Myönnetty, ei käytetty : Selvitys puhevammaisten tulkkauspalvelun haasteista ja mahdollisuuksista vuosina 2011–2014

Puhevammaisilla henkilöillä on ollut oikeus tulkkauspalveluun vuodesta 1994 lähtien. Kunnat vastasivat palvelun järjestämisestä ja kustannuksista 1.9.2010 saakka, jonka jälkeen järjestämis- ja kustannusvastuu on ollut Kelalla. Oikeus Kelan tulkkauspalveluun oli vuoden 2014 loppuun mennessä yhteensä 5 633 henkilöllä. Henkilöistä 1 689 oli puhevammaisia, joista vain noin 45 prosenttia käytti palvelua. Käyttöaste on ollut koko ajan merkittävästi alhaisempi kuin kuulovammaisilla ja kuulonäkövammaisilla asiakkailla. Palvelun alhainen käyttöaste herätti tarpeen selvittää, mistä tämä johtuu. Kela tilasi Kehitysvammaliitolta selvitystyön puhevammaisten henkilöiden tulkkauspalvelun käytöstä vuoden 2014 lopussa. Selvitystyö toteutettiin neljänä osakokonaisuutena, joiden tulokset nivottiin tähän julkaisuun. Puhevammaisten tulkkauspalvelun käyttöä tarkasteltiin Kelan rekisteritietojen, asiakasnäkökulman, tulkkinäkökulman sekä järjestönäkökulman valossa. Selvityksen toteutuksen tavoitteena oli luoda mahdollisimman monialainen näkemys palvelunkäyttöön vaikuttavista tekijöistä. Osakokonaisuuksista nousi esille useita eri tekijöitä, joiden nähtiin vaikuttavan palvelun käytön vähäisyyteen. Rekisteriaineiston analyysin tulokset osoittivat, että suurin vaikuttava tekijä palvelun käyttöön ovat tulkkiringit ja nimetyt tulkit. Niillä puhevammaisilla henkilöillä, joilla ei ole nimettyä tulkkia, on tulkkauspalvelun käyttö huomattavasti vähäisempää. Tulkkauspalvelun asiakkaiden näkökulman tarkastelussa havaittiin, että suurin syy käyttämättömyydelle oli se, että puhevammaisen henkilön tulkkaamisessa auttaa henkilön lähipiiri tai henkilökohtainen avustaja, jolloin koetaan, että tarvetta tulkille ei välttämättä ole. Tulkkien vastauksissa nousi esille keskeisenä syynä palvelun käyttämättömyyteen tulkkien tilaamisen vaikeus. Järjestöjen mukaan tulkkauspalvelun käytön vähäisyyteen liittyy puhevammaisen henkilön elinpiiriin ja sosiaaliseen verkostoon liittyviä tekijöitä. Ongelmia nimettiin olevan myös tulkkipalvelun käytössä, kuten esimerkiksi tulkin tilaamisessa sekä asiakkaiden yksilöllisiin tarpeisiin vastaamisessa. Keskeisinä Kelan tulkkauspalvelun kehittämiskohteina tulivat esiin riittävän isojen tulkkirinkien varmistaminen asiakkaille, tilausjärjestelmien monipuolistaminen sekä tulkin työn ja henkilökohtaisen avustajan työn yhdistämisen vaihtoehtojen selvittäminen

Keuhkovaltimoiden pallolaajennus - uusi hoito krooniseen tromboemboliseen pulmonaalihypertensioon

• Krooninen tromboembolinen pulmonaalihypertensio huonontaa merkittävästi elämänlaatua. Hoitamattomana se voi johtaa ennenaikaiseen kuolemaan.• Taudin vakiintunut hoitomuoto on kirurginen keuhkovaltimoiden endarterektomia. Lähes puolelle potilaista seei sovi tai tulos jää huonoksi.• Keuhkovaltimoiden pallolaajennus on uusi tehokas hoito osalle potilaista.• TYKS:n Sydänkeskuksessa on tehty keuhkovaltimoiden pallolaajennuksia vuodesta 2016 ja tulokset ovat olleet rohkaisevia.</p

Highly contaminated river otters (Lontra canadensis) are effective biomonitors of environmental pollutant exposure

River otters (Lontra canadensis) are apex predators that bioaccumulate contaminants via their diet, potentially serving as biomonitors of watershed health. They reside throughout the Green-Duwamish River, WA (USA), a watershed encompassing an extreme urbanization gradient, including a US Superfund site slated for a 17-year remediation. The objectives of this study were to document baseline contaminant levels in river otters, assess otters’ utility as top trophic-level biomonitors of contaminant exposure, and evaluate the potential for health impacts on this species. We measured a suite of contaminants of concern, lipid content, nitrogen stable isotopes (δ15N), and microsatellite DNA markers in 69 otter scat samples collected from twelve sites. Landcover characteristics were used to group sampling sites into industrial (Superfund site), suburban, and rural development zones. Concentrations of polychlorinated biphenyls (PCBs), polybrominated diphenyl ether flame-retardants (PBDEs), dichlorodiphenyl-trichloroethane and its metabolites (DDTs), and polycyclic aromatic hydrocarbons (PAHs) increased significantly with increasing urbanization, and were best predicted by models that included development zone, suggesting that river otters are effective biomonitors, as defined in this study. Diet also played an important role, with lipid content, δ15N or both included in all best models. We recommend river otter scat be included in evaluating restoration efforts in this Superfund site, and as a potentially useful monitoring tool wherever otters are found. We also report ΣPCB and ΣPAH exposures among the highest published for wild river otters, with almost 70% of samples in the Superfund site exceeding established levels of concern.publishedVersio

Determining collagen distribution in articular cartilage using contrast-enhanced micro-computed tomography

Objective: Collagen distribution within articular cartilage (AC) is typically evaluated from histological sections, e.g., using collagen staining and light microscopy (LM). Unfortunately, all techniques based on histological sections are time-consuming, destructive, and without extraordinary effort, limited to two dimensions. This study investigates whether phosphotungstic acid (PTA) and phosphomolybdic acid (PMA), two collagen-specific markers and X-ray absorbers, could (1) produce contrast for AC X-ray imaging or (2) be used to detect collagen distribution within AC. Method: We labeled equine AC samples with PTA or PMA and imaged them with micro-computed tomography (micro-CT) at pre-defined time points 0, 18, 36, 54, 72, 90, 180, 270 h during staining. The micro-CT image intensity was compared with collagen distributions obtained with a reference technique, i.e., Fourier-transform infrared imaging (FTIRI). The labeling time and contrast agent producing highest association (Pearson correlation, BlandeAltman analysis) between FTIRI collagen distribution and micro-CT -determined PTA distribution was selected for human AC. Results: Both, PTA and PMA labeling permitted visualization of AC features using micro-CT in non-calcified cartilage. After labeling the samples for 36 h in PTA, the spatial distribution of X-ray attenuation correlated highly with the collagen distribution determined by FTIRI in both equine (mean +/- S.D. of the Pearson correlation coefficients, r = 0.96 +/- 0.03, n = 12) and human AC (r = 0.82 +/- 0.15, n = 4). Conclusions: PTA-induced X-ray attenuation is a potential marker for non-destructive detection of AC collagen distributions in 3D. This approach opens new possibilities in development of non-destructive 3D histopathological techniques for characterization of OA. (C) 2015 The Authors. Published by Elsevier Ltd and Osteoarthritis Research Society International.Peer reviewe

Stroke as the First Manifestation of Atrial Fibrillation

Atrial fibrillation may remain undiagnosed until an ischemic stroke occurs. In this retrospective cohort study we assessed the prevalence of ischemic stroke or transient ischemic attack as the first manifestation of atrial fibrillation in 3,623 patients treated for their first ever stroke or transient ischemic attack during 2003-2012. Two groups were formed: patients with a history of atrial fibrillation and patients with new atrial fibrillation diagnosed during hospitalization for stroke or transient ischemic attack. A control group of 781 patients with intracranial hemorrhage was compiled similarly to explore causality between new atrial fibrillation and stroke. The median age of the patients was 78.3 [13.0] years and 2,009 (55.5%) were women. New atrial fibrillation was diagnosed in 753 (20.8%) patients with stroke or transient ischemic attack, compared to 15 (1.9%) with intracranial hemorrhage. Younger age and no history of coronary artery disease or other vascular diseases, heart failure, or hypertension were the independent predictors of new atrial fibrillation detected concomitantly with an ischemic event. Thus, ischemic stroke was the first clinical manifestation of atrial fibrillation in 37% of younger (<75 years) patients with no history of cardiovascular diseases. In conclusion, atrial fibrillation is too often diagnosed only after an ischemic stroke has occurred, especially in middle-aged healthy individuals. New atrial fibrillation seems to be predominantly the cause of the ischemic stroke and not triggered by the acute cerebrovascular event

Mortality after stroke in patients with paroxysmal and chronic atrial fibrillation - The FibStroke study

Background: Recent studies have reported that patientswith paroxysmal atrial fibrillation (AF) have lower risk of thromboembolism and better prognosis than patients with chronic AF. We sought to address the differences in ischaemic events in patients with paroxysmal AF and chronic AF.Methods: The FibStroke study is a cross-sectional observational multicenter registry that included AF patients with an ischaemic stroke, TIA (transient ischaemic attack) or intracranial bleed during 2003-2012 identified from discharge registries of four Finnish hospitals. Altogether 1448 patients with paroxysmal and 1808 patients with chronic atrial fibrillation suffered a total of 707 TIA-episodes and 2549 ischaemic strokes.Results: Mortality within 30 days after the index event was significantly lower in patients with paroxysmal AF than with chronic AF (7.6% vs 16.9%, p < 0.01). At the onset of event, 62.8% of the patients with paroxysmal AF were in sinus rhythm, and these patients had better prognosis after the event compared to patients with other rhythmthan sinus rhythm(mortality 5.2% vs 15.7%, p < 0.01). In the propensity score matched analysismortality after stroke was significantly lower in patients with paroxysmal AF than in patients with chronic AF (11.6% vs 17.8%, p < 0.01), while mortality after TIA was also lower, but did not reach statistical significance (0.4% vs 1.7%, p = 0.31).Conclusions: Asignificant proportion of strokes in AF patients occur in patients with paroxysmal AF, but they have better prognosis than patients with chronic AF. The prognosis is also significantly better in patients who are in sinus rhythm at the onset of event.

3D morphometric analysis of calcified cartilage properties using micro-computed tomography

Objective: Our aim is to establish methods for quantifying morphometric properties of calcified cartilage (CC) from micro-computed tomography (mu CT). Furthermore, we evaluated the feasibility of these methods in investigating relationships between osteoarthritis (OA), tidemark surface morphology and open subchondral channels (OSCCs). Method: Samples (n = 15) used in this study were harvested from human lateral tibial plateau (n = 8). Conventional roughness and parameters assessing local 3-dimensional (3D) surface variations were used to quantify the surface morphology of the CC. Subchondral channel properties (percentage, density, size) were also calculated. As a reference, histological sections were evaluated using Histopathological osteoarthritis grading (OARSI) and thickness of CC and subchondral bone (SCB) was quantified. Results: OARSI grade correlated with a decrease in local 3D variations of the tidemark surface (amount of different surface patterns (r(s) = -0.600, P = 0.018), entropy of patterns (EP) (r(s) = -0.648, P = 0.018), homogeneity index (HI) (r(s) = 0.555, P = 0.032)) and tidemark roughness (TMR) (r(s) = -0.579, P = 0.024). Amount of different patterns (ADP) and EP associated with channel area fraction (CAF) (r(p) = 0.876, P <0.0001; r(p) = 0.665, P = 0.007, respectively) and channel density (CD) (r(p) = 0.680, P = 0.011; r(p) = 0.582, P = 0.023, respectively). TMR was associated with CAF (r(p) = 0.926, P <0.0001) and average channel size (r(p) = 0.574, P = 0.025). CC topography differed statistically significantly in early OA vs healthy samples. Conclusion: We introduced a mu-CT image method to quantify 3D CC topography and perforations through CC. CC topography was associated with OARSI grade and OSCC properties; this suggests that the established methods can detect topographical changes in tidemark and CC perforations associated with OA. (c) 2018 The Authors. Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).Peer reviewe

Corrigendum: Quality of life and quality of education among physiotherapy students in Europe (Frontiers in Medicine, (2024), 11, (1344028), 10.3389/fmed.2024.1344028)

In the published article, an author name was incorrectly written as [Sara Laura Cortés-Amaro]. The correct spelling is [Sara Cortés-Amaro]. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated

Vihreä biotalous : 100-vuotiaan Suomen hyvinvoinnin ja kilpailukyvyn perusta

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Quality of life and quality of education among physiotherapy students in Europe

Background: The study of physiotherapy is challenging and can affect the students’ well-being and quality of life. The aim of this study was to describe and compare factors that could affect well-being among students across Europe. Methods: In this descriptive cross-sectional study using an online questionnaire survey, students of bachelor’s physiotherapy programs from 23 European faculties, from 8 countries, were interviewed on mental health and stress burden, sleep quality, dietary habits, and physical activity. Results: Although 75% of students rated their quality of life positively and 47% were satisfied with their mental health, 65% showed higher levels of stress and 51% described impaired sleep quality. The minimum physical activity of 150 min weekly was described by 79% of students, within which 67% engaged in strengthening twice a week. Students with a higher stress load/worse psychological health also showed worse sleep quality and lower amount of physical activity, women were significantly worse off. In terms of physical activity and sleep quality, students from Finland and Kosovo achieved the best results, while students from Italy, Greece, and Portugal achieved the worst. Students from Italy indicated the greatest dissatisfaction with the organisation of the study system and communication with teachers, while in Kosovo students rated the communication and study organisation the highest. All students had a problem with adhering to nutritional habits. Students from Italy and Spain, with the lowest body mass indexes and weight averages, were closest to the nutrition recommendations. Conclusion: We demonstrated that physiotherapy students are burdened with stress, suffer from sleep disorders, and do not follow the recommendations regarding nutrition nor physical activity. There are significant differences between universities and countries in some aspects