Hyvinkää Hospital

The extent to which adult second language (L2) learners can achieve native-like neural processing of complex inflectional morphology remains unresolved. This study used event-related fMRI to examine neural mechanisms underlying the potential gradual achievement of L1-like proficiency in adult learners of Finnish (L2) with Russian as their first language (L1). Three groups participated: late beginner learners (N = 15, mean exposure to Finnish 24.9 months), late advanced learners (N = 15, mean exposure to Finnish 131.8 months), and native Finnish speakers (N = 15). Participants completed overt and covert word generation tasks. In the overt task, they spoke an inflected word aloud; in the covert task, they silently generated a form and judged a visually presented form as correct or incorrect. Stimuli included high-, medium-frequency, and pseudoword stems, with or without consonant gradation (stem allomorphy). Beginners had significantly higher error rates in both tasks than advanced learners and native speakers, indicating challenges in morphological encoding and recognition. Advanced learners performed comparably to native speakers. Furthermore, only advanced learners and native speakers exhibited increased BOLD responses in the LIFG and MFG for stems requiring consonant gradation, suggesting a mechanism for the lexical lookup of stems. These findings indicate that proficient adult L2 learners can develop native-like neural patterns of morphological processing, particularly in handling complex inflectional forms. This research contributes to understanding the neural mechanisms underlying morphological development in adult L2 acquisition and underscores the critical role of proficiency in achieving native-like processing of morphological complexity. • Advanced L2 learners show native-like brain activation during word inflection. • Beginners rely on word frequency, showing higher BOLD for high freq. and pseudo words. • CG stems cause more errors and stronger BOLD than NoCG stems across all groups. • Only natives and advanced learners show ROI activation differences for CG stems.

Few population-based studies exist for gallbladder cancer (GBC). This study explored incidence, diagnostics, treatment, and survival of patients with GBC in a national cohort. Patients with GBC during 2006-2019 in Finland were included from Finnish Cancer Registry with manual patient data verification. GBC was diagnosed in 1183 patients. Overall incidence was 1.56:100,000 and it decreased over time (from 1.81 to 1.35, p < 0.001). For detailed analysis, 1016 patients were included. The proportion of patients with T2-T3 increased (from 46 % to 65 %; p < 0.001) and T4 decreased (from 35 % to 18 %; p < 0.001). Similarly, the proportion of patients with stage IVA decreased (from 10 % to 4 %, p = 0.002) and stage II increased (from 12 % to 20 %, p = 0.006). In total, 185 (18 %) patients underwent curative-intent surgery with a 92 % R0 resection rate. The proportion of curative-intent surgery increased (from 15 % to 23 %, p = 0.013), as well as use of adjuvant (from 19 % to 54 %, p < 0.001) and systemic chemotherapy (from 31.4 % to 42.1 %, p = 0.014). Median overall survival was 7 months and 5-year overall survival 14 %, which improved during the study period (from 12 % to 14 %, p = 0.007). The incidence of GBC decreased, and overall survival improved, likely due to increased surgical and oncological treatments.

Androgen deprivation therapy (ADT), either by surgical or chemical castration, is the standard treatment for metastatic prostate cancer (PCa). ADT induces osteoporosis and increases the risk of osteoporotic fractures, such as hip fractures. However, the effect of castration on overall survival (OS) after hip fracture is unclear. The aim of this study was to evaluate the association between ADT and OS among PCa patients with surgically treated low-energy hip fractures. Male patients with surgically treated low-energy hip fractures (ICD-10 codes S72.0, S72.1, and S72.2) were retrospectively identified from the databases of Pirkanmaa Hospital District during the years 2002-2018. Patients with pathological hip fractures were excluded from the analysis. Patients with prior PCa were identified (n = 323) and categorized into three groups according to therapy that affects testosterone levels: no hormonal therapy (n = 94), ADT (n = 212), and nonsteroidal antiandrogen (NSAA) (n = 17) at the time of the fracture. The primary outcome was OS after hip fracture surgery. Postoperative OS was analyzed using the Kaplan-Meier method, and the difference in OS between groups was analyzed using Cox regression in univariable, age-adjusted, and multivariable-adjusted models. Kaplan-Meier survival analysis suggested that patients under ADT had shorter OS after hip fracture surgery (p = 0.006). After adjustment for potential confounders in Cox regression models, no clear association was observed between ADT (hazard ratio (HR) 1.19, 95% confidence interval (CI) 0.90-1.58) or NSAA (HR 1.02 (0.59-1.78)) and OS when compared to patients with PCa not undergoing hormonal therapy. Higher age and comorbidities, rather than ADT, appeared to be associated with poorer OS. In the cohort of patients with PCa, who underwent surgery for low-energy hip fracture, ADT or NSAA utilization was not associated with OS. Wide CIs allow for both modest benefit and potential harm, and the findings should therefore be considered inconclusive.

To study first birth rates according to endometriosis subtype after surgical diagnosis among nulliparous women. Retrospective population-based cohort study using Finnish national registers, linking women with first surgical diagnosis of endometriosis to fertility and sociodemographic data. The follow-up started at diagnosis and ended at first birth, sterilization/bilateral oophorectomy/hysterectomy, emigration, death, age of 50 years or December 31, 2019-whichever came first. Cohort of 9,590 nulliparous women aged 15-49 years at first surgical diagnosis of endometriosis in 1998-2012 born in 1940-1979. Women were divided into subcohorts: solely peritoneal (n = 3,146, 32.8%), ovarian (n = 3,020, 31.5%), and deep endometriosis (n = 659, 6.9%). Women with combined, rare or unspecified forms of endometriosis comprised the subcohort of combined/other endometriosis (n = 2765, 28.8%). For subanalysis, we included those with prior infertility diagnosis, i.e., presumed pregnancy wish. Surgically diagnosed endometriosis. Incidence rate of first birth. Altogether 5,184 (54.1%) of all women with endometriosis had their first birth after surgical diagnosis of endometriosis. Women with ovarian endometriosis were the oldest at surgical diagnosis (32.5 [interquartile range 28.5-37.2] years). The incidence rate of first birth per 100 person-years was 7.67 (95% confidence interval [CI]: [7.46-7.88]) among all women. We calculated the incidence rate ratio between the subcohorts, and the peritoneal subcohort presented significantly higher incidence of first birth (9.44 [9.03-9.87]) than the other subcohorts. Before surgery, 4,374 (45.6%) women had been diagnosed with infertility, of whom 2,882 (65.9%) had a first birth. Incidence rate of first birth was higher (11.5 [11.1-12.0]) among these women. The analyses of crude and adjusted restricted mean survival time difference further demonstrated that women with peritoneal endometriosis had a significantly shorter time without first birth compared with women with ovarian or combined/other endometriosis. Peritoneal endometriosis was the most favorable subtype in terms of having a first birth. In addition, women with prior diagnosis of infertility had a good prognosis. The overall chance of first birth in women with surgically verified endometriosis seems good, but the findings emphasize the impact of both age and timely diagnosis of endometriosis, in addition to treatment of infertility.

High grade vaginal squamous intraepithelial lesion (HSIL) (or vaginal intraepithelial neoplasia; VAIN) is a rare human papillomavirus (HPV)‐related cancer precursor, which is commonly treated with laser vaporisation or other surgical methods to prevent progression to invasion. Vaginal HSIL has a substantial tendency to relapse despite treatment, for which HPV persistence is a known risk factor. Imiquimod is a topically applied immunomodulator and has shown promise in the treatment of high‐grade HPV‐related genital cancer precursors. The aim of this study was to assess the efficacy and patient compliance of self‐administered vaginal imiquimod in comparison to laser vaporisation in the treatment of vaginal HSIL. We recruited 56 women with histological vaginal HSIL into a randomised controlled trial of laser vaporisation and self‐administered vaginal imiquimod with follow‐up up to 6 months. Follow‐up visits included colposcopy, punch biopsies, and cervical or vaginal swabs for HPV genotyping. In per protocol analyses of 26 women in the laser arm and 27 women in the imiquimod arm, 53.8% and 77.8% (p = 0.07), respectively, showed histological regression at the end of the study. No progressions to invasion were detected during the study period. Genotype‐specific post‐treatment negativity for HPV occurred in 16.7% of the laser group and in 39.1% of the imiquimod group (p = 0.12). Imiquimod had short‐term adverse effects, but 93% completed treatment as instructed. We conclude that vaginal imiquimod is an effective treatment for vaginal HSIL and could be considered an alternative to laser vaporisation.

BackgroundWe investigate and try to find out the optimal duration and intensity for the treatment and content useful for clinical work. The aim of our study is to evaluate the effects of lifestyle intervention on the management of childhood overweight and to explore the factors that contribute to the outcome, as well as the costs for the health care system. The hypotheses of the study are that lifestyle intervention is efficient in reducing BMI-SDS and thus effective in preventing overweight from progressing to obesity, and it is also cost-effective.Methods and analysesWe aim to recruit 80 children and they randomize either to an intervention group or a control group with standard care. The intervention group receives intensive, family-based diet, and physical activity counseling, delivered by a multidisciplinary team of a pediatrician, a nurse, and a clinical nutritionist. The control group does not receive any lifestyle intervention during the study. The inclusion criteria are age of 6–12 years, weight-for-height ≥ + 40% or ≥ + 30%, and increasing curve. All participants fill out the study questionnaires and plasma samples are taken at baseline and at 12 months. Outcome variables will be compared between intervention and control groups.DiscussionIf the effects of this lifestyle intervention are positive and it is also cost-effective, the implication of our study will be of great importance to the treatment of childhood obesity and to improve the health care system.Trial registrationClinicalTrials.gov NCT06126679. Registered on 25 October 2028 in Finland.ORCID: 0009-0009-6659-5290.

Objective:To provide procedure-specific estimates of symptomatic venous thromboembolism (VTE) and major bleeding after abdominal surgery.Background:The use of pharmacological thromboprophylaxis represents a trade-off that depends on VTE and bleeding risks that vary between procedures; their magnitude remains uncertain.Methods:We identified observational studies reporting procedure-specific risks of symptomatic VTE or major bleeding after abdominal surgery, adjusted the reported estimates for thromboprophylaxis and length of follow-up, and estimated cumulative incidence at 4 weeks postsurgery, stratified by VTE risk groups, and rated evidence certainty.Results:After eligibility screening, 285 studies (8,048,635 patients) reporting on 40 general abdominal, 36 colorectal, 15 upper gastrointestinal, and 24 hepatopancreatobiliary surgery procedures proved eligible. Evidence certainty proved generally moderate or low for VTE and low or very low for bleeding requiring reintervention. The risk of VTE varied substantially among procedures: in general abdominal surgery from a median of <0.1% in laparoscopic cholecystectomy to a median of 3.7% in open small bowel resection, in colorectal from 0.3% in minimally invasive sigmoid colectomy to 10.0% in emergency open total proctocolectomy, and in upper gastrointestinal/hepatopancreatobiliary from 0.2% in laparoscopic sleeve gastrectomy to 6.8% in open distal pancreatectomy for cancer.Conclusions:VTE thromboprophylaxis provides net benefit through VTE reduction with a small increase in bleeding in some procedures (eg, open colectomy and open pancreaticoduodenectomy), whereas the opposite is true in others (eg, laparoscopic cholecystectomy and elective groin hernia repairs). In many procedures, thromboembolism and bleeding risks are similar, and decisions depend on individual risk prediction and values and preferences regarding VTE and bleeding.

BackgroundPain conditions and poorer mental health are associated with work disability. However, few studies have examined the association of concurrent pain and poorer mental health with sickness absence among younger employees. We examined separate and joint associations of chronic pain, multisite pain, and mental health with total and long-term all-cause sickness absence days among younger Finnish municipal employees.MethodsThe Young Helsinki Health-study data were collected in 2017 from 19–39-year-old employees of the City of Helsinki, Finland. Chronic (≥ 3 months) and multisite (≥ 2 body sites) pain and mental health (RAND-36 emotional wellbeing subscale dichotomized by median score) were self-reported (n = 3911). Chronic pain, multisite pain and mental health were analyzed separately and combined. Register data on total (≥ 1 workdays) and long-term (≥ 11 workdays) sickness absence days during the following year were obtained. Negative binomial regression analyses were performed with sociodemographic, socioeconomic, and health-related factors as confounders. Gender interaction and synergistic indices were examined.ResultsChronic multisite pain was associated with long-term sickness absence days (rate ratio [RR] 2.51, 95% CI 1.17–5.42). Chronic pain (RR 5.04, 95% CI 2.14–11.87) and multisite pain (RR 4.88, 95% CI 2.30–10.33) were associated with long-term sickness absence days among employees with poorer mental health. There was a synergistic interaction between gender and multisite pain for total sickness absence days (synergy index 1.80, 95% CI 1.27–2.54), with stronger associations among women.ConclusionsChronic and multisite pain are associated with long-term sickness absence among younger employees, particularly among women and employees with concurrent poorer mental health. Consideration of this knowledge at workplaces and in healthcare could help to identify and support employees at increased risk of later sickness absence.

There is an absence of data from large population-based cohort studies on the incidence of radiologically isolated syndrome (RIS). The incidence of RIS and the subsequent risk for multiple sclerosis (MS) were investigated. A population-based, retrospective cohort study was conducted using a data-lake-based analysis of digitalized radiology reports. All brain and spinal cord magnetic resonance imaging (MRI) in people aged 16-70 during the years 2005-2010 (n = 102,224) were screened using optimized search terms to detect cases with RIS. The subjects with RIS were followed up until January 2022. The cumulative incidence of RIS was 0.03% when all MRI modalities were included and 0.06% when only brain MRI was included according to MAGNIMS 2018 recommendation criteria. With the Okuda 2009 criteria, the respective figures were 0.03% and 0.05% (86% concordance). The overall risk for MS after RIS was similar, 32% by using the MAGNIMS and 32% by using the Okuda definition of RIS. Individuals aged <35.5 years exhibited the most significant predisposition to MS (80%), whilst those >35.5 years had less than 10% risk of MS. MS diagnosed after RIS constituted 0.8% of the incident MS cases in the population during 2005-2010. A population-wide context was provided for the incidence of RIS and its relationship to MS. MAGNIMS recommendations were only slightly more sensitive to detect RIS compared to the Okuda criteria. RIS has a subtle effect on the overall incidence of MS, yet the risk for MS in individuals under the age of 35.5 years is substantial.

Medical Device incident reporting is a legal obligation for professional users in Finland. We analyzed all medical device incident reports recorded into the national incident repository from January 2014 to August 2021. Almost 30% of the total of 5,897 recorded incidents were caused by top ten devices, of which electronic health records were the most common (332 incidents). High number of incidents caused by electronic health records arouses safety concerns. A further analysis is required to explore the causes of findings.