Faculty of Medicine
Recent Submissions
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(2023)Background Delayed graft function (DGF) after kidney transplantation is common and is associated with worse graft outcomes and a higher risk for acute rejection. However, little is known about factors affecting graft survival post-DGF. We studied the association of cold ischemia time (CIT) and Kidney Donor Profile Index (KDPI) with the long-term outcomes of deceased brain-dead donor kidneys with and without DGF. Methods Consecutive brain-dead donor kidney transplantations performed in Finland between 5/2004-12/2019 were analyzed. Multivariable models were used to study the association of KDPI and CIT with the graft survival of kidneys with early graft function (EF) or DGF. To confirm the finding in a US cohort, data from the Scientific Registry of Transplant Recipients (SRTR) registry (n=79224) was used. Results A total of 2637 kidney transplantations from the Finnish cohort were included, of which 849 (32%) had DGF. DGF was an independent risk factor for graft loss in the multivariable model, HR 1.32 (95% CI 1.14-1.53), p < 0.001. CIT was not an independent risk factor for graft survival in the multivariable model HR 1.00 per CIT hour (95% CI 0.99-1.02), p= 0.84, and the association of DGF remained similar regardless of the CIT length. KDPI was an independent risk factor for graft survival in the multivariable model HR 1.01 (95% CI 1.01-1.01), p <0.001, but the association of DGF remained similar regardless of KDPI. In the US cohort, the results were similar, but the association of DGF with the risk of graft loss was stronger with higher KDPI. Conclusions DGF and KDPI, but not CIT, are independently associated with kidney graft survival. The magnitude of the association of DGF with worse kidney graft survival is similar with different CITs, but higher among high KDPI kidneys.
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(2023)Objectives. The most prevailing theory on developmental dyslexia (DD) is the phonological deficit theory, according to which individuals with DD have impairments in neural processing of speech sounds. However, there is evidence that the cause of DD could be related to a fundamental impairment called categorical speech perception (CSP) deficit that is related to the perception of auditory phonemes categories. CSP deficits have been reported in children with or at risk for DD but the results are inconsistent and under debate. Therefore, the present study aimed to determine whether the CSP deficit can be detected in preschoolers at family risk for DD when compared to chronological-age controls and whether the performance on the CSP task predicts age-appropriate pre-reading skills. Methods. The study sample consisted of 49 5-year-old Finnish preschoolers of which 36 had a familial risk for DD and 13 were controls with no such risk. The CSP performance was evaluated with a behavioral speech sound categorization task and pre-reading skills with the LUKIVA scale. The data structure represented a hierarchical nested design, and therefore, the CSP performance was analyzed by using the Linear Mixed-Effects Model, and pre-reading skills by the Generalized Linear Mixed Model. Results and Conclusions. The at-risk children had a poorer performance on the CSP task than the control group; however, the difference was only marginally significant. The performance on the CSP task had no significant relationship with pre-reading skills. Since the difference in CSP performance between the groups was marginal, more research is needed to further validate the relationship between DD and CSP.
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(2023)Itsetuhoiset potilaat ovat suuri potilasryhmä päivystyspoliklinikoilla. Itsensä viiltäminen on toiseksi yleisin tapa vahingoittaa itseään, yleisin on yliannostuksen ottaminen. Itseään vahingoittaneiden potilaiden kohtaamisesta haastavan tekee se, että lääkärin tulisi huomioida varsinaisten vammojen lisäksi myös potilaan psykiatriset taustatekijät. Ranteiden viiltely johtaa harvoin kuolemaan, mutta ranteen hermojen, jänteiden ja verisuonten vaurioituminen voi johtaa vaikeaan käden toimintakyvyn häiriöön. Itseaiheutettu rannevamma sijaitsee yleensä potilaan ei-vallitsevassa yläraajassa. Tavallisimpia vaurioituvia rakenteita ovat keskihermo, värttinävaltimo ja ranteen kyynärluun puoleisen koukistajalihaksen sekä pitkän kämmenlihaksen jänteiden vammat. Kirurginen hoito toteutetaan ennen psykiatrisen hoidon alkamista. Käsikirurgiseen jatkohoitoon kuuluu tyypillisesti haavanhoitoa, lastoitusta sekä fysio- ja toimintaterapiaa. Itseään vahingoittaneiden potilaiden itsemurhariski on merkittävästi muuta väestöä suurempi. Nuoret ikäryhmät korostuvat ranteitaan viiltäneiden potilaiden joukossa. Taustalla on usein psykiatrisia häiriöitä, kuten mieliala-, ahdistuneisuus-, päihde- ja persoonallisuushäiriöitä. Mikäli potilaalla on jokin psykiatrinen diagnoosi, lisää se vaikeamman vamman todennäköisyyttä. Ranteiden viiltely voi olla tunnesäätelyn keino erityisesti potilailla, jotka kärsivät epävakaasta persoonallisuudesta. Potilaat voivat käyttää viiltelyä myös dissosiaatio-oireiden lievittämiseen. Vain osalla itseään ranteisiin viiltäneistä on itsemurhatarkoitus. Huomioitava on, että vammojen vaikeusaste ei korreloi itsemurhatarkoituksen kanssa, minkä takia psykiatrisen konsultaation on toteuduttava aina potilaan vammojen vaikeusasteesta riippumatta. Itseään vahingoittaneiden potilaiden psykososiaalisen arvion toteutumisessa on merkittäviä puutteita, eikä vakiintunutta hoitopolkua ole. Itseään viiltäneiden potilaiden psykiatrinen konsultaatio toteutuu vielä huonommin, kuin muilla tavoin itseään vahingoittaneiden. Itseaiheutetun rannevamman uusimisriskiä lisää vamman pinnallisuus ja potilaan naissukupuoli.
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(2023)Introduction Sexual well-being is associated with general well-being. Several factors, such as overweight, infertility, anxiety, and sex hormones, also play a role, but the effects of hormonal contraception remains a point of debate. We characterized the factors associated with sexual well-being in fertile-aged women following induced abortion. Methods A 5-year follow-up of a nested longitudinal cohort study examining the effects of routine provision of intrauterine contraception as part of abortion care. Sexual well-being, anxiety, and quality of life were assessed annually using validated questionnaires (McCoy Female Sexuality Questionnaire, State-Trait Anxiety Inventory and EuroQoL), along with data on general and reproductive health, and relationship status. Of the 742 women participating in the trial, 290 (39%) provided sufficient follow-up data and were included in this study. Results Based on trajectories of McCoy-scores across the 5-year follow up, two groups were identified: those with stable and higher (n=223, 76.9%) and those with declining sexual well-being (n=67, 23.1%). Women in the group of declining sexual well-being had significantly higher levels of anxiety and lower quality of life at all time points. They also had more often chronic diseases and were less happy in their relationships. No differences were found in method of contraception when classified as hormonal vs non- hormonal, or long-acting vs short-acting reversible contraception. Conclusions Lower anxiety and higher quality of life are associated with stable and higher sexual well- being. Method of contraception or relationship status are not associated with sexual well-being during long-term follow-up in fertile aged women.
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(2023)Objectives Few studies have focused on the association between childhood and young adulthood cancers and cancer screening attendance. Our aim was to assess the effect of cancer diagnosed before the age of 30 years on first-time cervical screening attendance. Methods Using the nation-wide and population-based Finnish Cancer Registry and the Mass Screening Registry, we identified 4,491 cancer patients born between years 1961 and 1988 and diagnosed with cancer before age 30 and alive at the time of first cervical cancer screening invitation at age 25 or 30 years. Attendance probability to screening was compared between individuals with and without a prior cancer diagnosis. Results Compared to women with no previous cancer (attendance probability of 58% in study period), difference in attendance to first-time screening invitation was observed among women with previous cervical cancer (24%), other malignant gynaecologic cancer (43%) and borderline ovarian tumours (48%). Attendance among women with other previous cancer types did not differ from women with no previous cancer. Differences in the attendance probability of cancer survivors and cancer free individuals also varied between catchment areas. Conclusions The low cervical cancer screening attendance among survivors of previous gynecologic cancers and borderline ovarian tumors calls for further exploration on the reasons. As attendance probability differed among survivors of gynecological and other types of cancer significantly only if the invitation came <5 years after the cancer diagnosis, one likely explanation is ongoing oncologic follow-up. Regional differences underline the importance of national guidelines.