The Finnish Cardiovascular Study (FINCAVAS): characterising patients with high risk of cardiovascular morbidity and mortality

BACKGROUND: The purpose of the Finnish Cardiovascular Study (FINCAVAS) is to construct a risk profile – using genetic, haemodynamic and electrocardiographic (ECG) markers – of individuals at high risk of cardiovascular diseases, events and deaths. METHODS AND DESIGN: All patients scheduled for an exercise stress test at Tampere University Hospital and willing to participate have been and will be recruited between October 2001 and December 2007. The final number of participants is estimated to reach 5,000. Technically successful data on exercise tests using a bicycle ergometer have been collected of 2,212 patients (1,400 men and 812 women) by the end of 2004. In addition to repeated measurement of heart rate and blood pressure, digital high-resolution ECG at 500 Hz is recorded continuously during the entire exercise test, including the resting and recovery phases. About 20% of the patients are examined with coronary angiography. Genetic variations known or suspected to alter cardiovascular function or pathophysiology are analysed to elucidate the effects and interactions of these candidate genes, exercise and commonly used cardiovascular medications. DISCUSSION: FINCAVAS compiles an extensive set of data on patient history, genetic variation, cardiovascular parameters, ECG markers as well as follow-up data on clinical events, hospitalisations and deaths. The data enables the development of new diagnostic and prognostic tools as well as assessments of the importance of existing markers

Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis

Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making

Shared Genetic Risk Factors of Intracranial, Abdominal, and Thoracic Aneurysms

Background: Intracranial aneurysms (IAs), abdominal aortic aneurysms (AAAs), and thoracic aortic aneurysms (TAAs) all have a familial predisposition. Given that aneurysm types are known to co‐occur, we hypothesized that there may be shared genetic risk factors for IAs, AAAs, and TAAs. Methods and Results: We performed a mega‐analysis of 1000 Genomes Project‐imputed genome‐wide association study (GWAS) data of 4 previously published aneurysm cohorts: 2 IA cohorts (in total 1516 cases, 4305 controls), 1 AAA cohort (818 cases, 3004 controls), and 1 TAA cohort (760 cases, 2212 controls), and observed associations of 4 known IA, AAA, and/or TAA risk loci (9p21, 18q11, 15q21, and 2q33) with consistent effect directions in all 4 cohorts. We calculated polygenic scores based on IA‐, AAA‐, and TAA‐associated SNPs and tested these scores for association to case‐control status in the other aneurysm cohorts; this revealed no shared polygenic effects. Similarly, linkage disequilibrium–score regression analyses did not show significant correlations between any pair of aneurysm subtypes. Last, we evaluated the evidence for 14 previously published aneurysm risk single‐nucleotide polymorphisms through collaboration in extended aneurysm cohorts, with a total of 6548 cases and 16 843 controls (IA) and 4391 cases and 37 904 controls (AAA), and found nominally significant associations for IA risk locus 18q11 near RBBP8 to AAA (odds ratio [OR]=1.11; P=4.1×10−5) and for TAA risk locus 15q21 near FBN1 to AAA (OR=1.07; P=1.1×10−3). Conclusions: Although there was no evidence for polygenic overlap between IAs, AAAs, and TAAs, we found nominally significant effects of two established risk loci for IAs and TAAs in AAAs. These two loci will require further replication

Structured child-centred interventions to support families with a parent suffering from cancer:from practice-based evidence towards evidence-based practice

Abstract Several studies have highlighted the need for the provision of extra support for parenting and for the children of families with parental cancer, with particular emphasis on the need to protect the psychosocial wellbeing of these children. However despite this, child-centred work still rarely forms part of clinical practice in adult health-care settings. The aims of the present work were: 1) to calculate a population-based estimate for the number of Finnish children affected by parental cancer, 2) to investigate whether these children had used specialised psychiatric services to a greater extent than their peers, 3) to conduct a systematic review of the scientific literature regarding the current state of structured interventions directly targeted at children with parental cancer, 4) to outline the clinicians' experiences of the use of structured child centred interventions in long-term clinical practice, and 5) to assess whether the “Let’s Talk about Children” (LT) and “Family Talk Intervention” (FTI) approaches have any impact on the psychiatric symptom profile of seriously somatically ill parents and their spouses. It was found that every 15th child (6.6% of the children) had a mother or father who was treated for cancer during the years 1987 to 2008. Cases of parental cancer increased these children’s use of specialised psychiatric services significantly by comparison with their peers. A systematic review revealed that the existing number of structured child-centred interventions was small and their methodological content was highly heterogeneous. Clinicians’ long-term experiences of the use of structured child-centred interventions in everyday clinical practice highlighted: the flexible choice of interventions, the importance of taking the children’s needs into account, inter–team collaboration and the need to regard death as an essential topic when working with families with parental cancer. A significant improvement in the parent’s psychological symptoms was observed four months after the completion of the structured intervention. It can be concluded that children affected by parental cancer comprise a substantial part of the general population. Both the increased use of specialised psychiatric services by the children and the positive effect of interventions on the parents justify the pursuance of research-based child-centred work.Tiivistelmä Useat viimeaikaiset tutkimukset ovat suosittaneet lisätukea vanhemmuudelle ja lapsille syöpäpotilaiden lasten psykososiaalisen hyvinvoinnin turvaamiseksi. Tästä huolimatta lapsikeskeistä työtä tehdään aikuisterveydenhuollossa vähän. Tämän tutkimuksen tavoitteena oli: 1) arvioida väestötasolla niiden suomalaisten lasten lukumäärä, joilla on syöpää sairastava vanhempi, ja verrata näiden lasten psykiatrisen erikoissairaanhoidon käyttöä muihin vastaavan ikäisiin, 2) selvittää systemaattisesti olemassa oleva tutkimustieto lapsikeskeisten strukturoitujen interventioiden käytöstä syöpää sairastavien vanhempien lapsilla, 3) tutkia työntekijöiden pitkäaikaisia kokemuksia strukturoitujen lapsikeskeisten interventioiden käytöstä osana jokapäiväistä kliinistä työtä, 4) selvittää kahden strukturoidun intervention, Lapset puheeksi -keskustelun ja Beardsleen perheintervention, vaikutusta vanhempien psykiatrisiin oireisiin neljä kuukautta intervention jälkeen verrattuna tilanteeseen ennen interventiota. Tulosten mukaan Suomessa 6,6 %:lla vuonna 1987 syntyneistä lapsista oli vanhempi, jota oli hoidettu syövän takia seurantajakson 1987–2008 aikana. Syöpää sairastavien vanhempien lasten psykiatrisen erikoissairaanhoidon käyttö oli tilastollisesti merkitsevästi kohonnut verrattuna muihin samanikäisiin. Lasten tukemiseen tarkoitettujen strukturoitujen interventioiden määrä oli vähäinen ja niiden tutkimuksellinen taso oli vaihteleva. Työntekijöiden kokemukset lapsikeskeisten interventioiden toteuttamisesta potilastyössä nostivat esille useita huomioonotettavia asioita: on tärkeää voida valita interventio joustavasti perheen tarpeiden mukaan, yli sektorirajojen ulottuva yhteistyö on keskeistä, lasten yksilöllisten tarpeiden huomioiminen on tärkeää, kuoleman teema nousee usein esille perheiden kanssa työskenneltäessä. Vanhempien psyykkisten oireiden todettiin vähentyneen intervention jälkeen tehdyssä mittauksessa verrattuna ennen interventiota tehtyyn mittaukseen. Tutkimuksen tulosten perusteella voidaan päätellä, että syöpäpotilaiden lapset muodostavat merkittävän ryhmän väestössä. Syöpäpotilaiden lasten lisääntynyt psykiatrisen erikoissairaanhoidon käyttö jo yksin ja myös interventioiden myönteiset vaikutukset puoltavat lapsikeskeisen työn kehittämistä aikuisterveydenhuoltoon. Kehittämistyön pohjana voidaan käyttää tässä tutkimuksessa käytettyjä strukturoituja lapsikeskeisiä interventioita

Parenthood mining using hashtag social network mining approach

Abstract Low birth phenomenon is a global trend with an important economic and societal consequences that stress global and holistic initiatives in western countries. This paper attempts to contribute to this issue by developing an original approach to mine parenthood patterns from Twitter social media platform. Relevant hashtags are employed to develop a social network-based approach to distinguish relevant communities. The three relevant online communities were identified. We conducted a topical based analysis to comprehend the discussion trend and sentiment analysis to further monitor issues of parenthood concerns. Examples of concerns raised by the community analysis include anxiety in autism parenting, stress in single parenting, college loans, and debts in pandemic time

The “Let’s Talk about Children” intervention in a Finnish school context:fidelity, parents’ experiences, and perceived benefits

Abstract The Let’s Talk about Children intervention is a tool for parents and professionals to work together to promote children’s positive development, resilience, and psychosocial well-being in social and healthcare services, at school, and in day care. The aim of this study was to evaluate the fidelity, parents’ experiences, and perceived benefits of using the Let’s Talk about Children intervention in a school context. Participants (N = 65 first-grader parents) completed an online questionnaire after the intervention. The results show that the intervention was delivered as designed and conducted with high fidelity. Parents’ experiences of the Let’s Talk about Children discussions were positive, parents felt that the atmosphere was good during the discussion, and the participants reported benefits from the intervention. Clinical trial registration: ClinicalTrials.gov, identifier NCT05038280

Parental death due to natural death causes during childhood abbreviates the time to a diagnosis of a psychiatric disorder in the offspring:a follow-up study

Abstract Parental death before adulthood has been shown to increase offspring’s risk of poor health and adverse social consequences. In a sample of 422 subjects with parental death (334 (79.1%) due to natural causes), and 6172 matched controls, those with parental death were given a diagnosis of a psychiatric disorder up to 28 years of age earlier than their controls (10-year survival proportions: 88.6% vs. 93.1%, p = 0.001). Our findings indicate that psychosocial support must be provided as early as when a parent falls ill, especially with those illnesses that are the most common causes of death in the population

Taming the exoscope : a one-year prospective laboratory training study

PurposeDigital 3D exoscopes have been recently introduced as an alternative to a surgical microscope in microneurosurgery. We designed a laboratory training program to facilitate and measure the transition from microscope to exoscope. Our aim was to observe the effect of a one-year active training on microsurgical skills with the exoscope by repeating a standardized test task at several time points during the training program.MethodsTwo board-certified neurosurgeons with no previous exoscope experience performed the same test tasks in February, July, and November during a 12-month period. In between the test tasks, both participants worked with the exoscope in the laboratory and assisted during clinical surgeries on daily basis. Each of the test segments consisted of repeating the same task 10 times during one week. Altogether, 60 test tasks were performed, 30 each. The test task consisted of dissecting and harvesting the ulnar and radial arteries of the second segment of a chicken wing using an exoscope (Aesculap AEOS). Each dissection was recorded on video and analyzed by two independent evaluators. We measured the time required to complete the task as well as several metrics for evaluating the manual skills of the dissection and handling of the exoscope system.ResultThere was a clear reduction in dissection time between the first and the last session, mean 34 min (SD 5.96) vs. 26 min (SD 8.69), respectively. At the end of the training, both neurosurgeons used the exoscope more efficiently utilizing more available options of the device. There was correlation between the dissection time and several of the factors we used for evaluating the work flow: staying in focus, zoom control, reduction of unnecessary movements or repetitive manual motions, manipulation technique of the vessel under dissection, handling of the instruments, and using them for multiple dissection purposes (stretching, cutting, and splitting).ConclusionContinuous, dedicated long-term training program is effective for microsurgical skill development when switching from a microscope to an exoscope. With practice, the micromotor movements become more efficient and the use of microinstruments more versatile.Peer reviewe

Rationale and description of implementation of regional collaborative service model for enhancing psychosocial wellbeing of children and families:Oulu collective impact study

Abstract Background: The psychosocial wellbeing of children and adolescents is an ongoing global concern. Despite positive outcomes of child- and family-focused programs, the fragmentation of services presents challenges. To enhance harmonization and diminish fragmentation of service policies, we implement a preventive collaborative service model for children and families. The rationale for our study is based on analyses of national and local data before implementing the service model in the pilot area. Methods: The need for a preventive service model for children and families was demonstrated using national and local data sources. First, a national school health survey was utilized to screen adolescents’ perceptions of their depressive symptoms and support. Second, time trends in child and adolescent psychiatric and child protection service use were investigated. For these aims, epidemiological data of the study area (city of Oulu) were compared with data from the whole country (Finland). Third, local usage data of the preventive stand-alone Let’s Talk About Children (LT) intervention before the service model implementation were evaluated. After these analyses, Let’s Talk About Children Service Model (LT-SM) implementation in the pilot area is described in detail. Results: The background data showed that 17% of the adolescents in the study area had reported depressive symptoms, and almost half of them had not received professional help. Child and adolescent psychiatric outpatient visits had increased during the last decade, but the number of visits remains lower in the study area compared with the country as a whole. The number of adolescent psychiatric inpatient days had increased contrary to a decreasing national trend. The number of urgent child welfare placements was also higher compared with the whole country. The local LT intervention data revealed very low utilization rates. These results indicated a necessity to enhance preventive and collaborative support for children and their families. This article describes the implementation of the LT-SM. Discussion: We demonstrated excessive use of curative services in social and health care and insufficient usage of the stand-alone preventive intervention. The LT-SM is now piloted in one regional service area of the city of Oulu. Its effectiveness will be evaluated when enough data have been accumulated for statistical analyses

Associations between adolescents’ social leisure activities and the onset of mental disorders in young adulthood

Abstract The association of leisure time activities with specific mental disorders has mainly remained unclear because of lack of such research. This study analyzed the association of different levels of social leisure time activity during adolescence (ages 15–16 years) with the incidence of mental disorders during adolescence and young adulthood between the ages of 16–33 years. The study population consisted of 6838 (females 51.5%) participants from the longitudinal follow-up study, the Northern Finland Birth Cohort 1986, covering 72% of the total 1986 birth cohort. Psychiatric morbidity of the participants was followed through nationwide health registers until the end of the year 2018 when the participants were 33 years old. High social leisure time activity in adolescence associated with lower incidence of psychiatric disorders in general, and specifically, with affective, anxiety, and substance use disorders. Low social leisure time activity was related to increased incidence of any psychiatric disorder in general, and particularly to anxiety and behavioral disorders. In terms of prevention of mental disorders, these study findings encourage families, schools and other communities to continue to enhance and develop community-based social leisure time activities for children and adolescents