Duodecim; laaketieteellinen aikakauskirja最新文献

Clinical trials aiming at developing targeted drug therapies require the identification of appropriate patient groups, utilizing both clinical information and the biological profile of the disease. The Finnish healthcare system provides exceptional possibilities for utilizing health data in identifying patient groups, planning of clinical sample studies and recruiting patients. Biobanks established at university hospitals together with the regional cancer centers play a central role in collecting biological specimens and attaching health data to the specimens. Combined with longitudinal health data, the collections of tissue specimens obtained in connection with the diagnosis offer versatile possibilities for the development of companion diagnostics of targeted drugs. Specimens collected on the basis of informed consent in connection with diagnosis and treatment enable the identification of patients suitable for drug trials, and a contact according to the consent. In the development of new functions, national collaboration - both geographical and between research infrastuctures - becomes of paramount importance. Combining the resources of biobanks, the genome strategy and the Comprehensive Cancer Center, an enabling legislation and, above all, patients with a positive attitude towards examinations, offer excellent possibilities for Finland to become the model country of individualized treatment.

Background: Eating disorders in boys are poorly detected in health care.

Material and methods: Among 922 boys attending evaluation for military service in Oulu, In 2013, disordered eating behavior was assessed by the SCOFF and Eating Disorder Inventory questionnaires (Drive fir thinness and Bulimia).

Results: Disordered eating behavior was present in 129 (14%) boys, of whom 57 (44%) were overweight. Every fourth overweight by had symptoms of eating disorders, typically constant thoughts of weight loss.

Conclusions: Screening of eating disorders should be included in medical examinations, especially in overweight boys.

In addition to medical expertise, competence-based medical training comprises communication and collaboration skills, professionalism, and leadership skills. Continuous feedback is essential for learning and development, and feedback only from the medical specialist examination taken in the end of training does not ensure thorough specialist training. Entrustable professional activity (EPA) is a unit of professional practice, defined as tasks or responsibilities typical of the specialty. EPA translates competence-based training into manageable and meaningful entities and provides tools for the evaluation of medical competence.

A multifactorial memory disease with old-age onset forms a continuum having at one end a "clear" Alzheimer-type form, with a pathophysiology involving a central role played by the accumulation of amyloid protein, and a purely arterial disease at the other end. Most of the cases exhibit a mixed form. As the options of prevention of arterial diseases are well known, this will also provide possibilities for extensive prevention of memory diseases. Central measures include physical activity, a healthy diet and intervention in risk factors - early enough, of course. What is good for the heart is generally good for the brain as well.

Annually approximately 160 new cervical cancers are diagnosed in Finland. Screening has decreased both incidence and mortality by 80%. Both primary HPV-testing and Pap smear can be used in screening. In the future HPV vaccination will decrease the number of cervical cancers. Abnormal findings in Pap smears indicate management. LSIL lesions are followed up especially among young women and HSIL lesions treated. Follow-up after treatment should be reliably arranged, because increased risk of cancer remains ever after treatment.

Lymphomas are a heterogenous group of malignant diseases. Identification of sub-groups has created pressure for a more detailed diagnosis and individualized treatment. Although the underlying genetic and molecular pathologic factors of the most common B-cell derived lymphomas, i.e. diffuse large B-cell lymphoma and follicular lymphoma, have become more accurate, prognosis is evaluated and treatment options still selected mainly on the basis of clinical variables. In the future, new generation sequencing methods that are becoming more common in clinical practice will allow the assessment of prognosis and treatment on the basis of biologic and genetic risk factors. To achieve this both comprehensive basic research and clinical drug trials taking the pathogenesis of different diseases into consideration are required.

The population of foreign origin in Finland is a heterogenic group, diverse for example with respect to reasons for and age at migration. While migration to Finland is a recent phenomenon, the size of the population of foreign origin has grown rapidly and will continue to increase. Changes in the population structure need to be taken into account in health promotion. For example lifestyle, health status, functional capacity, mental health, infectious diseases and reproductive health differ in foreign origin population compared with the general Finnish population. These differences may provide opportunities but also create challenges for service provision and health promotion planning.

Age-related macular degeneration is a condition affecting central vision, and is the leading cause of blindness and visual impairment in the western countries. For a long time, inflammation has been associated with the pathogenesis of the condition, and according to current knowledge, inflammation in the retinal pigment epithelial cells (RPE) results from an impairment of intracellular cleansing systems. In combination with the degeneration of RPE cells, this eventually leads to the destruction of light-sensing cells. By influencing the accumulation or elimination of waste material or the inflammatory reaction following its accumulation we may in the future possibly slow the progression of the disease or, in the best case, even cure it.

Background: The goal was to increase the knowledge of Full Outline of UnResponsiveness (FOUR) score in Finland, release its Finnish version and to evaluate its usefulness in Finnish ICU patients.

Materials and methods: The highest FOUR and Glasgow Coma Scale (GCS) scores of the adult ICU patients treated in Tampere University Hospital between 1st January and 31st October 2015 were analyzed retrospectively. In-hospital and 1-month mortality were the primary end-points.

Results: The Finnish version of FOUR performed comparably to previous studies. The ability of FOUR to predict mortality was equal to GCS.

Conclusions: FOUR is at least equal to GCS in predicting mortality of ICU patients.

A proximal humerus fracture typically occurs when an elderly woman falls directly onto her shoulder or on her outstretched arm. Local pain in the shoulder and immobility of the upper arm raise a suspicion of a significant injury. Other bone and tendon injuries in the shoulder region as well as dislocation of the shoulder should be considered on differential diagnosis. Diagnosis is achieved by plain X-ray. Most fractures can be treated conservatively. Consultation with an orthopedist is needed, if there are several fracture fragments with extensive dislocation.