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Abstract Background Incisional hernia is a frequent complication after loop-ileostomy closure, rationalizing hernia prevention. Biological meshes have been widely used in contaminated surgical sites instead of synthetic meshes in fear of mesh related complications. However, previous studies on meshes does not support this practice. The aim of Preloop trial was to study the safety and efficacy of synthetic mesh compared to a biological mesh in incisional hernia prevention after loop-ileostomy closure. Methods The Preloop randomized, feasibility trial was conducted from April 2018 until November 2021 in four hospitals in Finland. The trial enrolled 102 patients with temporary loop-ileostomy after anterior resection for rectal cancer. The study patients were randomized 1:1 to receive either a light-weight synthetic polypropylene mesh (Parietene Macro™, Medtronic) (SM) or a biological mesh (Permacol™, Medtronic) (BM) to the retrorectus space at ileostomy closure. The primary end points were rate of surgical site infections (SSI) at 30-day follow-up and incisional hernia rate during 10 months’ follow-up period. Results Of 102 patients randomized, 97 received the intended allocation. At 30-day follow-up, 94 (97%) patients were evaluated. In the SM group, 1/46 (2%) had SSI. Uneventful recovery was reported in 38/46 (86%) in SM group. In the BM group, 2/48 (4%) had SSI (p > 0.90) and in 43/48 (90%) uneventful recovery was reported. The mesh was removed from one patient in both groups (p > 0.90). Conclusions Both a synthetic mesh and biological mesh were safe in terms of SSI after loop-ileostomy closure. Hernia prevention efficacy will be published after the study patients have completed the 10 months’ follow-up.

The aim of this study was to contribute to the understanding of the reasons for low or high academic motivation among practical nursing students at risk of dropping out from vocational education and training. The research data consisted of semi-structured interviews with 14 Finnish students, which were analysed by qualitative content analysis. The analysis identified six motivational sources. Two of these sources – Responsible agency and Completing out of necessity – were related to engagement in studying, whereas two other sources – Exhaustion from learning challenges and Tight-roping between competing responsibilities – were related to disengagement from studying. Emotional drive and Social orientation were ambivalent motivation sources, partly pushing towards engagement as well as to disengagement, depending on the circumstances. Overall, the complicated reasons for low or high motivation were found to be heterogeneous and, consequently, the ways to support students may also vary.

We set out to assess the extent to which writing modality affects recollection in children and adolescents. We examined 10- to 11-year-old children’s (N = 63) and 16-year-old adolescents’ (N = 43) handwriting, keyboarding with a laptop computer and keyboarding with a touchscreen tablet computer or mobile phone in a within-subjects experimental design. Participants were instructed to write down stories dictated to them in the three writing modalities. Recollection of the stories was assessed using free recall of details in the stories. The results indicate that the writing modality affects recollection, handwriting leading to better recollection. However, currently, digital writing tools are inundating classrooms and workplaces around the globe, making their competent use a necessity in today’s world. For example, in Finland, students are obligated to use a laptop in upper secondary education and in the national final examination. In light of the results, we highlight the importance of balancing the instruction and practice of different writing modalities. Given the limitations of this study, we suggest conducting a larger-scale study and further research on the educational and cognitive implications of using and learning to write using multiple writing modalities.

Objective To assess the feasibility and evaluate the performance of a relaunched colorectal cancer (CRC) screening programme with different cut-offs for men and women.Design Population-based registry study.Setting Nine municipalities in Finland which started CRC screening with faecal immunochemical test (FIT) in April 2019 with cut-off levels 70 µg Hg/g faeces for men and 25 µg Hg/g faeces for women.Participants Men (n=13 059) and women (n=14 669) aged 60–66 years invited to screening during the first programme year.Outcome measures Participation rates, positivity rates, detection rates of CRC and advanced adenoma (AA), and positive predictive values (PPV) of FIT for CRC and AA.Results Altogether 21 993 invitees returned stool samples. The participation rate of women (83.4%; 95% CI 82.8 to 84.0) was significantly higher than that of men (74.7%; 95% CI 73.9 to 75.4). The positivity rates were 2.4% (2.2 to 2.7) and 2.8% (2.5 to 3.1), respectively. In total, 37 CRCs and 116 AAs were detected. The detection rates of CRC and AA per 1000 participants were 1.8 (1.1 to 2.9) and 7.2 (5.6 to 9.1) for men and 1.6 (0.9 to 2.4) and 3.8 (2.8 to 5.0) for women. The PPVs per 100 positive tests were 6.6 (4.0 to 10.3) and 25.7 (20.6 to 31.4) for men and 6.4 (3.9 to 9.8) and 15.5 (11.6 to 20.2) for women.Conclusions The chosen FIT strategy narrowed the gap in the diagnostic performance between men and women especially in the detection of CRC. The participation rates were excellent. The levels of positivity and detection rates were moderate and need further action. The results indicate that gender-specific protocols can be introduced to organised CRC screening. It is yet to be seen whether they are more effective than a uniform screening protocol.

This study is an intervention case study of fluency in Finnish-speaking children with dyslexia. Two 7-year-old children, a girl and a boy, were selected from the Jyvaskyla Longitudinal Study of Dyslexia. The intervention emphasised syllables as reading units, and proceeded from reading syllables to reading words and text. Letter knowledge, reading skills (syllables, words, pseudowords, and text reading), and syllable segmentation of words were measured before, immediately after, and three months after the intervention. The results showed that the intervention mainly affected fluency at the syllable level. The girl also showed some improvements in fluency (accuracy, speed) at the word and text reading level, too, while the boy improved in reading accuracy. Children with reading difficulties appear to benefit from fluency intervention; this should initially be based on emphasising syllables as a sublexical reading unit. However, the intervention should be sufficiently long-lasting, progressing piecemeal toward bigger reading units. (Contains 7 figures and 2 tables.)

Alterations in lipoprotein levels are reported to be related to an increased risk of gallstones. Plasma lipid metabolism is regulated by a number of proteins that are polymorphic in the population. The present research was designed to investigate the association between the polymorphisms of these proteins and the presence of various gallbladder diseases. Restriction fragment length polymorphisms (RFLPs) of apolipoprotein B (XbaI, EcoRI), apolipoprotein A-I (PstI, MspI), and cholesteryl ester transfer protein (CETP) (EcoNI, TaqIA, TaqIB) genes were examined in a series of 210 cholecystectomy patients operated on for symptomatic gallbladder disease and in 92 healthy controls. The patients were categorized into four groups according to the type of gallstones and the presence or absence of cholesterolosis. The distribution of CETP TaqIB polymorphism in the patients with cholesterol gallstones differed significantly from that in the controls, with the B1B1 jects (39.7%) (P = 0.036). The patients with both cholesterol and non-cholesterol stones had lower high density lipoprotein (HDL)-cholesterol levels than the control subjects. However, the most distinct difference was found in the gallstone patients with the B2B2 genotype (P = 0.006). The frequency of the X1X1 genotype of the apolipoprotein B XbaI polymorphism was markedly higher in the patients with acalculous cholesterolosis (48.9%) or cholesterolosis with stones (58.1%) than in the gallstone patients with cholesterol stones (27.2%) or with non-cholesterol stones (34.1%) (P = 0.002). The present data suggest that CETP gene polymorphism may ba associated with cholesterol gallstone disease, probably in combination with some additional factor that reduces the plasma HDL cholesterol concentration, especially in TaqIB B2B2 genotype.(ABSTRACT TRUNCATED AT 250 WORDS)

Background & Aims: Mutation carriers in Lynch syndrome families have a high risk for developing colorectal cancer during their lifetime. This study was designed to assess the cumulative risk for the development of colorectal adenoma or carcinoma in prospective colonoscopic surveillance. Methods: Data from the Finnish Hereditary Colorectal Cancer Registry electronic database on 420 Lynch syndrome mutation carriers without previous colorectal tumors were reviewed. Between March 1982 and May 2005 the mutation carriers underwent a total of 1252 colonoscopies. The total follow-up time was 3150 years (mean, 6.7 y/patient). Results: The cumulative risk of adenoma by age 60 was estimated as 68% (95% confidence interval [CI], 50%–80%) in men and 48% (95% CI, 29%–62%) in women. The estimated cumulative risk up to age 60 years for the development of cancer found as a result of surveillance at an interval of 2–3 years was 35% (95% CI, 16%–49%) in men and 22% (95% CI, 7%–34%) in women. Half of the adenomas were located proximal to the splenic flexure. Extracolonic cancer was diagnosed in 73 patients (18%). Conclusions: Adenoma would appear to be the most important lesion preceding cancer formation in Lynch syndrome and removal of adenomas decreases the risk for colorectal cancer (CRC). The Finnish surveillance protocol of colonoscopies at 2- to 3-year intervals facilitates patient adherence but includes an essential risk for CRC up to 60 years of age, but without CRC-related mortality when the surveillance instructions are followed. [Copyright &y& Elsevier]

Background: Because of the importance of airway management in emergency care, alternative methods with shorter learning curves for inexperienced personnel have been looked for as a substitute for endotracheal intubation (ETI). Methods: We compared the success of insertion, oxygenation and ventilation of the intubating laryngeal mask (ILMA), laryngeal tube (LT) and CobraPLA® (COB) in anaesthetized patients when used by paramedical students. After informed consent, 96 patients were monitored and anaesthetized for general surgery without the use of a muscle relaxant. After the induction of anaesthesia, 32 paramedical students inserted the ILMA, LT or COB in a random order and ventilated the patient for a 60-s period. The number of insertion attempts, the time needed for insertion, and oxygenation and ventilation parameters were recorded. The students gave a subjective evaluation of the airway devices after the test. Results: Twenty-four of the 32 students (75%) successfully inserted ILMA at the first attempt, compared with 14 of 32 (44%) for LT and seven of 32 (22%) for COB ( P < 0.001, ILMA vs. COB). One student failed to insert ILMA after all three attempts, compared with seven of 32 (21%) using LT and seven of 32 (21%) using COB ( P = not significant). Oxygenation and ventilation parameters did not differ between the groups after successful insertion. Conclusion: Clinically inexperienced paramedical students can successfully use ILMA in anaesthetized patients. Further investigations are warranted to study whether ILMA or LT can replace ETI in emergency airway management when used by inexperienced medical or paramedical staff. [ABSTRACT FROM AUTHOR]