Browsing by study line "ei opintosuuntaa"

Objective: The coronavirus disease COVID-19 causes neuropsychological problems to a proportion of patients having contracted the illness in the months following the illness and on a more long-term basis. Currently there is little knowledge about how the required level of care in the acute phase affects the presence of symptoms and their change over time. The objective of this study was to investigate the neuropsychological effects of COVID-19 from a patient self-reported symptoms and cognitive screening perspective. The study examines the effects of the required level of care in the acute phase and time since contracting the illness on self-reported symptoms and cognitive screening results three and six months after the acute phase. Furthermore, the aim was to illustrate the relationship between these two assessments. Methods: The data was collected within the RECOVID-20 project (Helsinki and Uusimaa Hospital District and University of Helsinki). Subjects (N = 164, of which 96 women, mean age 54.1 years) contracted COVID-19 in the spring of 2020. The data was collected from three different levels of care as required by the acute phase: intensive care unit patients, regular inpatient wards and patients who were ill at home. Self-reported symptoms were assessed with the A-B Neuropsychological Assessment Schedule and cognitive performance was measured by the Montreal Cognitive Assessment-Blind screening tool three and six months after the acute phase. Group differences and change over time was analysed using multivariate variance analyses and linear mixed models. Results and conclusions: About a third of all patients reported neuropsychological symptoms regardless of the level of care required in the acute phase both three and six months after the acute phase. Symptoms consisted mainly of fatigue, slowing and concentration problems. In the cognitive screening patients having received ICU and inpatient ward care performed worse compared to patients having been ill at home, but a statistically significant result was not detected when controlling for age. A statistically significant relationship between self-reported symptoms and cognitive performance was observed only in ICU patients at three months. Although the majority of COVID-19 patients do not have significant symptoms after the acute phase, there are patients that show preliminary signs of more chronic symptoms based on both self-reported symptoms and cognitive screening. More research is needed to investigate the causes of these symptoms.

Psychological pain is a concept, that describes pain in the mind, also know as psyache. It is a phenomenon closely related to suicidal acts (Shneidman, 1996; Baumeister, 1990, Troister and Holden 2010). Psycyhological pain is a relatively new concept and not yet that well known, atleast among general practicioners. For example in the USA 5,6% of the general population and 53% of the patients with severe mental illness are thought to suffer from psychological pain (American Psychiatric Association, 2003). Depression and hopelessness are perhaps the most well known factors in the development of suicidal ideation, atleast for people not familiar with the research literature of this field. However Troister and Holden (Troister and Holden, 2012) compared the effects of psychological pain, depression and hopelessness. The results were that out of depression, hopelessness and psychological pain psychological pain is the only variable that contributes significantly to a change in suicidal ideation. In this study the contributions of depression and hopelessness were reduced to statistically nonsignificant levels. Furthermore psycological pain has been identified as a high risk factor for suicide with a greater predictive power than depression (Olié et al., 2010; Pereira et al., 2010; Troister and Holden, 2010; Li et al., 2014; Troister et al., 2015). Neuroimaging can be used in psychiatric diagnostics and also in psychiatric research. In diagnostics neuroimaging can be used to for differentiate between psychiatric and somatic causes of a psychosis, as psychosis can arise from a psychiatric disorder or from for example a brain tumor. Neuroimaging can be used for example in the field of pain research. There is overlap between neural networks of physical and psychological pain, but it seems like these different types of pain have some unique brain areas as well (Meerwijk et al., 2013). In addition to neuroimaging one of the ways of measuring psychological pain is through questionnaires, of which there are several. Perhaps because of these overlapping neural networks of pain some of the medication used to treat physical pain seems to have a positive effect on suicidal population suffering from psychological pain. It seems like the dose needed to treat psychological pain is a lot smaller than a dose needed to treat equivalent physical pain (Yovell et al., 2016).

Aortic stenosis is the most important type of valvular heart disease among elderly patients, that often lead to valve replacement interventions. As the age structure shifts towards older age and life expectancy continues to rise, the prevalence of aortic stenosis is presumed to rise, resulting in more patients and additional expenses. Echocardiography is the most important tool for assessing aortic stenosis among patients. An experienced clinician can determine the severity of the disease with echocardiography alone, although the complete picture of a patient’s health must be evaluated during examination. The choice of intervention and timing thereof should be done by a heart team consisting consists of cardiologists, cardiac surgeons, radiologists, interventional radiologists and anaesthesiologists. Intervention is done by replacing the stenotic aortic valve with a functional synthetic valve either by surgical aortic valve replacement (SAVR) or by transcatheter aortic valve implant (TAVI). Echocardiography is used for evaluating prognosis and selecting type of care for each patient, based on the ECHO findings. This overview presents the use of transthoracic echocardiography as a tool for assessment of disease severity among patients with aortic stenosis, as well as advantages and limitations. The overview incudes a study of the clinical outcome of 30 patients with aortic stenosis treated with surgical aortic valve replacement and transcatheter aortic valve implant within the AS-AMYL study at the Helsinki University Hospital.

Aims of the study. It is well known that many adolescents do not get enough sleep. However, there is little research about the possible connection between adolescent sleep and family functioning. In addition, these studies vary greatly in, e.g., methodology and ages of the participants and only a few studies have used actigraphy. The aim of the present study is to examine the associations between family functioning and adolescent sleep, more specifically sleep duration, sleep quality and sleep timing. Methods. The present study was a part of SleepHelsinki!, a population-based research project based in the University of Helsinki. Sleep and family functioning of 308 adolescents (70.5% females), aged 15–18, were measured. Both subjective (PSQI) and objective (actigraphy) measures of sleep were used. Linear and logistic regressions were used to statistically analyze the associations between family functioning and sleep timing and subjective sleep quality. Results and conclusions. The association between family functioning and sleep duration was non-significant. When sex was adjusted for, the association between family functioning and sleep timing remained non- significant. However, the association between subjective sleep quality and general family functioning was statistically significant. Furthermore, problematic family functioning was related to a higher risk of poor sleep quality. Male sex was related to a higher risk of having a challenging circadian rhythm. Based on the results of the present study, family functioning is connected to subjective sleep quality and more problematic family functioning is a risk factor for lower quality sleep in adolescents.

Objective: Antisocial traits have negative short- and long-term effects on the individual and the society. Detecting early signs of antisocial traits is important in prevention of antisocial behavior. Studies have shown a strong correlation between animal cruelty in adolescence and antisocial traits in adulthood. However, the research on this correlation is insufficient. The objective of this study was to examine how animal cruelty in adolescence predicts development of antisocial traits. This was done by examining odds ratios in population-based research data. The study examines how animal cruelty by itself and combined with gender, affects the risk developing antisocial traits in young adulthood. This risk was also compared with 12 other DSM-III-R classified conduct disorder (CD) traits, and more precisely the link between theft and development of antisocial behavior. Methods: Subjects (N = 1330, of which 704 women) were from the FinnTwin-12 study, a population-based cohort study tracking the behavioral development among Finnish twins, born between 1983 and 1987. SSAGA-interviews were conducted on the same twins twice, first at the age of 14 and later at the age of 22 (mean = 22.4 years).Thirteen traits of CD (including animal cruelty), were evaluated at the age of 14 and seven traits of antisocial behavior at the age of 22. All statistical analyses were performed using multinomial logistic regression analysis. Results and conclusions: According to the study, animal cruelty in adolescence more than doubles the risk of developing two or more antisocial traits in young adulthood, compared to those who were not cruel to animals. The interaction between gender and cruelty to animals was not statistically significant. Compared to theft, animal cruelty appeared to be a weaker predictor of antisocial behavior, and was not found to have stronger or specific correlation with antisocial traits than other CD traits. The risk of developing these traits by animal cruelty alone, was reduced statistically insignificant when other CD traits were taken into account. In conclusion, animal cruelty has a strong statistical link with adulthood antisocial traits. However, effective prediction of antisocial traits requires other CD traits to be considered.

The aim of the study. Subjective time perception is prone to distortions, and one of the factors affecting it is a person's emotional state. Anticipation of unpleasant and threatening situations is of particular importance for coping. Previous research on the relationship between anticipation of unpleasant situations and perceived duration has shown conflicting results. Moreover, the experimental designs have been inadequate. The present study examines the effect of anticipating an unpleasant image and individual anxiety tendency on duration perception. The results are discussed in relation to the attentional gate model, which suggests that the influence of emotionality on perceived duration may be mediated through arousal or attentional allocation. Methods. Subjects (n=39) completed a temporal discrimination task in which the duration of a neutral visual cue stimulus was compared to previously learned short and long comparison durations. The colour of the stimulus indicated whether or not it was followed by an unpleasant image. The experiment consisted of three experimental conditions: (1) an unpleasant image was not anticipated nor presented, (2) an unpleasant image was anticipated but not presented, and (3) an unpleasant image was anticipated and presented. Psychometric functions were generated from the responses to obtain the points of subjective equality. The point refers to a duration that the person cannot distinguish as short or long. The effect of anticipating an unpleasant image and individual self-reported anxiety tendency on the points of subjective equality was analysed using multilevel linear modelling. Results. Anticipation of an unpleasant image led to longer perceived duration. Those reporting more anxiety perceived the duration of the cue stimulus to be longer than those reporting less anxiety. However, anxiety tendency did not moderate the effect of unpleasant image anticipation on perceived duration. Conclusions. Interpreted according to the attentional gate model, the perception of time passing slower is explained by arousal induced by the anticipation of an unpleasant situation, which speeds up the internal clock. In addition, anxious individuals are more aroused during anticipation, which is why they perceive time to pass more slowly than others. The role of attention in the relationship between anticipation of an unpleasant situation and duration perception seems to be more pronounced in situations where the threat is more biologically significant.

Objectives. Prematurely born (<37 gestational weeks) children are at increased risk for difficulties in language development and literacy skills, including pre-reading skills, reading and writing. Previous studies investigating full-term populations suggest that language skills are strongly correlated with reading acquisition. This connection is not widely studied in preterm sample and the findings of previous investigations have incongruity. The aim of this study is to examine the language development and literacy skills of children born extremely preterm (ELGA, born <28 gestational weeks) and/or with extremely low birth weight (ELBW, birth weight <1000 grams) at seven years of age. This thesis also investigates the possible association between language abilities and literacy skills in the sample of preterm children and a full-term born comparison group (born >37 gestational weeks). This study is part of the multidisciplinary cohort study of prematurely born children called PIPARI (the Development and Functioning of Very Low Birth Weight Infants from Infancy to School Age). Methods. The sample of this Master´s thesis includes 63 ELGA/ELBW children and 107 full-term born children who participated in the PIPARI study and were living in monolingual Finnish-speaking families. The language skills were assessed using the Five to Fifteen parent questionnaire (subdomains Comprehension, Expressive language skills, Verbal Communication) and the Peabody Picture Vocabulary Test-Revised. Pre-reading and reading skills were measured with the Jyväskylä First Steps study test material (phonological awareness, letter knowledge, rapid automized naming, single word reading, single word writing) and with the Five to Fifteen parent questionnaire (subdomains Reading and writing, General learning). Results and conclusion. The language and literacy skills at seven years of age were statistically significantly weaker in children born ELGA/ELBW when compared to the full-term controls. The Five to Fifteen questionnaire subdomain Verbal communication was the only skill that did not differ significantly between the groups. There was a clear and significant association between language and literacy skills with both preterm and full-term groups. In the preterm group the connection between language and literacy skills were stronger and appeared wider among the different language components. The results of this study support the previous findings that preterm children have an elevated risk for difficulties in language and literacy skills. In addition, this study provides further evidence for the associations between language abilities and literacy skills in school age in children born ELGA/ELBW. It is important that preterm children get the appropriate developmental follow-ups and support still at school age.

Avhandlingen är en litteraturöversikt om de olika formerna av prediabetes och deras inverkan på hälsan. Prediabetes är ett tillstånd där blodsockervärden är högre än normalt, men uppfyller inte typ 2-diabeteskriterierna. Prediabetes föregår ofta typ 2-diabetes under flera år. Prediabetes kan indelas i olika former: IGT (impaired glucose tolerance, nedsatt glukostolerans), IFG (impaired fasting glucose, fastehyperglykemi) och förhöjt HbA1c-värde. IGT definieras som ett glukosvärde på 7.8–11.0 mmol/l, två timmar efter glukosbelastning. IFG definieras som ett förhöjt fasteglukosvärde. Gränserna för fasteglukosvärdet varierar idag beroende på institution. WHO (World Health Organisation) definierar IFG som ett fasteglukosvärde på 6.1–6.9 mmol/. ADA (American Diabetes Association) har sänkt den nedre gränsen och definierar IFG som ett fasteglukosvärde på 5.6–6.9 mmol/l. ADA har även infört HbA1c-värde som ett nytt alternativ för att upptäcka prediabetes. ADA definierar prediabetes som ett HbA1c-värde på 39–47 mmol/mol. Blandformer mellan de olika formerna av prediabetes är även vanliga. IGT och IFG har påvisats skilja sig patofysiologiskt från varandra. IGT karaktäriseras primärt av insulinresistens i skelettmuskulaturen, medan IFG karaktäriseras primärt av insulinresistens i levern. Forskning har påvisat att mikro- och makrovaskulära diabeteskomplikationer kan redan förekomma vid prediabetes. Livstilsåtgärder och olika farmakologiska preparat har bevisats kunna minska risken för IGT att progredierar till typ 2-diabetes. I dagsläget är däremot bevis för nyttan av livstilsåtgärder och farmakologiska preparat vid behandlingen av IFG, ännu otillräckliga.

Objectives: The aim of this study was to test if the new phonemic awareness intervention affected the reading skills of Finnish-speaking children in grades 3 to 5 who had had challenges in learning to read or write. The control group attended to a rapid naming intervention. The effects of the interventions were measured with phonological processing, reading and writing tests. In addition, we were interested in what kind of children benefit from the phonemic awareness intervention the most. Because the study and interventions were conducted remotely, we also got some evidence of how children’s reading difficulties can be assessed and rehabilitated remotely. Methods: This study involved 34 Finnish-speaking children who had not learned to read or write as expected. The children were from grades 3rd to 5th and located across Finland. Twenty of them took part in a new phonemic awareness intervention and fourteen in a naming intervention. The groups had congruent background information and reading skills. The phonemic awareness intervention was adapted to the skills of each child. The whole study, including interventions, was done remotely using Zoom. Both interventions lasted four weeks, consisting of twelve 10 to 15 minutes long exercise sessions. Children’s reading and writing skills and some other skills relevant to literacy like phonological awareness, working memory and rapid naming were assessed before and after the intervention. Results and Conclusions: Intervention groups did not significantly differ from each other in the development of phonological processing, reading and writing. Both groups progressed in phonological processing and reading during the intervention. The benefits of the exercises were also separately assessed among children who performed below average in the measured tasks. Even then there were no statistically significant differences between the groups. Neither age nor prior reading skills predicted the magnitude of benefit from phonological awareness intervention. However, this study indicates that literacy skills can be assessed and practiced remotely.

Tavoite: Toiminnanohjaus vastaa kognition ja käyttäytymisen koordinoinnista arjen tilanteissa ja on siten keskeinen päivittäisistä haasteista selviämiseksi. Tutkimuksia COVID-19-infektion yhteyksistä toiminnanohjaukseen ja erityisesti sen arkielämän ilmiasuihin on toistaiseksi vähän. Tämän tutkielman tarkoituksena on tutkia Behavior Rating Inventory of Executive Function (BRIEF-A) -mittarilla arvioitua arjen toiminnanohjausta 3 ja 6 kuukautta COVID-19-infektion akuuttivaiheen jälkeen. Tavoitteena on selvittää yhteyksiä akuuttivaiheen edellyttämään hoidon tasoon (tehohoito, tavallinen vuodeosasto, ei sairaalahoitoa) ja ajallisia muutoksia 3:sta 6:teen kuukauteen. Lisätavoitteena on selvittää, miten itsearvio on yhteydessä läheisen arvioon tilanteesta. Menetelmät: Tämä tutkimus on osa RECOVID-20-tutkimusprojektia. Otokseen (n = 154) kuului 111 COVID-19-potilasta, joiden akuuttivaiheen edellyttämä hoito erosi (tehohoito n = 42, tavallinen vuodeosasto n = 40, ei sairaalahoitoa n = 29), sekä 43 tervettä verrokkia. Mittarina käytettiin BRIEF-A-kyselyä, jonka osallistujat ja heidän läheisensä täyttivät 3 ja 6 kuukautta akuuttivaiheen jälkeen (kontrolliryhmä kerran). Potilaiden ja verrokkien sekä hoitoryhmien välisiä eroja BRIEF-A:n itsearvion summapistemäärässä (GEC) 3 ja 6 kuukauden kohdalla tarkasteltiin yleistetyillä lineaarisilla malleilla. Ajallisia muutoksia itsearvion summapistemäärässä, itsearvion ja läheisen arvion eroa, sekä näiden yhteyksiä hoidon tasoon tutkittiin yleistetyillä sekamalleilla. Ikä, sukupuoli ja koulutustaso kontrolloitiin kaikissa analyyseissa. Tulokset ja johtopäätökset: Tämä tutkimus on tiettävästi yksi ensimmäisistä arjen toiminnanohjauksen ja COVID-19-infektion yhteyksiin keskittyvistä tutkimuksista. Keskeiset tulokset viittaavat siihen, että arjen toiminnanohjauksen ongelmat eivät lisäänny COVID-19-infektion jälkeen. On kuitenkin huomattava, että yksilöllinen vaihtelu oli suurta, eli osa toipuvista potilaista saattaa olla alttiimpia kokemaan toiminnanohjauksen ongelmia arjessaan. Keskimäärin arjen toiminnanohjauksen tila ei näyttänyt muuttuvan merkittävästi 3 ja 6 kuukauden mittauksien välillä, mutta muutoksen suunta vaihteli akuuttivaiheen hoidon tason mukaan. Tehohoidossa olleilla potilailla itsearvioidut ongelmat näyttivät keskimäärin lisääntyvän hieman, kun taas muilla potilailla muutos oli laskeva. Lisäksi havaittiin, että osallistujat raportoivat keskimäärin enemmän ongelmia kuin heidän läheisensä. Yllättäen ero oli pienin tehohoidossa hoidetuilla potilailla, mikä saattaa johtua lisääntyneestä tarkkailusta vakavan lähipiirissä ilmenneen sairauden jälkeen. Kokonaisuudessaan tämän tutkimuksen tulokset viittaavat alustavasti arjen toiminnanohjauksen erillisyyteen muista kognition ja toiminnanohjauksen osa-alueista.