Skulptur, Pferd mit Fohlen RWU (Reichsstelle für Film und Bild in Wissenschaft und Unterricht) - jedoch ohne gedrucktes Etikett; RWU (Reichsstelle für Film und Bild in Rund Rund R) - but without a printed label Image
Odprti dostop
Pferd m. säugendem Füllen (Olympia) | R.W.U 6114a |
Horse with feeding (Olympia) | R.W.U 6114a |
Complex parts require specific processing. Computer aided manufacturing solutions make their mark and optimize the manufacturing process. Different CAM software's have different philosophy with ...different capabilities. TEBIS CAM software brings more facilities and opportunities to manufacturing a complex part. In the paper was presented this capability on real part. It was made the comparison between two different milling strategies: one classical milling strategy-Contour parallel strategy, versus adaptive milling strategy. Was presented the way how was implement the TEBIS CAM software and the results of manufacturing. The time of manufacturing was significantly reduced with 43% using the adaptive milling strategy and the surface accuracy was improved.
Introduction
Depression is twice as common in women as in men, especially in the young age group. Multiple factors may contribute to this gender difference. Growing attention is being focused on the ...role of sex hormones, including those of hormonal contraception
(HC). Some recent studies have indicated a higher risk of depression among women using HC, although the results are inconclusive.
Objectives
The aim of this study is to examine the associations between the use of hormonal contraception and the risk of depression in childbearing age women.
Methods
The original cohorts for the study included all women aged 15-49 years with at least one redeemed prescriptions for HC in Finland in 2017 (n=294,356), and a 1:1 age-matched cohort of non-users. After exclusion of prevalent cases (n=35,102), all incident cases of depression (as recorded in the Care Register of Health Care and Register of Primary Health Care Visits) in 2018-2019 were identified (n=23,480), and a 4:1 age-matched control group (n=93,920) was selected from the above cohorts. Current use of HC in the 180 days before the event was compared in cases and controls, and associations with risk of depression were tested via conditional multivariate logistic regression models.
Results
During the follow-up, 23,480 incident cases of depression were identified. Current use (in the 180 days before the event) of HC (OR 0.82, 95% CI 0.79-0.85), in particular of estradiol- or
ethinylestradiol-containing combined HC was associated with a lower risk of depression (OR 0.83, 95% CI 0.76–0.89; OR 0.74, 95% CI 0.71–0.78, respectively) compared to non-use of HC. The results remained significant (OR 0.87, 95% CI 0.81-0.95; and OR 0.77, 95% CI 0.73-0.81, respectively) after controlling for covariates (marital and socioeconomic status, education level, chronic diseases). Use of progestin-only contraception was not associated with altered risk of depression.
Conclusions
Use of HC in childbearing age women is not associated with increased risk of depression. Rather, the use of estradiol- or ethinylestradiol-containing HC is associated with a lower risk of depression.
Disclosure of Interest
None Declared
Introduction
In Finland more than 40% of fertile aged women used some type of hormonal contraception (HC) in the period 2010-2013. A proportion of women using HC complains of side effects, including ...mood symptoms. The relationship between the use of HC and the risk of attempted suicide (AS) is still a matter of debate.
Objectives
To assess the association of the use of HC with the risk of AS during 2017-2019.
Methods
Data were retrieved from the Prescription Centre, Care Register of Health Care, Register of Primary Health Care Visits and Statistics Finland. A total of 587 823 women, aged 15-49 years, using and not using HC in 2017 were analysed in the initial incidence study. All incident AS cases during 2018-2019, and their 4:1 age-matched controls (1 174 346 person-years) were analysed in a nested case-control setting via conditional logistic regression models.
Results
Altogether 818 AS cases occurred during the follow-up (incidence rate: 0.70/1000 person-years, 95% CI 0.65–0.75), with an IRR of HC vs. no-HC use of 0.73 (0.63–0.83). Current use (in the 180 days before the event) of estradiol- or ethinylestradiol-containing HC was associated with a lower risk of AS (0.53, 0.33–0.87; 0.49, 0.37–0.64, respectively) compared to non-use of HC. After controlling for covariates (marital and socioeconomic status, education level, use of psychotropic medications), only current use of HC containing ethinylestradiol remained significant (0.39, 0.23–0.65).
Conclusions
A lower risk of AS is associated with the use of HC, and specifically of ethinylestradiol-containing
HC.
Disclosure
No significant relationships.
Abstract
STUDY QUESTION
Do women with endometriosis have lower first live birth rate before surgical diagnosis than women without verified endometriosis?
SUMMARY ANSWER
Compared to reference women, ...the incidence of first live birth was lower in women prior to surgical verification of endometriosis irrespective of the type of endometriosis.
WHAT IS KNOWN ALREADY
Endometriosis is associated with pain and reduced fertility. The mechanism of infertility is partly explained by anatomical, endocrinological, and immunological changes. Over the past decades, the treatment of both endometriosis and infertility has evolved. Knowledge of fertility far before surgical diagnosis of endometriosis in large cohorts and of different types of endometriosis has been lacking. The diagnostic delay of endometriosis is long, 6–7 years.
STUDY DESIGN, SIZE, DURATION
Retrospective population-based cohort study focused on the time period before the surgical verification of endometriosis. All women with surgical verification of endometriosis in 1998–2012 were identified from the Finnish Hospital Discharge Register and the reference cohort from the Central Population Register. Data on deliveries, gynecological care, and sociodemographic factors before the surgical diagnosis were gathered from Finnish national registers maintained by the Finnish Institute for Health and Welfare, the Digital and Population Data Services Agency, and Statistics Finland.
PARTICIPANTS/MATERIALS, SETTING, METHODS
All women aged 15–49 years at the time of surgical verification of endometriosis (ICD-10: N80.1–N80.9) in Finland during 1998–2012 were identified (n = 21 620). Of them, we excluded women born in 1980–1999 due to the proximity of the surgical diagnosis (n = 3286) and women left without reference (n = 10) for the final endometriosis cohort of 18 324 women. From the final cohort, we selected sub-cohorts of women with isolated diagnosis of ovarian (n = 6384), peritoneal (n = 5789), and deep (n = 1267) endometriosis. Reference women were matched by age and residence and lacked registered clinical or surgical diagnosis of endometriosis (n = 35 793). The follow-up started at the age of 15 years and ended at the first birth, sterilization, bilateral oophorectomy, hysterectomy, or until the surgical diagnosis of endometriosis or corresponding index day—whichever came first. Incidence rate (IR) and the incidence rate ratio (IRR) of first live birth before the surgical verification of endometriosis with corresponding CIs were calculated. In addition, we reported the fertility rate of parous women (the number of all children divided by the number of parous women in the cohort) until the surgical verification of endometriosis. The trends in first births were analysed according to the women’s birth cohort, type of endometriosis, and age.
MAIN RESULTS AND THE ROLE OF CHANCE
Surgical diagnosis of endometriosis was set at the median age of 35.0 years (IQR 30.0–41.4). Altogether 7363 women (40.2%) with endometriosis and 23 718 (66.3%) women without endometriosis delivered a live born infant before the index day (surgery). The IRs of the first live birth per 100 person-years were 2.64 (95% CI 2.58–2.70) in the endometriosis cohort and 5.21 (95% CI 5.15–5.28) in the reference cohort. Between the endometriosis sub-cohorts, the IRs were similar. The IRR of the first live birth was 0.51 (95% CI 0.49–0.52) between the endometriosis and reference cohorts. Fertility rate per parous woman before the surgical diagnosis was 1.93 (SD 1.00) and 2.16 (SD 1.15) in the endometriosis and reference cohorts (P < 0.01). The median age at the first live birth was 25.5 (IQR 22.3–28.9) and 25.5 (IQR 22.3–28.6) years (P = 0.01), respectively. Between the endometriosis sub-cohorts, women in the ovarian sub-cohort were the oldest at the time of surgical diagnosis with the median age of 37.2 years (IQR 31.4–43.3), (P < 0.001). Altogether 44.1% (2814) of the women with ovarian, 39.4% (2282) with peritoneal, and 40.8% (517) with deep endometriosis delivered a live born infant before the diagnosis. IRRs between the endometriosis sub-cohorts did not differ. Fertility rate per parous woman was lowest, 1.88 (SD 0.95), in the ovarian sub-cohort compared to 1.98 (SD 1.07) in the peritoneal and 2.04 (SD 0.96) in deep endometriosis (P < 0.001). Women with ovarian endometriosis were oldest at first live birth compared to women in other sub-cohorts with a median age of 25.8 years (IQR 22.6–29.1) (P < 0.001). Cumulative distributions of first live birth were presented according to age at first live birth and birth cohorts of the participants.
LIMITATIONS, REASONS FOR CAUTION
The increasing age at first live birth, increasing practice of clinical diagnostics, conservative treatment of endometriosis, a possible effect of coexisting adenomyosis, and use of artificial reproductive treatments should be considered when assessing the results. In addition, the study is limited due to possible confounding effects of socioeconomic factors, such as level of education. It should be noted that, in this study, we assessed parity only during the years preceding the surgical verification of endometriosis.
WIDER IMPLICATIONS OF THE FINDINGS
The need for early diagnosis and relevant treatment of endometriosis appears clear given the impairment of fertility prior to its surgical verification.
STUDY FUNDING/COMPETING INTEREST(S)
The study was funded by the Hospital District of Helsinki and Uusimaa and by Finska Läkaresällskapet. The authors report no conflicts of interest. All authors have completed the ICMJE Disclosure form.
TRIAL REGISTRATION NUMBER
N/A.
•Comparative effectiveness of mindfulness over relaxation was examined in large RCT.•Girls and 13-year-olds seemed to benefit from mindfulness over relaxation.•Benefits among boys who continued ...regular mindfulness practice at 6 months’ follow-up.•Short 9-lesson mindfulness program in school context provides modest results.•Overall, no consistent effects on resilience, socio-emotional functioning or depressive symptoms.
Mindfulness-Based Interventions (MBIs) have shown promising effects on mental health among children and adolescents, but high-quality studies examining the topic are lacking. The present study assessed the effects of MBI on mental health in school-setting in an extensive randomised controlled trial.
Finnish school children and adolescents (N = 3519), aged 12–15 years (6th to 8th graders), from 56 schools were randomized into a 9 week MBI group, and control groups with a relaxation program or teaching as usual. The primary outcomes were resilience, socio-emotional functioning, and depressive symptoms at baseline, at completion of the programs at 9 weeks (T9), and at follow-up at 26 weeks (T26).
Overall, mindfulness did not show more beneficial effects on the primary outcomes compared to the controls except for resilience for which a positive intervention effect was found at T9 in all participants (β=1.18, SE 0.57, p = 0.04) as compared to the relaxation group. In addition, in gender and grade related analyses, MBI lowered depressive symptoms in girls at T26 (β=−0.49, SE 0.21, p = 0.02) and improved socio-emotional functioning at T9 (β=−1.37, SE 0.69, p = 0.049) and at T26 (β=−1.71, SE 0.73, p = 0.02) among 7th graders as compared to relaxation.
The inactive control group was smaller than the intervention and active control groups, reducing statistical power.
A short 9-week MBI in school-setting provides slight benefits over a relaxation program and teaching as usual. Future research should investigate whether embedding regular mindfulness-based practice in curriculums could intensify the effects.
Background
Higher all‐cause mortality in asthmatics has been shown previously. Polysensitization is associated with higher morbidity among asthmatic children, and allergic rhinitis and/or allergic ...conjunctivitis (AR/AC) are associated with higher morbidity in adult asthmatics. Little is known about the effect of AR/AC and other factors on mortality among adult asthmatics. The aim was to study mortality and its risk factors in adults with and without asthma.
Methods
We randomly selected 1648 asthmatics with age over 30 years from national registers and matched the asthma sample with one or two controls. Baseline information was obtained by a questionnaire in 1997, and the study population was linked with the death certificate information of Statistics Finland from 1997 to 2013. Overall and cause‐specific survival between the groups was compared in several adjusted models.
Results
During a mean follow‐up period of 15.6 years, 221 deaths among 1052 asthma patients and 335 deaths among 1889 nonasthmatics were observed. Cardiovascular diseases were the main cause of death in both groups. Asthma was associated with increased all‐cause mortality (adjusted HR 1.25; 95% CI 1.05‐1.49, P = .011) as well as mortality from chronic obstructive pulmonary disease (HR 12.0, 4.18‐34.2, P < .001) and malignant neoplasms of respiratory organs (HR 2.33, 1.25‐4.42, P = .008). Among asthmatics, smoking was associated with increased all‐cause mortality, and self‐reported AR/AC was associated with decreased mortality. Among nonasthmatics, smoking, and obesity were associated with increased all‐cause mortality, whereas female gender showed an association with a decreased risk.
Conclusions
Increased mortality among adult asthmatics was largely explained by the development of COPD, malignant respiratory tract neoplasms, and cardiovascular diseases. Smoking cessation is important for reduction in total mortality in both asthmatic and nonasthmatic adults. AR/AC was associated with decreased mortality only in asthmatics. Thus, studies in other populations of larger size are needed to explore further the nature of this association.
We evaluated the sedative, haemodynamic and respiratory effects of dexmedetomidine and compared them with those of midazolam in children undergoing magnetic resonance imaging (MRI) procedures.
Eighty ...children aged between 1 and 7 yr were randomly allocated to receive sedation with either dexmedetomidine (group D, n=40) or midazolam (group M, n=40). The loading dose of the study drugs was administered for 10 min (dexmedetomidine 1 μg kg−1 or midazolam 0.2 mg kg−1) followed by continuous infusion (dexmedetomidine 0.5 μg kg−1 h−1 or midazolam 6 μg kg−1 min−1). Inadequate sedation was defined as difficulty in completing the procedure because of the child's movement during MRI. The children who were inadequately sedated were given a single dose of rescue midazolam and/or propofol intravenously. Mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation ( SpO2) and ventilatory frequency (VF) were monitored and recorded during the study.
The quality of MRI was significantly better and the rate of adequate sedation was higher in group D than in group M (P<0.001). In group D, the requirement for rescue drugs was lower and the onset of sedation time was shorter than in group M (P<0.001). MAP, HR and VF decreased from baseline during sedation in both groups (P<0.001).
Dexmedetomidine provided adequate sedation in most of the children aged 1–7 yr without haemodynamic or respiratory effects during MRI procedures.
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