Lääketieteellinen tiedekunta

 

Recent Submissions

  • Burck, Martin (Helsingin yliopisto, 2017)
    Tutkimuksessa selvitettiin lasten kasvoluiden murtumien mekanismit ja kliiniset piirteet sekä selvitettiin kirjallisuuskatsauksen avulla millä tavalla lasten murtumat eroavat aikuisten murtumista. Tutkimusaineisto muodostui niiden alle 19-vuotiaiden potilaiden sairauskertomuksista ja röntgenkuvista, jotka vuosina 2005 - 2007 saivat kasvoluiden murtumadiagnoosin Helsingin ja Uudenmaan sairaanhoitopiirissä (HUS) Töölön sairaalassa tai kirurgisessa sairaalassa. Potilaita oli 89. Lasten kasvoluiden murtumat ovat harvinaisia. Vain 1 % - 15 % kaikista kasvojen alueen murtumista todetaan lapsilla. Kasvoluiden murtumat ovat yleisempiä pojilla. Kaatumiset, liikenne- ja urheiluonnettomuudet ovat yleisimpiä syitä lasten kasvoluiden murtumiin. Iän myötä väkivallan osuus etiologisena tekijänä lisääntyy. Tytöillä hevosurheilu on merkittävä kasvoluiden murtumien aiheuttaja. Lasten kasvoluiden murtumat eroavat aikuisista useilla eri tavoilla, johtuen mm. ikään liittyvistä elintavoista sekä kasvojen rakenteiden kehitysvaiheista. Lisäksi kasvojen luusto, on aikuisiin verrattuna joustavampaa, joten lapsen kasvoluun murtuman aiheuttajaksi vaaditaan yleensä suurienerginen vamma.
  • Rekola, Lauri (Helsingin yliopisto, 2017)
    Despite decades of study, no ironclad conclusion has been reached concerning the biological function of sleep in humans. Recent theories have proposed that sleep might play a role in maintaining cortical excitability at safe levels by downregulating excessive intersynaptic connections accumulated during a waking episode. In line with this theory, sleep deprivation has been shown to increase cortical excitability in studies using transcranial magnetic stimulation (TMS) and electroencephalography (EEG). In this pilot study (N=4) we used magnetoencephalography (MEG) to study the effects of 24 hours of sleep deprivation on somatosensory evoked fields (SEFs). Sleep deprivation increased the amplitude of primary somatosensory P35m component by 36%. Our preliminary findings confirm and delineate the previous EEG findings of enhanced somatosensory activation after sleep deprivation, thus indicating increased cortical excitability following sleep loss.
  • Lyly, Lauri (Helsingin yliopisto, 2017)
    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.
  • Tarkkila, Heikki (Helsingin yliopisto, 2017)
    Työterveyshuollossa digitalisaatio on luonut uusia viestintäkanavia lääkärin ja potilaan väliseen kommunikaatioon mutta myös ammattilaisten väliseen konsultointiin. Hyvin toimiva konsultaatioyhteys työterveysaseman ja erikoislääkärin välillä mahdollistaa yhä useamman potilaan hoitamisen työterveysasemalla ilman erikoislääkärikäyntejä. Viime vuosina konsultaatioiden tekemiseen on alettu käyttää perinteisen puhelimen ja paperikonsultaation rinnalla moderneja etälääketieteen työkaluja kuten videopuheluita ja pikaviestejä. Digitalisaatio on edennyt työterveyshuollossa nopeasti verrattuna muuhun perusterveydenhuoltoon, mutta tutkimusta aiheesta on tehty vielä vähän. Lukuisat yksityiset työterveyspalvelutuottajat tarjoavat potilailleen viestipalveluja ja etävastaanottoja. Työterveyspotilaat ovat otollinen käyttäjäkunta etäpalveluille, sillä he ovat esimerkiksi eläkeikäiseen väestöön verrattuna tottuneita käyttämään digitaalisia laitteita ja käyttöliittymiä. Työterveyshuollossa yhtenä konsultaation osapuolena on tarvittaessa myös työnantaja. Tässä tutkimuksessa tarkastellaan kirjallisuuskatsauksen pohjalta, miten modernit digitaaliset etälääketiedetyökalut soveltuvat työterveysaseman sisäiseen ja erikoissairaanhoidon väliseen konsultaatiotoimintaan. Tavoitteena on selvittää, mitkä tekijät vaikuttavat digitaalisen konsultaation kustannuksiin ja miten kustannusrakenne vertautuu perinteiseen vastaanottotoimintaan. Potilaan ja ammattilaisen välisessä etäviestinnässä säästöjä syntyy työnantajan näkökulmasta vähentyneistä työterveyshuollon vastaanottokäynneistä ja säästyneestä työajasta. Erikoislääkärin etäkonsultaatioilla voi syntyä säästöä työnantajalle, jos työterveyssopimukseen kuuluvat erikoislääkärin vastaanottokäynnit. Julkisen erikoissairaanhoidon lähetteiden vähentymisestä hyötyy yhteiskunta sekä työnantaja säästyneestä työajasta. Toisaalta työterveysaseman palvelutuottaja hyötyy taloudellisesti, jos se saa suoriteperusteisen korvauksen hoitaessaan potilaan itse erikoissairaanhoidon lähetteen sijaan.
  • Ruskola, Jasmine (Helsingin yliopisto, 2017)
    Seksuaalirikostilastot, jotka perustuvat viranomaisten tietoon tulleisiin raiskauksiin, ovat pitkään olleet noususuuntaiset, mutta edustavat ainoastaan murto-osaa kaikista raiskauksista. Tutkimuksemme tavoitteena oli selvittää muutoksia raiskauksiin liittyvissä tekijöissä 1900-luvun jälkimmäisellä puoliskolla ja näiden mahdollista yhteyttä viranomaisten tietoon tulleiden raiskausten määrän nousuun. Aineistosta kerättiin tietoa laajalti itse tapahtumaan sekä uhriin ja tekijään liittyen. Tiedot kerättiin kaikista Helsingin oikeuslääkäriasemalle seksuaalirikostutkimuksiin tulleista joka kymmenenneltä vuodelta vuodesta 1952 vuoteen 2002. Aineistomme koostuu 378 tapauksesta. Vuodesta 1982 eteenpäin uhrien iässä on nähtävissä selkeä painopisteen siirtymä alle 16-vuotiaista 17-32-vuotiaisiin. Vuotta 2002 lähestyttäessä alati kasvava osa uhreista on tapahtumia edeltävästi käyttänyt alkoholia ja raiskauksia tapahtuu öisin aiempaa useammin. Aineistossamme on kyselytutkimuksiin verrattuna yliedustettuna tapaukset, joissa tekijä on uhrille tuntematon. Tilastoitujen raiskausten määrän nousu liittynee enemmän muutoksiin raiskaukseen suhtautumisessa ja ilmoitusherkkyyden lisääntymiseen kuin raiskausten olosuhteiden muutoksiin.
  • Halonen, Sanna (Helsingin yliopisto, 2017)
    Parodontiitin hoito edellyttää hammaskohtaisten hoitoennusteiden määrittämistä hoidon alussa. Katsauksessa tarkastellaan potilaskohtaisia ja suun paikallisia tekijöitä, joiden on esitetty heikentävän hampaiden hoitovastetta. Tavoitteena on selvittää, kuinka eri tekijät tulisi huomioida hammaskohtaisissa ennusteissa ja kuinka täsmällinen hoitoennuste on suhteessa toteutuneeseen hoitovasteeseen. Kirjallisuuskatsauksen aineistoon valittiin tutkimukset otsikon ja tiivistelmän perusteella MEDLINE-tietokannasta seuraavilla hakusanoilla: periodontal disease, tooth loss, prognosis, treatment outcome, prognostic model. Aineisto koostuu pitkän aikavälin retrospektiivistä tutkimuksista, joissa ylläpitohoitojakson keskimääräinen pituus on yli viisi vuotta. Hoitovaste on yksilöllistä ja jopa hammaskohtaista. Ikä, parodontiitin alkuperäinen diagnoosi, tupakointi ja huono hoitomyöntyvyys ovat tekijöitä, joilla on osoitettu olevan yhteyttä hampaiden menettämisen kanssa. Edelleen kaivataan kuitenkin lisää tutkimusnäyttöä myös isännänvasteesta, mikrobitekijöistä sekä potilaan psykososiaalisesta asemasta ja geneettisistä tekijöistä, joiden rooli parodontiitin kehittymisessä ja etenemisessä on vielä epäselvä.
  • Pääsky, Elias (Helsingin yliopisto, 2017)
    Tutkimuksen tarkoituksena oli kartoittaa Potilasvakuutuskeskukseen saapuneita vahinkoilmoituksia keinojuuri-implanttien aiheuttamista N. alveolaris inferiorin (NAI) vaurioista. Tavoitteena oli selvittää hermovaurion etiologisia tekijöitä ja muodostaa käsitys, miten niitä voisi ehkäistä. Aineisto koostui vuosina 1996—2013 saapuneista potilasvahinkoilmoituksista, jotka liittyivät EBB10-koodiin (hampaan keinojuuren asettaminen). Aineistosta analysoitiin NAI:n vaurioihin liittyvät ilmoitukset (n=50) ja niitä verrattiin muihin implanttivahinkoihin (n=318). Ryhmien välisiä eroja testattiin Khi-toiseen ja Fisherin eksaktilla testillä. Aineisto analysoitiin Excel- ja SPSS-ohjelmalla. Hermovaurion kokeneiden keski-ikä oli 56 vuotta (± SD 9,8). Naiset tekivät miehiä useammin ilmoituksen hermovauriosta (P<0,05). Hermovaurioista maksettiin useammin korvausta kuin muista implanttivahingoista (P<0,05). Yleisin syy hermovauriolle oli toimenpiteen puutteellinen suunnittelu (60 %). Hermovaurion yhteydessä implantteja menettäneitä potilaita havaittiin olleen vähemmän kuin muiden implanttikomplikaatioiden yhteydessä (P<0,001). Johtopäätöksenä todetaan, että NAI:n vaurio on harvinainen komplikaatio, joka on usein seurausta epäasianmukaisesta toimenpiteestä. Vaurion välttämiseksi tulisi kiinnittää huomiota hermokanavan anatomiaan sekä sen kuvautumiseen riittävän selkeänä röntgentutkimuksissa. Lisäksi hermovaurion hoidossa saattaisi olla tarvetta uudistetulle käsitykselle aikaisemmasta interventiosta.
  • Lee, Moon Hee (Helsingin yliopisto, 2017)
    Cancer immunotherapy has advanced with the introduction of anti-PD-1 therapy. Anti-PD-1 therapy blocks the inhibitory immune checkpoint receptor PD-1, and allows T cells to regain their cytotoxic potentials in response to cancerous cells. Amongst the cytotoxic lymphocytes other than T cells, natural killer (NK) cells have not been fully explored regarding anti-PD-1 treatment. With this in mind, our aim was to characterize the immunophenotype of the immune cells in patients diagnosed with renal cell carcinoma (RCC), and separate their corresponding tumor infiltrating lymphocytes (TILs). Altogether, we analyzed the immunophenotype of the T and NK cells and RCC tumor cells from 13 RCC patients using flow cytometry. In addition, we tested the function of NK cells against RCC cells using various cell line models (NK-92 and RCC cell lines), and monitored the cytotoxicity in real time using a cell impedance assay. Based on the results, we suggest that patients diagnosed with RCC possess unique immune profiles depending on the individual, but also share characteristics regarding the tumor. In addition, NK cells have the potential to activate a cytotoxic response to RCC cells. By phenotyping the TILs, potential novel biomarkers for immuno-oncological (IO) therapy could be detected, which could aid in determining which patients would most likely benefit from immunological therapies such as anti-PD-1 treatment.
  • Virkkunen, Sirke (Helsingin yliopisto, 2017)
    Objective. Oral pulse granuloma (OPG) is an oral inflammatory lesion characterized by the presence of hyaline rings with numerous multinucleated giant cells. The etiopathogenesis of this lesion is thus far unclear, as is the composition of the hyaline rings. Our aim was to investigate whether the hyaline rings contain cellulose. Study Design. Using a newly developed staining method for cellulose, we studied 18 histologic samples diagnosed as OPG, in addition to 3 samples originally diagnosed as "normal" foreign body reactions. In our study, visualization of cellulose is based on its spesific binding to the carbohydrate binding module of β-1,4-glycanase. Results. All samples diagnosed as OPG were positive for cellulose staining localized in hyaline rings. In addition, 1 lesion (of 3), first diagnosed as a foreign body reaction without the presence of hyaline rings, was positive for cellulose By horseradish peroxidase staining. Conclusions. We show for the first time that cellulose is present in OPG lesions, indicating that cellulose might be the initial cause of formation of these lesions. (Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:464-467)
  • Suokas, Frans (Helsingin yliopisto, 2017)
    Objectives: The present study tests the hypothesis of the association of an asphyxic insult, as defined by a low perinatal Apgar score to cognitive performance on adulthood, which has not been the objective in previous studies. The study questions are whether the low Apgar score without other symptoms predisposes one to a lower educational attainment, lower speech production capabilities and other cognitive impairments in adulthood. Based on previous studies conducted on younger individuals, the hypotheses were that individuals with a low Apgar score 1) have lower educational attainment and 2) perform worse on tasks that stress speech production than controls. Additionally, it was analyzed whether the individuals with a low Apgar score have lower 3) general intelligence, 4) verbal intelligence, 5) perceptual organization, 6) attentional skills and executive functions and 7) memory functions than controls. Methods: The participants were selected from a birth cohort of 22359 deliveries during 1971–1974 that had been followed-up until the latest measurements in 2014–2016, when the participants were aged 40–45 years of age. Asphyxia group consisted of participants with an Apgar score below 7 at least two times at 1, 5, and 15 minutes after delivery without other perinatal risk conditions (N = 80). Control group consisted of participants without any perinatal risk conditions (N = 83). It was analyzed whether the asphyxia group had an increased risk for attaining maximally a secondary level education. Measures of cognition were conducted with standardized neuropsychological tests. Childhood maladaptive living environment was included in the analyses as a covariate. Logistic regression was used in the analyses of educational attainment. In the neuropsychological tests, t-tests were conducted for the unadjusted analyses and analyses of covariance for the adjusted analyses with the covariate. Results and conclusions: The individuals who had suffered asphyxia had higher likelihood to remain in the secondary level education. They performed worse on reading speed, semantic verbal fluency, semantic abstract reasoning and on a task of processing and psychomotor speed. After adjustment for the childhood living environment, their general intelligence was also lower than controls. It was confirmed that the consequences of perinatal asphyxia extend to adulthood. Based on the results, it was assumed that the temporal cortex and basal ganglia are especially sensitive to asphyxic insults. It is suggested that the individuals, who have suffered from perinatal asphyxia, will be followed-up at the onset of their studies and provided with environmental support to avoid academic underachievement.
  • Rantanen, Eveliina (Helsingin yliopisto, 2017)
    Objectives. Assessment of language development and differential diagnosis between typical bilingual language development and developmental language disorders in bilingual children is difficult due to lack of appropriate diagnostic tools and norms. Dynamic assessment has been proposed as a complementary method in which learning potential is assessed instead of current language skills. Graduated prompting as dynamic assessment method involves helping children with the tasks by presenting graduated prompts. The aim of the study was to add information about the dynamic assessment of language skills in preschool-age children acquiring Finnish as their second language and its applicability in the differential diagnosis. Methods. A dynamic assessment method was translated and adapted into Finnish and piloted with eight bilingual children aged between 4 to 6 years whose home language was not Finnish, Swedish or Sami language. Half of the children were typically developing bilinguals and half were bilinguals with diagnosed or suspected developmental language impairment. Children’s language skills and learning of receptive and expressive vocabulary as well as sentence production were assessed. Test scores were analyzed quantitatively and compared between groups and matched pairs. The usefulness of the prompts was analyzed qualitatively. In addition, the usability and the suitability of the method for the assessment of bilingual children were examined. Results and conclusions. The typically developing children scored slightly higher in the dynamic measures of vocabulary. In the static pre- or post measures of vocabulary or in the measures of sentence production no such difference was found. The results of the vocabulary assessment were in line with previous studies stating dynamic assessment having potential as a differential diagnostic tool. Score differences were minor and the sample was small, thus the results cannot be generalized. The assessment method is short enough to be carried out in single assessment session but complicated to use and rate. The used tasks need be improved further. However, new dynamic assessment methods in Finnish can be developed based on the information gathered in the study.
  • Sepänmäki, Pauliina (Helsingin yliopisto, 2017)
    The Objective. According to many studies, social isolation, decreased quality of life and psychosocial problems such as depression are some of the most difficult consequences of aphasia. The aim of this study was to explore the amount and the quality of aphasic peoples’ social participation. The questions of the study were how much and what kind of social events did the participants have and also how happy they were with the quality of the participation. In addition, one aim of this study was to find out what kind of thoughts did the participants have about the impact of aphasia on their social life. The further goal was to survey the importance of aphasia groups. Data and Methods. Four chronically aphasic people were included in the study. They all took part in an aphasia group in an adult education center. The participants kept a diary for two weeks, marked all of their social occasions and gave a satisfaction-score for each of them. Later the participants took part in a semi-structured interview where their views and experiences on social life were examined. In addition, the participants filled the Communication Activity Log to evaluate the amount and the quality of their daily communication Results. The participants participated in different social events every day despite of the severity of the aphasia. The quality of the communication did not seem to have effect on the amount of the communication. The satisfaction in social events was reasonably high with only a few exceptions. Overall, the participants thought that they had succeed to adapt to live with aphasia. Despite the difficulties in communication, they felt that they could participate in social life although they had some limitations. They all avoided occasions with a lot of people because they felt that it was difficult to participate in conversations. All of the participants took regularly part in activities that were targeted for aphasic people because they felt that such occasions were easy to participate in. All of the participants had lost friends after the stroke, and hoped they could participate more in social occasions. Severe solitude or social isolation wasn’t, however reported. All of the participants had regular contact with the people that were important for them. The participants felt that the general knowledge about aphasia was quite low, which made it more difficult to communicate with strangers. It was easier to communicate with familiar people, but even the closest family members didn’t always understand the consequences of aphasia.
  • Kaasalainen, Iina (Helsingin yliopisto, 2017)
    Aim. Neurogenic stuttering typically starts after brain injury. In previous research the variation of neurogenic stuttering between different tasks has been contradictory. There is a lack of domestic research on neurogenic stuttering and foreign material is similarly limited. Also, consistent practices between investigations are absent from the literature. The purpose of this study is to provide new information on neurogenic stuttering and other aspects of fluency in patients who have brain injuries.Methods. Five people with a brain injury and diagnosis of neurogenic stuttering after injury took part in this research. The control group consisted of five participants with a brain injury but without neurogenic stuttering. Speech tasks included cartoon narra-tion and spontaneous speech. The data was analyzed by calculating speech and articu-lation rates, the total amount of pauses, non-fluent pauses, pause durations and pause types most commonly occurring for each task. In addition, quantitative and qualita-tive characteristics of stuttering were evaluated by calculating percentages and aver-age duration of stuttering and by classifying different types of stuttering. Results and conclusions. The speech and articulation rate were slower in cartoon nar-ration task in comparison to spontaneous speech. The durations of pauses were longer and more non-fluent pauses existed in cartoon narration task than spontaneous speech. In both tasks the most common type was the dysrytmic pause. In cartoon nar-ration task, there was more stuttering whereas in spontaneous speech the durations of stuttering were longer in comparison to cartoon narration task. In this research speech task had influence on the variation of quantitative and qualitative characters of speech fluency on neurogenic stutterers.
  • Parkkila, Minna (Helsingin yliopisto, 2017)
    Objectives: Autism spectrum disorder is characterized by social, communication, and behavioral deficits which are proposed to lie at the extreme end of a continuum of autistic traits. Milder manifestations of these traits are continuously distributed across the general population. A clear cut-off between subclinical traits and the clinical spectrum is found difficult to define. A broad range of early developmental abnormalities are associated with autism spectrum. Slow acquisition of social, language and motor skills are widely recognized in the clinical spectrum. This study aims to clarify if similar developmental difficulties is associated with milder autistic traits. Methods: This study is part of the Arvo Ylppö Longitudinal Study. The study cohort consisted from 2193 infants born between 1985 - 1986 in the Hospital District of Helsinki and Uusimaa. The majority of the cohort compromised of infants who needed to be admitted to the neonatal intensive care unit within 10 days of birth, and a smaller part of infants who were born between the same time period but did not need hospital care within 10 days of birth. The current sample was selected from participants who were assessed by Griffiths Mental Developmental Scales at the age of 20 months and who completed Autism Spectrum Quotient (AQ) at the follow-up between the ages of 24 - 27. Association between Griffiths sub-scales and autistic traits were analyzed using linear and logistic regression. Results and conclusions: An association was found between early social and language development and the amount of autistic traits at the follow-up in early adulthood. Lower performance in both sub-scales were associated with higher amount of autistic traits. No association were found between early fine or gross motor skills and autistic traits. The results indicates that early development of social and language skills are associated with mild autistic traits in adulthood in the general population.
  • Yrttiaho, Janica (Helsingin yliopisto, 2017)
    Objectives. Can individual differences in the way people manage their own lives (life management) be explained from the perspective of life history theory? Understanding these differences is important since life management has a great impact on the wellbeing of people. Life history theory has already been proven to explain many individual differences in the human cognition; this study aimed to expand this field of knowledge. Life history theory states, that the early-life environment of an individual shapes her life history strategies, adapting her to her environment. The events that serve as reminders of mortality in the environment of an individual (mortality cues) were hypothe-sised to activate different life history strategies in individuals with different childhood environ-ments. This was hypothesised to be reflected as differences in life management. The study also sought to find out, if the observation that people can react differently to a similar mortality cue can be explained by their strategy's impact on their locus of control. Methods. The data used in this study came from the Cardiovascular Risk in Young Finns Study. The relationship between early-life environment (childhood socioeconomic status, SES) and life management (the Self-directedness scale in the Temperament and Character Inventory and two items concerning coping) was explored in the study. Regression analysis was used to analyse whether mortality cues moderated the relationship between SES and self-directedness. Logistic regression analysis was used to analyse whether they moderated the relationship between SES and coping. Sample size was 2 103 for analyses concerning self-directedness (mean age = 31.48 years) and 773 for those concerning coping (mean age = 20.66 years). Results and conclusions. Individuals with lower childhood SES felt that things outside their control were influencing their life more than did those with higher childhood SES. Lower SES was also connected with lower self-directedness in general. The tendency to use one way of coping over another after facing the death of a friend or a family member seemed to depend on childhood SES. Individuals with lower childhood SES used more approach coping; those with higher childhood SES used more avoidance coping. Life history theory seems to be a relevant scientific framework for stu-dying individual differences in life management. Differences in life management might help to understand why people with different backgrounds might react differently to a similar mortality cue. However, no interaction effect on life management was found between the other mortality cues used in the study and childhood SES. Sporadic incidences that are a natural part of life do not seem to activate life history strategies permanently. It is advised then, that especially when the activation of life history strategies is explored using an experimental study design, the results should be interpre-ted keeping in mind the possibility that single cues might only activate strategies temporarily.