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Improving antibiotic prescribing in LMICs : Insights from an outpatient clinic in Pakistan
No full textBackground Most human antibiotic use occurs in outpatient care and is a key driver of antimicrobial resistance (AMR). Although sales statistics suggest that high-income countries consume more antibiotics overall, the steepest growth is seen in low- and middle-income countries. Sales data – incomplete and non-transparent – reveal little about prescriptions to individual patients. Detailed, clinic-level data are essential for identifying targets for stewardship. We investigated antibiotic use and prescription appropriateness in an outpatient clinic in Pakistan – a country with some of the world's highest reported AMR prevalences. Methods Patients attending an outpatient clinic near Lahore were interviewed immediately after their clinic visit and again one month later. Clinical data were collected through patient interviews, and antibiotic prescriptions were extracted from patient records. Results Of the 983 participants, 398 (40.5 %) were prescribed antibiotics at the primary visits. Metronidazole was the single most common agent, followed by first-generation cephalosporins, fluoroquinolones, and amoxicillin–clavulanate; phenoxymethylpenicillin and amoxicillin were only minimally prescribed. One-third of prescriptions (33.2 %) were combination regimens, 90.2 % of which included metronidazole. Guideline-concordant first- or second-line choices accounted for only 23.4 % of prescriptions. Of all patients, 493 (50.2 %) attended a one-month control visit. Of these, 233 (47.3 %) also saw a practitioner during the visit; 73 of them (31.3 %) were prescribed antibiotics. Conclusions Antibiotic prescribing was excessive and discordant with recommended first-line therapies, favouring broad-spectrum agents and combination treatments – practices likely influenced by the negligible time available per patient. Our findings highlight the need to adapt antimicrobial stewardship interventions to limited-resource contexts.Peer reviewe
Rhizosphere resilience : Exploring microbial diversity and metabolic responses in long-term eucalyptus plantations
No full textThe large-scale cultivation of eucalyptus has led to significant ecological challenges, such as declines in soil microbial diversity and soil degradation. To address these issues, management practices incorporating nitrogenfixing species and adjusted rotation periods have been proposed. However, their impacts on rhizosphere soil microorganisms and metabolites remain insufficiently understood. This study employed metagenomic and untargeted metabolomics techniques to investigate the response of rhizosphere microorganisms and metabolites in eucalyptus plantations under different management regimes: monoculture plantation, plantation mixed with a nitrogen-fixing tree species, monoculture second-generation plantation, and second-generation mixed plantation. The results revealed that mixed plantation increased microbial diversity compared to continuous cropping. In contrast, second-generation monoculture led to a loss of unique microbial species and reduced microbial community stability compared to the first-generation monoculture. In nutrient-poor pure second-generation plantations, the bacterium Gemmatimonadetes (relative abundance: PF: 0.13 %, PS: 0.39 %, MF: 0.14 %, MS: 0.21 %)-which plays a key role in soil phosphorus cycle-was enriched. Although continuous cropping improved the organic phosphorus mineralization function, it decreased the abundance of genes related to carbon (rbcL and ppc) and phosphorus cycle (phoP and ppk2). The metabolite fluocinolone is negatively correlated with carbon, nitrogen and phosphorus cycle gene components in our dataset, while echinocystic acid and bezitramide are positively correlated. These findings highlight that mixed plantations enhance the ecological niche of eucalyptus rhizosphere by altering the interaction between rhizosphere microbial composition, function, and host plant metabolism.Peer reviewe
Contributing factors of pediatric medication errors involving high-alert medications : A qualitative content analysis of self-reported medication safety incidents
No full textBackground: High-alert medications can cause severe medication errors (MEs) in pediatrics. A comprehensive understanding of the factors contributing to errors is needed to establish risk management actions. Objective: To analyze incident reports involving high-alert medications and describe the contributing factors (CFs) of MEs in pediatrics. Methods: A retrospective document analysis study utilizing an abductive qualitative content analysis of self-reported medication safety incidents concerning high-alert medications at a pediatric university hospital from 2018 to 2020. Incident reports (n = 426) were first subjected to an inductive qualitative content analysis to identify and categorize CFs, then quantified by frequencies and percentages, and ultimately deductively categorized based on the elements of the Systems Engineering Initiative for Patient Safety (SEIPS) model. The analysis was first conducted by one independent researcher, then reviewed by a second researcher, and later reviewed by the entire research group. Results: A total of 933 CFs were identified, concerning 85.0 % (n = 362/426) of the incident reports. The most common main categories of CFs pertained to verifying the correct drug (11.1 %; n = 104/933), medications and pharmaceuticals (10.6 %; n = 99/933), and resourcing (10.5 %; n = 98/933). Over half of the CFs were linked to SEIPS elements involving tasks (39.6 %, n = 370) and tools and technologies (20.8 %, n = 194). Conclusions: The CFs of pediatric MEs involving high-alert medications are multifaceted and have a wide impact on the entire system design, from organizational strategies to individual tasks. Risk management actions and further studies addressing pediatric-specific challenges are required to ensure the most optimal systemic defenses, enabling proactive monitoring error-provoking conditions in clinical practice.Peer reviewe
Urban planners should not be afraid of AI
No full textThe accelerating development of artificial intelligence (AI), particularly large language models (LLMs) that power tools such as ChatGPT (OpenAI), Claude (Anthropic), or Gemini (Google DeepMind), has sparked both excitement and apprehension across many fields. In urban planning, a discipline deeply rooted in human values, spatial reasoning, and local context, the emergence of AI has prompted mixed reactions. Some planners are enthusiastic adopters, while others remain cautious, often citing a lack of technical expertise or ethical concerns. A common barrier to adopting large language models in planning practice is the perceived need for technical expertise. Yet the reality is that it is not necessary to be an AI expert in order to use these tools. More importantly, it is not necessary to become one. Off-the-shelf AI models have become accessible enough to empower urban planners to pose new questions, explore alternative futures, and engage communities in more dynamic and inclusive ways. The real opportunity lies not in developing new models, although some may pursue that direction, but in discovering, evaluating, and creatively applying existing ones to urban challenges.Peer reviewe
Självförvållade traumatiska skador på främre halsen hos äldre vuxna i Finland
No full textBackground: Self-inflicted neck injuries are rare but potentially life-threatening. Considering the stable suicide rates among elders and the projected aging of the Finnish population, the incidence of these injuries may increase. This study aimed to examine the prevalence, risk factors, and management of self-inflicted anterior neck injuries among elders in Finland.
Methods: We retrospectively reviewed all patients aged ≥65 years treated for trauma to the anterior neck within the Helsinki and Uusimaa Hospital district during 2005–2023. Patients were identified using ICD-10 codes, and electronic patient records were carefully reviewed. Of 288 identified cases, 81 met the inclusion criteria.
Results and discussion: The occurrence of self-inflicted injuries has slightly increased in recent years and represented 28% (23/81) of the whole cohort. Most individuals were male (91.3%), with a history of psychiatric comorbidities and alcohol misuse, although acute intoxication at presentation was uncommon (8.7%). While overall mortality was low (8.7%), a significant proportion of patients had penetrating (56.5%) and multi-site injuries (47.8%), requiring immediate clinical evaluation, hospital admission, and surgical management. Despite the severity of injuries, clinical outcomes were favourable with short ward time (2.5 days) and infrequent need for intensive care or airway management (17.4%).
Conclusion: Self-inflicted anterior neck injuries in older adults remain rare but a clinically significant entity due to their potential severity and high demand for hospital resources. These findings highlight the need for timely multidisciplinary management as well as further research to improve current guidelines and means of prevention.Bakgrund: Självförvållade främre halsskador är sällsynta men potentiellt livshotande skador. Med beaktande på den stabila självmordsincidensen bland åldringar och det förväntade åldrandet av den finska befolkningen kan förekomsten av dessa skador förväntas öka. Syftet med studien var att utreda förekomst, riskfaktorer och handläggning av självförvållade främre halsskador bland äldre vuxna i Finland.
Metoder: En retrospektiv genomgång gjordes av alla patienter ≥65 år som vårdats för trauma mot främre halsen inom Helsingfors och Nylands sjukvårdsdistrikt under perioden 2005–2023. Patienter identifierades via ICD-10 koder, och en noggrann genomgång elektroniska journalerna utfördes. Av 288 identifierade fall uppfyllde 81 inklusionskriterierna, varav 23 var självförvållade.
Resultat och diskussion: Under de senaste åren har dett skett en liten ökning i förekomsten av självförvållade skador, och dessa motsvarade 28% (23/81) av hela kohortet. De flesta individerna var män (91.3%) med historia av psykiatriska komorbiditeter. Fastän att alkoholmissbruk var vanligt, var akut berusningstillstånd vid ankomst sällsynt (8.7%). Även om mortaliteten var låg (8.7%), var en stor andel av skadorna penetrerande (56.5%), på flera delar av kroppen (47.8%), och krävde omedelbar klinisk bedömning, sjukhusvård samt kirurgiska interventioner. Trots skadornas allvar, var de somatiska resultaten goda med korta vårdtider (2.5 dagar) och litet behov av intensivvård eller luftvägshantering (17.4%).
Slutsats: Självförvållade främre halsskador hos äldre är fortsatt ovanliga men kliniskt relevanta på grund av sin potentiella allvarlighetsgrad och anmärkningsvärda resurskrav. Fynden betonar behovet av snabb multidisciplinär handläggning, samt vidare forskning kring prevention och prehospital mortalitet inom denna population
Satisfied or frustrated? Basic psychological needs profiles and their associations with work-related outcomes among teachers
No full textTeachers' optimal functioning and well-being depend on the fulfillment of their basic psychological needs for autonomy, competence, and relatedness. This study examined how the satisfaction and frustration of these needs configure in teachers' experiences. Using latent profile analysis on two cross-sectional samples of Finnish teachers (2021: N = 993; 2023: N = 1279), we identified three profiles that appeared consistently across both samples (Dominantly Fulfilled, Socially Fulfilled, and Socially Unfulfilled), as well as one profile unique to the latter (Autonomy-Oriented with Low Competence Frustration). Differences between profiles emerged in relation to teachers' background characteristics (age, gender, and educational context) and perceived work-related outcomes (work engagement, meaning of work, burnout, and turnover intentions). While having all three needs met was most strongly associated with favorable outcomes, even the fulfillment of a single need appeared beneficial. The findings highlight the value of nuanced, person-oriented approaches for advancing both theory and practice.Peer reviewe
Effect of β-glucan molecular weight on oat bread quality and staling
No full textβ-Glukaanin teknofunktionaalisten ominaisuuksien tiedetään riippuvan muun muassa sen pitoisuudesta, rakenteesta ja molekyylipainosta. Gluteenittomassa leivonnassa β-glukaani, nostaa taikinan nestefaasin viskositeettia, kilpailee vedestä tärkkelyksen kanssa ja hidastaa sen ulosvirtaamista. Tämän seurauksena gluteenittoman leivän tilavuus kas-vaa, sisusrakenne jää pehmeäksi ja fysikaalinen vanheneminen hidastuu. β-Glukaanin molekyylipainon vaikutusta gluteenittoman kauraleivän laatuun ja fysikaaliseen vanhe-nemiseen ei kuitenkaan ole aiemmin systemaattisesti tutkittu. Maisterintutkielmani ta-voite oli selvittää, miten kauran β-glukaanin molekyylipaino vaikuttaa gluteenittoman kauraleivän laatuun ja fysikaaliseen vanhenemiseen. Tutkimushypoteesin mukaan mole-kyylipaino vaikuttaa leivän laatuun (tilavuus, sisusrakenteen kovuus) ja fysikaaliseen vanhenemiseen (sisusrakenteen kuiva-ainepitoisuuden ja kovuuden muutos, amylopektii-nin uudelleenkiteytyminen).
Tutkimuksessa valmistettiin kevyellä elintarvikelaatuisella uuttoprosessilla kaksi β-glukaaniuutetta. Toisen uutteen β-glukaani hydrolysoitiin osittain β-glukanaasilla. Lei-vonnoissa leivottiin neljä näyteleipää. Kahden leivän taikinavedestä 50 % korvattiin β-glukaaniuutteella ja yhden taikinan endogeeninen β-glukaani hydrolysoitiin osittain. Uut-teiden ja leipien β-glukaanin keskimääräinen molekyylipaino määritettiin HPSEC:llä. Tuoreiden leipien tilavuudet mitattiin laserskannerilla. Varastoinnin aikaisia muutoksia leipien sisusrakenteeseen mitattiin aineenkoetuslaitteella ja amylopektiinin uudelleenki-teytymistä DSC:llä. Mittaukset suoritettiin yhden, kahden ja viiden päivän varastoinnin jälkeen.
Taikinan β-glukaanin osittainen hydrolysoiminen johti leivän suurempaan ominaistila-vuuteen ja pehmeämpään sisusrakenteeseen. Leivän fysikaaliseen vanhenemiseen se ei kuitenkaan vaikuttanut. Uutetta sisältäneiden leipien sisusrakenne ei ollut kovempi kuin kontrollileivässä, vaikka amylopektiinin uudelleenkiteytyminen oli viiden päivän varas-toinnin jälkeen edennyt voimakkaampaa. Lisätyn β-glukaanin osuus uuteleipien kaikesta β-glukaanista oli pieni, eikä sen molekyylipaino vaikuttanut leipien tutkittuihin ominai-suuksiin.Techno-functional properties of β-glucan are known to depend on factors such as concen-tration, structure, and molecular weight. In gluten free baking, β-glucan increases viscosi-ty of dough liquor, competes with starch for water, and limits starch leaching during past-ing. As a result, bread volume increases, crumb structure remains softer, and staling is delayed. However, the specific impact of β-glucan molecular weight on the quality and staling of gluten-free oat bread has not been systematically studied. This study aimed to determine whether the molecular weight of oat β-glucan affects the quality and staling of gluten-free oat bread. It was hypothesised that molecular weight significantly affects bread quality (specific volume, crumb hardness) and staling (changes in dry-solids con-tent, crumb hardness, and amylopectin retrogradation).
Two food-grade β-glucan extracts were produced using a mild extraction process. In one extract, β-glucan was enzymatically partially hydrolysed. Four different breads were baked. In two formulations, 50 % of the dough water was replaced with β-glucan extracts. In a third, the endogenous β-glucan in the dough was partially hydrolysed. The average molecular weight of β-glucan in the extracts and bread was determined with high-performance size-exclusion chromatography (HPSEC). Bread volume was measured with a laser scanner. Changes in bread crumb structure and amylopectin retrogradation were assessed using a Texture Analyser (TA) and differential scanning calorimetry (DSC), respectively, after one, two, and five days of storage.
Partial hydrolysis of endogenous β-glucan led to an increased specific volume and a soft-er crumb. However, this did not appear to influence bread staling. The crumb hardness of breads with β-glucan extract was not higher than that of the control bread, even though the amylopectin retrogradation was more intense after five days of storage. The propor-tion of added β-glucan relative to total β-glucan in the breads was small, which likely explains why its molecular weight did not affect the measured bread characteristics
Maksillaosteotomia ja rhinoplastia huuli - ja suulakihalkioilla
No full textIn Finland approximately 88 living babies are born with cleft lip and palate (CLP) every year. Patients with CLP may develop midfacial retrusion, maxillary hypoplasia, and crossbite during growth. For correction of maxillary hypoplasia, maxillary Le Fort I osteotomy or bimaxillary osteotomy is used. In addition, rhinoplasty might be needed to correct nasal deformity.
Maxillary advancement may affect speech in patients with cleft lip and palate. Both velopharyngeal function (VPF) and articulation can change. A major problem is the deterioration of velopharyngeal function. Patients often also need rhinoplasty either simultaneously with maxillary osteotomy or in a staged separate operation after osteotomy.
This retrospective study examined non-syndromic cleft lip/palate patients who had undergone Le Fort I osteotomy or bimaxillary osteotomy and possibly open rhinoplasty at the Helsinki Cleft Palate and Craniofacial Center between the years 2002 and 2016. Pre- and postoperative lateral cephalograms were digitized to evaluate cephalometrically the amount of surgical change. Standardized speech video recordings were used to analyze VPF and articulation of alveolar consonants before and after maxillary advancement. The speech was assessed perceptually and instrumentally by an experienced cleft speech pathologist. Medical charts were accessed through the hospital’s archives and database.
When evaluating VPF (n=93), the mean maxillary advancements were 4.00 mm horizontally and -3.90 mm vertically, and when evaluating articulation (n=57) 4.65 mm and -3.82 mm, respectively. The amount of maxillary advancement did not have a significant effect on VPF or articulation. However, the patients with borderline or more severe velopharyngeal insufficiency (VPI) preoperatively had a risk for a significant negative change in speech. There were no differences between maxillary and bimaxillary osteotomy.
The overall articulation (especially the sounds /s/ and /l/) improved significantly postoperatively. Preoperative articulation errors of /s/ were related to palatal inclination of the upper incisors.
Of the 99 patients who underwent maxillary osteotomy, 45 needed rhinoplasty. In 25 patients (25%), rhinoplasty was performed in a second operation after the first procedure, and in 20 patients (20%) rhinoplasty was performed simultaneously with maxillary osteotomy. The overall complication rate was 14%, with no difference emerging between patients with and without simultaneous rhinoplasty.
To conclude, the amount of maxillary advancement affects neither VPF nor articulation in patients witch cleft. Orthognathic surgery may improve articulation but can deteriorate VPF in patients. Of patients who underwent maxillary osteotomy, 45% needed rhinoplasty. The need was highest in patients with BCLP and UCLP. Staged and simultaneous procedures were almost equally common with similar complication rates.Suomessa syntyi vuonna 2020 88 elävää lasta, jolla oli huuli- ja suulakihalkio. Osalle potilaista kehittyy yläleuan kasvuhäiriö. Yläleuan kasvuhäiriö ja siihen liittyvä vaikea ristipurenta sekä kasvojen ja nenän deformiteetti hoidetaan useimmiten yläleuan Le Fort l – osteotomia-leikkauksella tai molempien leukojen leikkauksella (bimaksillaariosteotomia).
Yläleuan osteotomian riskinä voi olla halkiossa puheen huononeminen ja nenäportin toimintavajeen eli velofaryngeaalisen insuffisienssin (VPI) korostuminen. Osa potilaista tarvitsee myös nenänkorjausleikkauksen (rhinoplastia). Tämä voidaan tehdä joko erikseen osteotomialeikkauksen jälkeen tai samassa leikkauksessa osteotomian kanssa.
Tässä retrospektiivisessä tutkimuksessa tutkittiin huuli- ja suulakihalkiopotilaita, joille oli tehty Le Fort I -osteotomia tai bimaksillaariosteotomia sekä mahdollinen rhinoplastia HUSin Huuli- ja suulakihalkiokeskuksessa (Husukessa) vuosina 2002–2016. Leikkausta ennen ja leikkauksen jälkeen otetut kallolateraalikuvat digitoitiin kefalometrisesti leukojen kirurgisen siirron määrän ja kasvojen ja leukojen luusto- ja pehmytkudosmuutosten määrittämiseksi. Halkiokeskuksen puheterapeutit tutkivat puheen VPI-piirteitä ja artikulaatiota käyttäen standardisoituja puheen arvioimismenetelmiä puhevideotallenteita. Potilaiden taustatiedot haettiin sairaskertomuksista.
Tutkimuksessa todettiin, että yläleuan siirron määrällä eteen-, ylös- tai alaspäin, ei ollut merkittävää vaikutusta VPI-piirteiden korostumiseen tai artikulaatioon. VPI-piirteitä arvioitaessa keskimääräinen yläleuan siirron määrä oli 4.0 mm eteen ja 3.9 mm alas (n=93) ja artikulaatiota arvioitaessa 4.65 mm eteen- ja 3.82 mm alaspäin (n=57). Riskiä VPI-piirteiden huononemiselle ei ollut niillä potilailla, joilla nenäportin toiminta oli ennen leikkausta normaali. Riski VPI-piirteiden lisääntymiselle oli potilailla, joilla oli lievää tai vaikea-asteisempaa VPI-piirteistöä jo ennen leikkausta. Yläleuan tai molempien leukojen leikkausten välillä ei ollut merkittävää eroa.
Artikulaatio parani (erityisesti /s/ ja /l/ äänteiden osalta) osteotomian myötä. Niillä potilailla, joilla oli pystyt yläetuhampaat, oli preoperatiivisesti alttius /s/ äänteen virheisiin.
45 % potilasta, joille tehtiin osteotomialeikkaus tarvitsi myös nenäleikkauksen. Neljäsosalle potilaista tehtiin nenäleikkaus erillisessä operaatiossa yläleuan siirron jälkeen, viidesosalle samassa operaatiossa kuin osteotomia. Komplikaatiota todettiin 14 prosentilla. Se, tehtiinkö nenäleikkaus erikseen vai yhdessä osteotomian kanssa, ei vaikuttanut merkittävästi komplikaatioiden ilmaantuvuuteen.
Johtopäätöksinä todettiin, että osteotomialeikkauksessa tehdyn yläleuan siirron määrä ei vaikuta puheen nenäportin toimintavajeeseen eikä artikulaatioon potilailla, joilla on halkio. Ortognaattinen kirurgia voi parantaa artikulaatiota, mutta heikentää nenäportin toimintavajetta huuli- ja suulakihalkiopotilailla. 45 % potilaista, joille tehtiin osteotomialeikkaus tarvitsi myös nenäleikkauksen. Rhinoplastian tarve oli suurin potilailla, joilla oli tois- tai molemminpuolinen huuli- suulakihalkio. Se, tehtiinkö nenäleikkaus erikseen vai yhdessä osteotomian kanssa, ei vaikuttanut merkittävästi komplikaatioiden ilmaantuvuuteen
A simple and fast technique to cannulate the contralateral gate
No full textIn challenging anatomy and large aneurysms, cannulation of the contralateral gate may be time-consuming and sometimes requires crossover approach with a snare. At Helsinki University Hospital, we have since 2016 used the so-called side-rail technique. This technique is described in detail in this paper including video material on the performance of the procedure. We have found this simple technique to be time and radiation sparing, and we now use it routinely in most endovascular aortic repair procedures.Peer reviewe