critical care physicians due to the slightly unusual presentation, incomplete anamnestic information, and a bias to consider COVID-19 in the current exceptional circumstances. Conclusions. Emergency care providers are instructed to consider all patients with respiratory distress as potential COVID-19 patients. However, the clinical course of COVID-19 infection is usually mild in children. Therefore, alternative causes for serious breathing difficulty are more likely, and all differential diagnoses should be considered in the usual unbiased manner.Peer reviewe

Embryonic modernity: infectious dynamics in early nineteenth-century Finnish culture

The article explores the early decades of the nineteenth century as an era of what we call embryonic modernity. It focuses on Finland which, in 1809, became a Grand Duchy of the Russian empire. The article concentrates on early mass phenomena as embryos of an emerging modern culture. We scrutinize our subject through three different lenses, starting with social infectivity on a minor scale, the unrest caused by students. We then investigate the contagiousness of ideas seen through the press as a news medium in the 1820s. The last section concentrates on the news about cholera and its rapid spread during the early 1830s. We argue that historical embryos were formations of social relationality, composed of affects, beliefs, expectations and sentiments. These formations of emotive dynamics had the capacity to be imitated; they became components of larger social entities by extending their contagiousness to new regions and populations.</p

Textual Migration Across the Baltic Sea : Creating a Database of Text Reuse Between Finland and Sweden

Publisher Copyright: © 2022 Copyright for this paper by its authors. Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0)In this paper, we present a database and an interface on text reuse between newspapers and journals published in the Swedish language in Sweden and Finland during the 1645-1918 time frame. Using two national, digital newspaper collections, we detected their textual similarities with a computational method to study the textual migration, i.e., information flows, between the two countries. For purposes of this project, we developed a database of detected clusters of text reuse and an online interface to search, examine and analyse the transnational movement of information. The database, Text Reuse in the Swedish-language Press, 1645-1918, is accessible online and includes texts from over 1, 100 newspapers and journals published at approximately 150 locations at various times during the 274-year time frame.Peer reviewe