Duodecim; lääketieteellinen aikakauskirja
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Sexually offending behavior by adolescents may be directed towards children, age-mates and adults. Neurocognitive and psychiatric disorders and the associated inability to age-related interpersonal relationships and inability to control the sexual desires activated during adolescence may lead a young person to seek inappropriate sexual satisfaction from children. ⋯ Interventions should be focused on the distorted cognitions and attitudes maintaining the injurious sexual behavior, and on the risk of criminal behavior in general. Pharmacological therapy, mainly with SSRI drugs, has also been tested in adolescents.
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Central aspects in the prevention of pain from becoming chronic are good management of acute pain, early recognition of risk factors and a multidisciplinary working approach. Postherpetic neuralgia can probably be prevented with a vaccine and medication. In the prevention of prolonged postoperative pains there is some evidence of the effect of local anesthetics and ketamine, but their clinical significance is unclear. Multidisciplinary therapeutic and rehabilitative actions can be taken to prevent prolongation and recurrence of lower back pain especially in patients having an increased risk of chronic pain.
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Gleason grading of tumor biopses is the only method to distinguish clinically significant prostate cancer. Local cancer is usually symptomless, and men would benefit from functional screening. ⋯ In blood test diagnostics, established use is made only of the levels of prostate-specific antigen (PSA) and free PSA. New methods for blood test diagnosis are "Prostate Health Index" and the four-kallikrein panel.
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Transgender people find their natal sex and the corresponding gender role unpleasant and alien, and wish to be able to live in the gender role and body of the other sex. Gender dysphoria is effectively alleviated by sex reassignment treatments. ⋯ Psychiatric symptoms at the initiation of the transition process, discrimination, negative attitudes, losses in relationships, and complications in somatic treatments may deteriorate the social integration and quality of life of the transgender people. Health-care professionals can ease the transition process by organizing support for transgender individuals according to the same principles as they do for other people.
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The most common symptoms of cardiac sarcoidosis and giant cell myocarditis are atrioventricular block, ventricular tachycardia and cardiac insufficiency. Magnetic resonance imaging of the heart or positron emission tomography are utilized to evaluate the possibility of inflammatory heart disease. ⋯ The cause of cardiac sarcoidosis is not known, but granulomatous inflammation can be suppressed with corticosteroids. In giant cell myocarditis, more powerful immunosuppression is utilized than in sarcoidosis, but one third of the patients still require heart transplantation within one year from the diagnosis.