360 research outputs found
Suomalaisten vauvojen vanhempien tulevaisuuden lapsitoiveiden kartoitus multinomiaalisella logistisella regressiolla
TiivistelmÀ. Viime vuosikymmenen ajan syntyvyys on laskenut tasaisesti Suomessa. Tutkielmassa pyrittiin selvittÀmÀÀn tekijöitÀ, jotka vaikuttavat suomalaisten tuoreiden vanhempien tulevaisuuden lapsitoiveisiin. Tutkielmassa kÀytetty aineisto, FinLapset-kyselytutkimus, antaa mahdollisuuden tutkia tÀmÀnkaltaista tutkimuskysymystÀ. Kyselytutkimus toteutettiin vuonna 2020 ja se on Terveyden ja hyvinvoinnin laitoksen toteuttama. Kyselyyn vastasi yhteensÀ 14 820 vanhempaa.
Vasteena toimivat vastaukset kysymykseen ââToivotko tulevaisuudessa lisÀÀ lapsiaââ, jotka jaettiin kolmeen luokkaan, ââeââ, ââkyllĂ€ââ ja ââei osaa sanoaââ. Vastetta tarkasteltiin multinomiaalisella logistisella regressiolla, joka soveltuu moniluokkaisen vastemuuttujan tilanteeseen, jossa luokille ei oleteta jĂ€rjestystĂ€. Tulevaisuuden lapsitoiveita tarkasteltiin vanhemman roolin, iĂ€n, koulutuksen, syntymĂ€maan, uupumuksen sekĂ€ perheen lapsiluvun (perheessĂ€ ei ennestÀÀn muita lapsia/muitakin lapsia) mukaan. Saadut tulokset esitetÀÀn vetosuhteinta (odds ratio) sekĂ€ todennĂ€köisyysskaalalle piirettyinĂ€ kuvaajina.
Saaduista tuloksista havaittiin, ettÀ voimakkaimmin vanhempien tulevaisuuden lapsitoiveisiin vaikutti vanhemman ikÀ sekÀ perheen lapsiluku. Myös vanhemman uupumuksella, syntymÀmaalla ja koulutuksella havaittiin olevan merkitystÀ lapsitoiveita kysyttÀessÀ. Muuttujien vÀlillÀ havaittiin myös merkittÀviÀ yhdysvaikutuksia.
Tutkielmassa saadut tulokset tukevat hyvin aiempaa tutkimustietoa. Jatkossa kyselyaineistoon liitettÀvien rekisteritietojen avulla tutkimuskysymystÀ on mahdollista tarkentaa, varsinkin lapsiluvun osalta. Uusien kyselytutkimusten avulla voitaisiin kerÀtÀ trendidataa, jonka avulla syntyvyyden kehittymistÀ Suomessa voitaisiin tutkia vielÀkin paremmin
Work disability before and after a major cardiovascular event: a ten-year study using nationwide medical and insurance registers
We examined the trajectories of work disability before and after IHD and stroke events. New IHD (nâ=â13521) and stroke (nâ=â7162) cases in 2006-2008 were retrieved from nationwide Swedish hospital records and their annual work disability days five years before and after the date of diagnosis were retrieved from a nationwide disability register. There was no pre-event differences in disability days between the IHD and stroke cases and five years prior to the event, they were close to those observed in the general population. In the first post-event year, the adjusted mean days increased to 83.9 (95% CI 80.6-86.5) in IHD; to 179.5 (95% CI 172.4-186.8) in stroke, a six-fold increase in IHD and 14-fold in stroke. Work disability leveled off among the IHD cases but not among those who had stroke. The highest disability levels for the fifth post-event year after a stroke event was associated with pre-existing diabetes (146.9), mental disorder (141.2), non-employment (137.0), and immigrant status (117.9). In a working-age population, the increase in work disability after a cardiovascular event decreases close ï»żï»żto the pre-event level in IHD but remains particularly high after stroke; among patients with comorbid depression or diabetes, immigrants, and those not in employment
Diagnosis-Specific Work Disability before and after Lumbar Spine Decompression SurgeryâA Register Study from Sweden
Low back pain (LBP) patients undergoing lumbar spine decompression surgery (LSDS) often suffer from multi-comorbidity and experience high work disability. This study aimed to identify diagnosis-specific work disability patterns in all LBP-patients before and after LSDS during 2008â2010, that were aged 19â60 years and living in Sweden (n = 10,800) and compare these patterns to LBP-patients without LSDS (n = 109,179), and to matched individuals without LBP (n = 472,191). Work disability days (long-term sickness absence (LTSA), disability pension (DP)) during the three years before to three years after the cohortâs entry date were identified by generalised estimating equations. LBP-patients undergoing LSDS had higher overall work disability during the three years following surgery (LTSA: 23.6%, DP: 6.3%) than LBP-patients without LSDS (LTSA: 19.5%, DP: 5.9%), and those without LBP (LTSA: 7.9%, DP: 1.7%). Among patients undergoing LSDS, the prevalence of work disability due to dorsopathies increased from 20 days three years before surgery to 70 days in the year after and attenuated to 30 days in the third year following surgery. Work disability for other diagnoses remained stable at a low level in this group
Diagnosis-Specific Work Disability before and after Lumbar Spine Decompression SurgeryâA Register Study from Sweden
Low back pain (LBP) patients undergoing lumbar spine decompression surgery (LSDS) often suffer from multi-comorbidity and experience high work disability. This study aimed to identify diagnosis-specific work disability patterns in all LBP-patients before and after LSDS during 2008â2010, that were aged 19â60 years and living in Sweden (n = 10,800) and compare these patterns to LBP-patients without LSDS (n = 109,179), and to matched individuals without LBP (n = 472,191). Work disability days (long-term sickness absence (LTSA), disability pension (DP)) during the three years before to three years after the cohortâs entry date were identified by generalised estimating equations. LBP-patients undergoing LSDS had higher overall work disability during the three years following surgery (LTSA: 23.6%, DP: 6.3%) than LBP-patients without LSDS (LTSA: 19.5%, DP: 5.9%), and those without LBP (LTSA: 7.9%, DP: 1.7%). Among patients undergoing LSDS, the prevalence of work disability due to dorsopathies increased from 20 days three years before surgery to 70 days in the year after and attenuated to 30 days in the third year following surgery. Work disability for other diagnoses remained stable at a low level in this group
Body-mass index and risk of obesity-related complex multimorbidity : an observational multicohort study
Background The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). Methods We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (Peer reviewe
Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study
BACKGROUND: The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases). METHODS: We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114â657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499â357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (â„30·0 kg/m2), overweight (25·0-29·9 kg/m2), healthy weight (18·5-24·9 kg/m2), and underweight (<18·5 kg/m2). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated. FINDINGS: Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74-2·93; PAF 19·9% [95% CI 19·3-20·5]) for developing at least one obesity-related disease, 5·17 (4·84-5·53; 34·4% [33·2-35·5]) for two diseases, and 12·39 (9·26-16·58; 55·2% [50·9-57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose-response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94-3·68; PAF 13·3% [95% CI 9·6-16·3]). The same pattern of results was observed in the UK Biobank cohort. INTERPRETATION: Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens. FUNDING: Wellcome Trust, Medical Research Council, National Institute on Aging
Hepcidin and iron species distribution inside the first-trimester human gestational sac
We have investigated factors affecting iron distribution in the first-trimester gestational sac, by the measurement of transferrin, non-transferrin-bound iron (NTBI) and pro-hepcidin (Hep) in maternal serum, coelomic fluid (CF) and amniotic fluid (AF) and by immunostaining for Hep in villous and secondary yolk sac biopsies. These samples were obtained from 15 first-trimester pregnancies at 8â11 weeks gestation. Transferrin concentrations were significantly lower in fetal (0.56 mg/ml) than maternal serum (1.71 mg/ml), with very low concentrations in CF and AF (0.09 mg/ml). In contrast, transferrin saturations were significantly higher in fetal (77%) than maternal serum (33%). NTBI was present in fetal serum, CF and AF, presumably as a consequence of low transferrin concentrations in these compartments. Pro-Hep was present at lower levels in fetal (140.0 ± 11.1) than maternal serum (206.2 ± 9.2) and at low concentrations in CF (19.4 ± 3.1) and AF (21.8 ± 5.2). Immunostaining with Hep antibody was found in the syncytiotrophoblast of first-trimester placenta as well as in mesothelial and endodermal layers of the secondary yolk sac at 10 weeks. The presence of Hep in syncytiotrophoblast cells of first-trimester placenta as well as in mesothelial and endodermal layers of the secondary yolk sac suggest a key regulatory role for this protein in iron transfer to the first-trimester fetus. The low transferrin concentrations and the presence of NTBI in CF and AF suggest that transferrin-independent iron transfer is important in early gestation
Transgenic Rescue of the LARGEmyd Mouse: A LARGE Therapeutic Window?
LARGE is a glycosyltransferase involved in glycosylation of α-dystroglycan (α-DG). Absence of this protein in the LARGEmyd mouse results in α-DG hypoglycosylation, and is associated with central nervous system abnormalities and progressive muscular dystrophy. Up-regulation of LARGE has previously been proposed as a therapy for the secondary dystroglycanopathies: overexpression in cells compensates for defects in multiple dystroglycanopathy genes. Counterintuitively, LARGE overexpression in an FKRP-deficient mouse exacerbates pathology, suggesting that modulation of α-DG glycosylation requires further investigation. Here we demonstrate that transgenic expression of human LARGE (LARGE-LV5) in the LARGEmyd mouse restores α-DG glycosylation (with marked hyperglycosylation in muscle) and that this corrects both the muscle pathology and brain architecture. By quantitative analyses of LARGE transcripts we also here show that levels of transgenic and endogenous LARGE in the brains of transgenic animals are comparable, but that the transgene is markedly overexpressed in heart and particularly skeletal muscle (20â100 fold over endogenous). Our data suggest LARGE overexpression may only be deleterious under a forced regenerative context, such as that resulting from a reduction in FKRP: in the absence of such a defect we show that systemic expression of LARGE can indeed act therapeutically, and that even dramatic LARGE overexpression is well-tolerated in heart and skeletal muscle. Moreover, correction of LARGEmyd brain pathology with only moderate, near-physiological LARGE expression suggests a generous therapeutic window
Mediation and the Best Interests of the Child from the Child Law Perspective
What is the best interests of the child in family mediation and is mediation in the best interests of the child? In this article, I use child law and the United Nations Convention on the Rights of the Child combined with mediation theory to discuss these questions. Both mediation and the best interests of the child are open for multiple interpretations. Using facilitative and evaluative mediation theory and the legal concept âthe best interests of the childâ, I explore and compare the understandings of these concepts as they apply to family mediation. This includes a discussion of the advantages and disadvantages of facilitative as well as evaluative mediation orientations in terms of protecting the best interests of the child. Finnish court-connected family mediation is a combination of both mediation orientations, and the mediator is obliged to secure the best interests of the child. From a theoretical point of view, this seems to be a challenging combination.Peer reviewe
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