Nainen, ole itse aktiivinen : 25 - 49-vuotiaiden naisten rintojen omatarkkailu

Rintasyöpä on Suomessa naisten yleisin syöpäsairaus, johon sairastuu vuosittain yli 4000 naista. Vuonna 2009 rintasyöpään sairastuneita naisia oli 4 461 ja samana vuonna rintasyöpään menehtyi 821 naista. Rintojen omatarkkailu on yksi tärkein tekijä rintasyövän varhaistoteamisessa, joka taas mahdollistaa nopeamman hoitoon pääsyn. Naiset jättävät rintansa tutkimatta, vaikka kuolleisuus rintasyöpään on merkittävä. On siis oletettavaa, että on olemassa joitain tekijöitä, jotka estävät rintojen omatarkkailun. Tarkkailemalla omia rintojaan naiset voivat löytää mahdolliset muutokset ja päästä varhain mahdollisiin tutkimuksiin. Opinnäytetyö käsittelee aihetta rintasyövän varhaistoteaminen ja siihen liittyen omatarkkailun esteet. Opinnäytetyön tilaajana on yhdistys ProMama ry. Opinnäytetyö on kvalitatiivinen eli laadullinen tutkimus. Opinnäytetyön tarkoitus on kartoittaa naisten rintojen omatarkkailun toteuttamista ja esteitä sekä saada rintojen omatarkkailuohjaustilanteisiin kehittämisideoita. Opinnäytetyömme tavoitteena on antaa tietoa rintojen omatarkkailun kouluttajille ohjaustilanteiden kehittämiseen. Aineisto kerättiin avoimilla kysymyksillä 25 - 49-vuotiailta naisilta sähköpostin välityksellä ja se analysoitiin induktiivisella sisällönanalyysillä. Vastauksia tuli neljä kappaletta. Tulokset osoittivat, että naisten toteuttama rintojen omatarkkailu on epäsäännöllistä ja vähäistä. Vastaajilta nousi rintojen omatarkkailun toteuttamiseen useita estäviä tekijöitä. Näitä olivat muun muassa epävarmuus, laiskuus ja unohtaminen. Vastaajien keskuudessa koettiin rintojen omatarkkailusta saadun ohjauksen jääneen vähäiseksi. Rintojen omatarkkailun ohjauksen tulisi olla säännöllistä ja laadukasta. Ohjausta olisi hyödyllistä antaa jo kouluterveydenhuollossa. Jatkotutkimusaiheena voisi selvittää, miksi terveydenhuollon ammattilaiset eivät ole sitoutuneita antamaan tarpeeksi laadukasta ohjausta rintojen omatarkkailuun. Lisäksi voisi olla hyödyllistä selvittää, kuinka terveydenhuollon peruskoulutuksen opetusohjelmassa opetetaan tulevia ammattilaisia rintojen omatarkkailun ohjaamiseen.Breast cancer is the most common cancer among Finnish women. More than 4000 women get breast cancer annually. 4, 461 women had breast cancer and 821 women died from breast cancer in 2009. Breast self-examination is one of the most important factors in early detection of breast cancer which enables faster access to treatment. Women do not do breast self-examination even though breast cancer survival rate is rather low. Therefore, it can be assumed that there are factors that prevent breast self-examination. By observing their own breasts, women can find the changes and get access to medical examinations early. Early detection of breast cancer is the subject of this thesis. ProMama ry, a nationwide organization for breast health promotion, is the commissioner of this thesis. The purpose of this qualitative thesis was to study how women implemented breast self-examination and obstacles to it and also to obtain development ideas for breast self-examination counseling. The aim of the thesis was give information to trainers of breast self-examination that they could develop counseling situations. The material was collected with open questions from 25-49-year-old women through e-mail and analyzed through inductive content analysis. Four respondents answered the questions. The results showed that the self-examination of breasts was performed irregularly and superficially. The respondents named several factors that prevented breast self-examination. These included uncertainty, laziness and forgetting. The respondents also felt that breast self-examination counseling was insufficient. Breast self-examination counseling should, therefore, be regular and of high quality. It would be useful to provide counseling already in school health service. Further studies could clarify why public health professionals are not committed to provide high quality breast self-examination counseling. It could also be useful to study what future professionals are taught about breast self-examination counseling in the syllabus of the basic education of the public health service

A novel fed-batch based cultivation method provides high cell-density and improves yield of soluble recombinant proteins in shaken cultures

<p>Abstract</p> <p>Background</p> <p>Cultivations for recombinant protein production in shake flasks should provide high cell densities, high protein productivity per cell and good protein quality. The methods described in laboratory handbooks often fail to reach these goals due to oxygen depletion, lack of pH control and the necessity to use low induction cell densities. In this article we describe the impact of a novel enzymatically controlled fed-batch cultivation technology on recombinant protein production in <it>Escherichia coli </it>in simple shaken cultures.</p> <p>Results</p> <p>The enzymatic glucose release system together with a well-balanced combination of mineral salts and complex medium additives provided high cell densities, high protein yields and a considerably improved proportion of soluble proteins in harvested cells. The cultivation method consists of three steps: 1) controlled growth by glucose-limited fed-batch to OD₆₀₀~10, 2) addition of growth boosters together with an inducer providing efficient protein synthesis within a 3 to 6 hours period, and 3) a slow growth period (16 to 21 hours) during which the recombinant protein is slowly synthesized and folded. Cell densities corresponding to 10 to 15 g l^-1cell dry weight could be achieved with the developed technique. In comparison to standard cultures in LB, Terrific Broth and mineral salt medium, we typically achieved over 10-fold higher volumetric yields of soluble recombinant proteins.</p> <p>Conclusions</p> <p>We have demonstrated that by applying the novel EnBase^®Flo cultivation system in shaken cultures high cell densities can be obtained without impairing the productivity per cell. Especially the yield of soluble (correctly folded) proteins was significantly improved in comparison to commonly used LB, Terrific Broth or mineral salt media. This improvement is thought to result from a well controlled physiological state during the whole process. The higher volumetric yields enable the use of lower culture volumes and can thus significantly reduce the amount of time and effort needed for downstream processing or process optimization. We claim that the new cultivation system is widely applicable and, as it is very simple to apply, could widely replace standard shake flask approaches.</p

Neonatal Intestinal Failure Is Independently Associated With Impaired Cognitive Development Later in Childhood

Objective: The impact of pediatric intestinal failure (IF) on neurodevelopment beyond infancy has not been systematically studied. Our aim was to evaluate cognitive and motor impairment and to identify risk factors for adverse outcomes among children with IF. Methods: We conducted a cross-sectional single-center study at the Helsinki University Children's Hospital. Patients with IF with >60 days of parental nutrition (PN) dependency aged between 3 and 16 years (n = 40) were invited to participate. The cognitive and motor skills were evaluated using validated tests: Wechsler Preschool and Primary Scale of Intelligence, 3rd edition, Wechsler Intelligence Scale for Children, 4th edition, and Movement Assessment Battery for Children, 2nd edition. Results: All the patients attending the study tests (n = 30, males = 24) were included. Their median age, gestational age, and birth weight was 7.5 (range 3-16) years, 35 (interquartile range [IQR] 28-38) weeks and 2238 (IQR 1040-3288) grams, respectively. Median duration of PN was 13 (IQR 5-37) months and 9 patients were currently on PN. Median intelligence quotient was 78 (IQR 65-91) and 10 (35%) patients had an intelligence quotient under 70 (-2 standard deviation). Significant motor impairment was detected in 10 patients (36%) and milder difficulties in 8 (28%). Adverse cognitive outcome was associated with neonatal short bowel syndrome, number of interventions under general anesthesia, and length of inpatient status, whereas adverse motor outcome was associated with prematurity. Conclusion: Clinically significant cognitive and motor impairments are alarmingly common among neonatal patients with IF. We recommend early neurodevelopmental follow-up for all children with IF.Peer reviewe

Size and composition of the lexicon in prematurely born very-low-birth-weight and full-term Finnish children at two years of age

"This paper focuses on the aspects of the lexicon in 66 prematurely born very-low-birth-weight and 87 full-term Finnish children at 2;0, studied using the Finnish version of the MacArthur Communicative Developmental Inventory. The groups did not differ in vocabulary size. Furthermore, the female advantage in vocabulary size was not seen in preterm children. The overall shapes of the trajectories for the main lexical categories as a function of vocabulary size were highly similar in both groups and followed those described in the literature. However, there were significant differences in the percentage of nouns and grammatical function words between the two groups. The results suggest that prematurity 'cuts off' the female advantage in vocabulary development. Furthermore, it also seems that there are differences between prematurely born and full-term children in the composition of the lexicon at 2;0. The findings support the universal sequence in the development of lexical categories.""This paper focuses on the aspects of the lexicon in 66 prematurely born very-low-birth-weight and 87 full-term Finnish children at 2;0, studied using the Finnish version of the MacArthur Communicative Developmental Inventory. The groups did not differ in vocabulary size. Furthermore, the female advantage in vocabulary size was not seen in preterm children. The overall shapes of the trajectories for the main lexical categories as a function of vocabulary size were highly similar in both groups and followed those described in the literature. However, there were significant differences in the percentage of nouns and grammatical function words between the two groups. The results suggest that prematurity 'cuts off' the female advantage in vocabulary development. Furthermore, it also seems that there are differences between prematurely born and full-term children in the composition of the lexicon at 2;0. The findings support the universal sequence in the development of lexical categories.""This paper focuses on the aspects of the lexicon in 66 prematurely born very-low-birth-weight and 87 full-term Finnish children at 2;0, studied using the Finnish version of the MacArthur Communicative Developmental Inventory. The groups did not differ in vocabulary size. Furthermore, the female advantage in vocabulary size was not seen in preterm children. The overall shapes of the trajectories for the main lexical categories as a function of vocabulary size were highly similar in both groups and followed those described in the literature. However, there were significant differences in the percentage of nouns and grammatical function words between the two groups. The results suggest that prematurity 'cuts off' the female advantage in vocabulary development. Furthermore, it also seems that there are differences between prematurely born and full-term children in the composition of the lexicon at 2;0. The findings support the universal sequence in the development of lexical categories."Peer reviewe

Duplication/triplication mosaicism of EBF3 and expansion of the EBF3 neurodevelopmental disorder phenotype

Deleterious variants in the transcription factor early B-cell factor 3 (EBF3) are known to cause a neurodevelopmental disorder (EBF3-NDD). We report eleven individuals with EBF3 variants, including an individual with a duplication/triplication mosaicism of a region encompassing EBF3 and a phenotype consistent with EBF3-NDD, which may reflect the importance of EBF3 gene-dosage for neurodevelopment. The phenotype of individuals in this cohort was quite mild compared to the core phenotype of previously described individuals. Although ataxia tended to wane with age, we show that cognitive difficulties may increase, and we recommend that individuals with EBF3-NDD have systematic neuropsychological follow-up. (c) 2021 The Authors. Published by Elsevier Ltd on behalf of European Paediatric Neurology Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator

Background: Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown. Methods: We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up. Results: Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%-15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%-19.1%) in those without (chi(2)=1.834, P=0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%-21.0%) versus 6.3% (95% CI, 0.7%-54.0%; chi(2)=0.814, P=0.367) in definite CS and 7.6% (95% CI, 3.8%-15.1%) versus 3.3% (95% CI, 0.5%-22.9%; chi(2)=0.680, P=0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis (P=0.033) but not by Class I or IIa ICD indications (P=0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%-71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation. Conclusions: Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.Peer reviewe

Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator

Background:Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown.Methods:We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up.Results:Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%-15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%-19.1%) in those without (chi(2)=1.834, P=0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%-21.0%) versus 6.3% (95% CI, 0.7%-54.0%; chi(2)=0.814, P=0.367) in definite CS and 7.6% (95% CI, 3.8%-15.1%) versus 3.3% (95% CI, 0.5%-22.9%; chi(2)=0.680, P=0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis (P=0.033) but not by Class I or IIa ICD indications (P=0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%-71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation.Conclusions:Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.</p

Manifestations and Outcome of Cardiac Sarcoidosis and Idiopathic Giant Cell Myocarditis by 25-Year Nationwide Cohorts

Background Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) share many histopathologic and clinical features. Whether they are parts of a one-disease continuum has been discussed.Methods and Results We compared medical record data of 351 CS and 28 GCM cases diagnosed in Finland since the late 1980s and followed until February 2018 for a composite end point of cardiac death, aborted sudden death, and heart transplantation. Heart failure was the presenting manifestation in 50% versus 15% (PP=0.044), of GCM and CS, respectively. At presentation, left ventricular ejection fraction was P=0.004). The median (interquartile range) of plasma NT-proBNP (N-terminal pro-B-type natriuretic peptide) was 5273 (2782-11309) ng/L on admission in GCM versus 859 (290-1950) ng/L in CS (PPPConclusions GCM differs from CS in presenting with more extensive myocardial injury and having worse long-term outcome. Yet the key determinant of prognosis appears to be the extent of myocardial injury rather than the histopathologic diagnosis.</p

Miten hoidat hampaitasi? : selkokielinen materiaali Savonlinnan maahanmuuttajille

Tämän opinnäytetyön tavoitteena oli Suomeen tulleiden maahanmuuttajien suun terveyden edistäminen. Opinnäytetyönä laadittiin selkokielinen suun terveyttä edistävä materiaali hiljattain Suomeen saapuneille maahanmuuttajille. Materiaalin avulla voidaan ohjata maahanmuuttajia hyviin suun terveystottumuksiin kuten oikeaan ravitsemukseen, hampaiden oikeaan hoitoon ja puhdistamiseen sekä selittää mm. mitä napostelu tarkoittaa. Materiaali tehtiin yhteistyössä Savonlinnan ohjaus- ja palvelupiste Navigaattorin sekä suun terveydenhuollon kanssa. Maahanmuuttajien määrä kasvaa Suomessa koko ajan. Tämä luo haasteen suun terveydenhoitotyölle ja etenkin suun terveyttä edistävälle työlle. Hyvän hoidon saavuttamiseksi tieto eri kulttuureista ja niiden tavoista on välttämätöntä. Kuitenkaan kaikkien kulttuurien ja eri kulttuureihin kuuluvien ihmisten tapojen omaksuminen ei ole mahdollista. Yhteisen kielen puute ja vähäinen suomen kielen taito vaikeuttavat suomalaisten suun terveystottumusten opettamista ulkomaalaiselle asiakkaalle. Lisäksi maahanmuuttajille on laadittu hyvin vähän suun terveyden edistä-mistä tukevaa materiaalia. On huomattu, että hyvä terveyden edistämisen materiaali tukee terveys tottumusten opettamista ja omaksumista. Tekemällä suun terveyden edistämisen materiaalin selkokielellä mahdollistimme op-pimisen, ymmärtämisen ja tasa-arvon toteutumisen. Laadittu materiaali koostuu kahdesta osasta: selkokielisestä Miten hoidat hampaitasi? -oppaasta sekä sitä tukevista suun terveyden edistämisen päivistä vasta Suomeen tulleille burmalaisille maahanmuuttajalapsille ja -aikuisille. Suun terveyttä edistävät päivät kohdennettiin molemmille ryhmille omanlaisiksi. Näillä suun terveyden edistämisen päivillä tapahtui myös selkokielisen -oppaan pilotointi. Opinnäytetyön luotettavuus ja sen sisältämän tiedon paikkansapitävyys varmistettiin hakemalla tutkimuksiin perustuvaa tietoa eri lähteistä. Tiedon haussa käytettiin hyväksi omia kokemuksia aiheesta, etsittiin tietoa suun terveyteen liittyvistä tekijöistä, maahanmuuttajista suun terveydenhuollosta, suun terveydenhuollon ongelmista kohdata maahanmuuttaja, selkokielisestä kirjoittamisesta ja hyvän terveyden edistämisen materiaalin tuottamisesta. Lisäksi Miten hoidat hampaitasi? -opas sai selkokeskuksen myöntämän virallisen selkologon. Miten hoidat hampaitasi? -opasta ei ole suunnattu vain yhdelle maahanmuuttajaryhmälle, jolloin sen käyttöaste on suurempi. Selkokielisyyden vuoksi oppaasta on hyötyä myös muille selkokieltä tarvitseville, kuten esimerkiksi kehi-tysvammaisille tai henkilöille, joilla on lukemis- ja kirjoittamisvaikeuksia. Oppaan sisältö rajattiin siten, että se tukisi hyvän suun omahoidon toteutumista, jonka on tutkittu ehkäisevän yleisimpiä suun sairauksia. Oppaan sisältämä ennaltaehkäisevä materiaali näin ollen voisi myös vähentää suun terveydenhuollon kustannuksia.  The purpose of this thesis was to promote oral health of immigrants who have just moved to Finland. The thesis is in essence an oral health educating material in plain language for those immigrants who had just moved to Finland. With the material one can educate immigrants to maintain good oral health and give instructions for right nutrition, how to clean and take care of your teeth and explain, for example, what snacking means. The material was made in co-operation with guidance and service point Navigaattori and the oral health care of Savonlinna. The number of immigrants in Finland is growing. This poses a challenge for oral health care and especially for oral health promoting and educating. To be able to give a good treatment for a patient it is necessary to have some knowledge about different cultures and the habits of those cultures. Although absorbing all the knowledge about different cultures and the habits of the people practicing the cultures is not possible. The lack of common language or a slight command of spoken and written Finnish make it challenging to teach Finnish oral health habits to a foreigner customer. Besides there isn’t a lot of a material that supports oral health educating. It's been discovered that good material in oral health promoting helps to teach and absorb good oral health habits. By doing the oral health promoting material in plain language, it made learning, understanding and equality possible. The material that had been made consists of two parts: How to take care of your teeth? -guidebook in plain language was the first part and the second was two oral health educating and promoting events for Burmese child and adult immigrants, that had just moved to Finland. The oral health promoting events were tailor made for the respective two groups. The piloting of the How to take care of your teeth? -guidebook also happened in these oral health educating and promoting events. The reliability and correctness of the information in thesis was secured by searching for the information for it from different researches and sources. In the lookup we took advantage of our own experiences about the subject, searched for knowledge about the factors that affect oral health, information about immigrants in oral health care, the problems that the oral health care had with encountering an immigrant, about writing in plain language and making good oral health promoting material. On top of that the How to take care of your teeth? -guidebook was given official plain language logo by the center of plain language. How to take care of your teeth? -guide book has not been aimed for only one immigrant group which makes it more usable. Because it's been made in plain language it is also useful for other groups that use plain language, like mentally disabled or for people that have difficulties in reading or understanding. The content of the guidebook was defined so that it would support the good oral health care being fulfilled and with that it would prevent the common oral diseases. By that the promoting material could also lessen the expenses of oral healthcare