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Deaths due to external causes (non-natural deaths) constitute a significant part of child mortality globally and also in Europe. Epidemiological literature on non-natural deaths among children in Europe was reviewed in an aim to provide a basis for the development of more effective preventive strategies. Epidemiological studies were searched from the OvidMEDLINE database, and articles were selected based on predefined inclusion criteria. The risk of bias was assessed with a critical appraisal checklist of Joanna Briggs Institute. In all, 43 articles met inclusion criteria. Most studies covered entire populations and mortality data was collected from official registries. Suicide was the most popular external cause of death studied. Significantly less study time periods extended to the 2010s (n=12) compared to the 2000s (n=25). In general, the incidence of non-natural deaths has decreased from 1990 to 2021, which in the most part is due to the reductions in transport-related and other non-intentional non-natural deaths. Reductions were observed in suicides as well. More research is needed as further advances in reducing non-natural mortality can be achieved. The present review builds a foundation for future research studies addressing epidemiology of non-natural deaths in children.

Norovirukset ovat tavallisimpia aikuisten virusvatsatautien aiheuttajia. Norovirus tarttuu helposti ihmisestä toiseen useimmiten feko-oraaliteitse. Vatsatauti on tavallisesti nopea ja itsestään ohi menevä eikä vaadi sairaalahoitoa, mutta voi aiheuttaa perussairaille vakavankin taudin. Tartuttavuutensa ja kestävyytensä ansiosta norovirus aiheuttaa epidemioita esimerkiksi sairaaloissa, jossa se leviää potilaasta toiseen henkilökunnan välityksellä. Epidemiat aiheuttavat sairaaloille kustannuksia ja johtavat ylimääräisiin kuolemiin. Kunnollisella siivouksella ja käsihygienialla voidaan epidemioita merkittävästi rajoittaa. Tutkimuksen tarkoituksena oli yrittää tunnistaa vuodeosastolla sellaisia pintoja, joista norovirus on vaikeasti puhdistettavissa, jotta siivous osattaisiin kohdistaa riskipaikkoihin. Näytteitä otettiin Kaunialan sairaalan vuodeosastolta, jossa oli äskettäin ollut norovirusepidemia. Kolmesta huoneesta otettiin yhteensä 25 pintanäytettä pumpulitikuilla ja sideharsoilla. Näytteet analysoitiin reaaliaikaisella RT-PCR:llä. Yhdestä näytteestä löytyi noroviruksen nukleiinihappoa. Se oli peräisin potilas-wc:n suihkutuolista. Kyseisen huoneen potilaalla oli vatsatautioireita edellisen kerran 10 vuorokautta sitten näytteenottohetkestä. Tutkimus osoittaa että helposti ulosteella kontaminoituvat paikat, kuten suihkutuolit ja alusastiat, voisivat käsin kosketettaessa toimia epidemian ylläpitäjänä ja levittäjänä, jos niitä ei puhdisteta kunnolla.

Early-onset cardiomyopathies (CMPs) are disorders that bring a heavy burden for families as they often lead to early death among children. CMP may be defined as a disease affecting the myocardium and its ability to pump blood efficiently. While CMPs can be both of acquired and hereditary origin, heterogeneous genetics often explain the early onset of such diseases with varying phenotypes. This study aimed to offer molecular diagnoses to three patients within the ‘KidCMP cohort’ (n=74, University Hospital Helsinki) and characterize their disease-causing genes in early-onset CMPs. Additionally; it aimed to develop patient-specific tools to study disease mechanisms in more detail. While candidate pathogenic variants were identified through whole-exome sequencing, the validation of these variants was approached through experimental work at RNA and protein level as well as molecular modeling. Using whole-exome sequencing data, we identified novel candidate disease genes in three patients from the ‘KidCMP’ cohort: TMOD1, NRAP and PGM5. While NRAP has been previously reported in a family with autosomal dominant transmission of adult dilated CMP and incomplete penetrance, TMOD1 and PGM5 have not been previously associated with disease. TMOD1 (Tropomodulin-1) presented a homozygous missense mutation in our patient, and the conservation in species and molecular modeling of the identified variant further supported its underlying role in teenage-onset dilated CMP. Cytoskeletal stability and sarcomeric force transmission are likely to be disrupted as a result of the mutation in this actin-binding protein. NRAP (Nebulin-related-anchoring protein) presented a homozygous nonsense mutation in the second patient and RNA analysis from cells and heart tissue revealed mRNA to escape nonsense-mediated decay. This gene occupies an important role in myofibril assembly and anchoring actin filaments to the cell membrane. Based on the induced premature stop codon we judged this variant to lead to a loss of function and to underlie severe early-onset dilated CMP in our patient. PGM5 (Phosphoglucomutase-like protein 5) presented a compound heterozygous missense mutation in the third patient and protein analysis revealed the affected protein to be present in reduced form. PGM5 interacts with actin filaments and occupies an important role in myofibril formation as well as cell-cell contact. Homology modeling showed the variants to cluster in the disease-associated region of the homologous PGM1 gene. Based on this, we judge this variant to underlie early-onset dilated CMP in our patient. Overall, these findings suggest a valuable role of whole-exome sequencing in disclosing the heterogeneous genetic background of this field of diseases. By identifying and characterizing novel disease genes as presented here, we offer important knowledge for targeted treatment options and further research.

Sydän- ja verisuonisairaudet ovat edelleen johtava kuolinsyy länsimaissa. Tämän tutkielman aihe, ei-ST-nousuinfarkti (NSTEMI), kuuluu akuutin koronaarisyndrooman kirjoon yhdessä ST-nousuinfarktin (STEMI) ja epävakaan angina pectoriksen (UAP) kanssa. Hoidosta on sekä Euroopan kardiologiyhdistyksen että Suomen Käypä Hoito -työryhmän suositus. Tutkielmassa tarkastellaan hoitosuositusten toteutumista HUS-alueella FinnHeart-ohjelman piiriin kuuluvista kardiologisista korteista ajalta 9/2012 - 8/2016 yhdistettynä sepelvaltimoiden varjoainekuvauksen ajanvaraustietoihin. Menetelmänä on tilastollinen analyysi rakenteellisista sairauskertomuksista käymättä läpi jatkuvatekstisiä sairauskertomuksia. Erityisenä tarkastelun kohteena on hoitosuositusten toteutuminen hoidon viiveen, pallolaajennuksen ja lääkehoidon osalta. Lisäksi tarkastellaan kuolleisuutta sepelvaltimotaudin riskitekijöiden, aiemmin todettujen sydän- ja verisuonisairauksien, sepelvaltimoiden varjoainekuvauslöydöksen ja pallolaajennuksen suhteen. Hoidolle asetetut tavoitteet toteutuvat aineistossa kohtalaisen hyvin ja kestävät myös kansainvälisen vertailun huomattavasti suurempaan aineistoon ruotsalaisesta SCAAR-rekisteristä.

Aim. According to earlier research, motivation is closely related to many issues in sports, such as success, enjoyment, persistence and intensity. The self-determination theory (SDT) was chosen as the theoretical framework of the present study. According to the SDT, motivation is divided into intrinsic motivation, extrinsic motivation and amotivation. In the present study, an attempt was made to examine the effects of motivation on dropout from organized ice hockey among adolescent boys. In addition, the purpose was to examine the effects of motivation on success in ice hockey and how parental support and pressure affect players' motivation. Method. Participants (n=671) of the study consisted of 14- and 15-year-old boys participating ice hockey. They completed a survey questionnaire which included Sport Motivation Scale (SMS) and Parental Involvement Sport Questionnaire (PISQ). The player license information was collected from the Finnish Ice Hockey Association. Motivational profiles were developed using cluster analysis. In order to examine motivational differences and differences among parental involvement in clusters, the Kruskal-Wallis test was conducted. Results and conclusion. Based on cluster analysis, four different motivational subgroups were identified: 1) high amotivation, 2) low intrinsic and extrinsic motivation, 3) high intrinsic and extrinsic motivation and 4) high intrinsic motivation. The participants in group 1 were more likely to drop out from ice hockey and were less successful than the participants in other groups. When it comes to parental involvement, the participants in group 4 reported more support from parents than the participants of groups 1 and 2. The participants in group 4 also reported less pressure from parents than the participants in other groups. The present findings appear to support previous research on the role of motivation in the prediction of dropout. The current findings highlight the importance of supporting young athletes' motivation for their sport participation. It is recommended that the sport practitioners should invest more on supporting especially the development of athletes' intrinsic motivation.

Lääkäreiden käyttäjäkokemuksia sähköisistä potilastietojärjestelmistä on kartoitettu vuosina 2010 ja 2014 Suomessa ensi kertaa. Tutkimukset havaitsivat lääkäreiden olevan tyytymättömiä sähköisiin järjestelmiin. Tämän tutkimuksen tarkoitus oli syventyä nuorten lääkärien käyttäjäkokemuksiin potilastietojärjestelmistä ja verrata niitä vanhempien lääkäri-ikäpolvien kokemuksiin. Tutkimusaineisto kerättiin sähköisellä kyselytutkimuksella vuonna 2014. Tutkimuksen kohteena olivat työikäiset, potilastyötä tekevät lääkärit. Tutkimukseen vastasi n. 23% kliinisessä työssä olevista lääkäreistä Suomessa. Vastaajat jaettiin neljään ikäryhmään. Nuoria edustivat alle 35-vuotiaat lääkärit, joista valtaosa oli erikoistuvan vaiheen kliinikkoja. Nuorilla, diginatiiveilla lääkäreillä oli kokemusta useammasta järjestelmästä, mutta lyhyemmältä ajalta kuin vanhemmilla ryhmillä. Nuoret osoittautuivat vanhempia lääkäreitä kriittisemmiksi järjestelmäkäyttäjiksi, ja olivat tyytymättömiä erityisesti järjestelmien teknisiin ominaisuuksiin, visuaalisuuteen ja toimintalogiikkaan. Nuoret olivat myös huolissaan järjestelmien vaikutuksesta potilasturvallisuuteen. Kriittisyyden taustalla tulkittiin olevan kokemattomuus paperipohjaisista järjestel-mistä, vähäisempi kliininen kokemus, erikoistuvan lääkärin työnkuva sekä uran alkuvaiheen työnhallinnan haasteet, jotka osaltaan altistavat huonon käytettävyyden aiheuttamille ongelmille. Nuorten tyytymättömyyden todettiin viittaavaan siihen, että järjestelmien käytettävyysongelmat eivät ratkea itsestään uuden tietoteknisesti taitavamman käyttäjäsukupolven astuessa työelämään.

Objectives. The first aim of this study was to examine the factor structure of the Adolescent Dissociative Experiences Scale (A-DES) with more advanced methods than before, because the results of previous studies performed by traditional factor analysis had been inconclusive. The second aim of this study was to examine the measurement invariance of the A-DES across groupings by sex, age (younger than 16-year-olds versus at least 16-year-olds), number of friends, illicit drug use, transgender disposition and exposure to bullying at school. The third aim of this study was to create abbreviated versions of the A-DES with 5, 10 and 20 items and compare the information value of these versions to the original 30-item questionnaire. Methods. The sample (n = 4072) of this study was regional, population-based and consisted of adolescents attending lower and upper secondary schools. The average age of the participants was 16.1 years (with standard deviation of 1.5 years). Variables of the study were based on the A-DES questionnaire items, some items of the YSR-questionnaire and questions concerning illicit drug use. The factor structure of the A-DES was examined with item response theory (IRT) methods using Samejima’s Graded Response Model. Measurement invariance was examined with DIF analysis based on logistic regression analysis, likewise employing Samejima’s Graded Response Model. Abbreviated versions of the A-DES were created utilizing IRT item fit indices and the results of the DIF analysis. Results and conclusions. The factor structure of the A-DES turned out to be one-dimensional. Previous suggestions of three- and four-dimensional factor structure were not supported. The A DES was also highly measurement invariant over differences in sex, age, number of friends, illicit drug use, transgender disposition and exposure to bullying at school. The amount of dissociation among Finnish adolescents expressed by their A-DES responses was quite low compared to several other countries, which must be taken into account when using the Finnish-language questionnaire. Relative to the number of items, the information values of the abbreviated versions were comparable to the original A-DES.

Aims. Mental disorders in adolescence are common, and when left untreated, they can significantly affect the developmental phase of adolescence, impacting development throughout life. Changes in experiencing emotions are typical in mental disorders, however, normal fluctuation of emotions in adolescence may impact the early detection of disorders in young people. Currently there is little research on the connection between temporal fluctuation of emotions and mental disorders in adolescence. This thesis is studying the variation in temporal fluctuation of emotions, mental alertness and self-control in adolescents that have at least one mental disorder, or no mental disorders, as well as the connection between such temporal fluctuations with different mental disorders. In addition, this thesis is studying the connection between the number of simultaneous mental disorders and the intensity of emotions, mental alertness and self-control. Methods. The studied group consisted 342 16–18-year-old adolescents from Helsinki, out of which 69.6% were girls. The data used in the study was part of the second stage of the SleepHelsinki! cohort study by the University of Helsinki. “MINI” interview technique was used for assessing the mental disorders and PsyMate™ application (which is based on the ESM method) was used for assessing the temporal fluctuation of emotions, mental alertness and self-control. The connections were examined with linear mixed models. Results and conclusions. The study did not detect any difference in the observed temporal fluctuation of emotions when comparing the adolescent that had at least one mental disorders with those that did not have any mental disorders. A greater number of detected mental disorders had a connection with weaker joyfulness and satisfaction, more intense depression, anxiety and irritability, as well as better experienced self-control. The number of disorders was not detected to have an affiliation with mental alertness. The study did not detect a systematic connection between temporal fluctuation of emotions and mental disorders, but some reference of connection between certain disorders and temporal fluctuation of emotions was detected. In the future it would be beneficial to study these connections while considering the impact of situational factors into emotions. 40 % of the adolescent observed in this study had at least one current mental disorder. Therefore, the common occurrence of mental disorders in the adolescent indicates the necessity to improve the understanding of the characteristic features of adolescent mental disorders, such as their impact in the changes in emotions.

Tämä tutkielma tarkastelee nuorten (15–24-vuotiaiden) raskauksia Suomessa vuosina 2018–2021. Nuorten raskauksiin liittyy enemmän obstetrisia riskejä kuin vanhempien ikäryhmien, teini-ikäisillä odottajilla mm. riski anemiaan, eklampsiaan, virtsatieinfektioihin ja pyelonefriitteihin on muita ikäryhmiä suurempi. Tosin varsinaisesti synnytykseen liittyviä komplikaatioita näyttäisi esiintyvän nuorempien synnyttäjien keskuudessa vähemmän kuin vanhemmilla synnyttäjillä. Lisäksi teiniraskaudella on todettu olevan epäedullisia vaikutuksia naisen terveyteen myöhemmässä elämässä tai ainakin samanlaiset sosioekonomiset riskitekijät, jotka vaikuttavat teiniraskauksien esiintymiseen, johtavat helpommin myös sosioekonomiseen huono-osaisuuteen myöhemmin elämässä. Tutkielmassa tarkastellaan Suomen sadan asukasluvultaan suurimman kunnan nuorten raskaus-, keskeytys- ja synnytyslukuja vuosilta 2018–2021. Lisäksi vertaillaan näiden esiintyvyyttä kaupunkimaisten, taajaan asuttujen ja maaseutumaisten kuntien välillä. Raskauksien, raskaudenkeskeytysten sekä synnytysten esiintyvyyttä vertaillaan muihin Pohjoismaihin ja Eurooppaan, sekä Yhdysvaltoihin, joissa on kehittyneistä maista korkein teiniraskauksien esiintyvyys. Pohjoismaissa teini-ikäisten raskaudet ovat edelleen viime vuosina vähentyneet ja verrattuna Yhdysvaltoihin raskauksien määrä on huomattavan matala. Tutkielman tulosten mukaan 15–19-vuotiailla raskaudet ovat edelleen harvinaisia, ja suurempi osa päättyy keskeytykseen kuin synnytykseen. Kuitenkin kaupunkimaisissa kunnissa asuvilla myös tässä ikäryhmässä raskauksia esiintyy harvemmin, ja ne todennäköisemmin päättyvät raskaudenkeskeytykseen verrattuna maalaismaisiin kuntiin. Teiniraskauksien määrä Suomessa on kuitenkin Pohjoismaisessakin näkökulmasta tarkastellen edelleen matala. 20–24-vuotiailla raskaudet ovat yleisempiä, tässäkin ikäryhmässä raskauksia esiintyy erityisesti taajaan asutuissa ja maaseutumaisissa kunnissa ja huomattavasti suurempi osa raskauksista päättyy keskeytykseen kaupunkimaisissa kunnissa.

Aims of the study In recent years, social media use has increased among young people. Researchers have been concerned about a possible negative influence of social media use to young peoples’ mental health. Previous studies have found evidence of a cross-sectional association between social media use and mental distress, however only few longitudinal studies have been published so far. Thus, definite conclusions about the direction of the possible association cannot be made. Further, the longitudinal association has not been studied separately in men and women, even though there is some evidence of gender differences. The aim of this study is to observe the association between social media use and mental distress both ways over a period of one year among young people, considering men and women separately. Methods The sample in this study (n=9967) consisted of young people between the ages of 16 and 25 who participated in a British survey “Understanding Society: the UK Household Longitudinal Study” (2011-2015). Mental distress was assessed with the GHQ-12 questionnaire and social media use with the question “How many hours do you spend chatting or interacting with friends through social websites on an average weekday?” The survey was filled out once a year. The study was conducted with a repeated measurements method by using multilevel modeling and utilizing data from five different time points. The associations were first examined cross-sectionally and then longitudinally. Linear regression analyses and (ordinal) logistic regression analyses were used as the main statistical methods. Results and conclusions The social media use and mental distress of young people had a cross-sectional association in both men and women. Frequent use of social media (over 7h per day) predicted higher mental distress in a longitudinal setting, however only in women. There was no conclusive influence of mental distress on social media use in a longitudinal setting among neither sex. However, the results indicated that this kind of association might be more likely in men. All observed effect sizes were small, which can be due to the study design, which did not consider the different social media content, usage style or personality-related factors. Thus, these factors could have had an impact on the strength of the associations in question. In the light of these findings, social media use does not appear as harmful to young peoples’ mental health as previously assumed.