DOSIS 1/2022

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under debate (Shah-Kulkarni et al. 2016, Tsai et al. 2017, Preston et al. 2018). In several studies, altered levels of the hormones secreted from thyroid gland, i.e., triiodothyronine (T3) and thyroxine (T4), as well as the level of thyroid-stimulating hormone (TSH) secreted from the pituitary gland, were associated with prenatal PFAS exposure. It is well established that T3 and T4 hormones are responsible for critical body functions, e.g., thermoregulation, neurodevelopment, movement of nerve impulses and growth regulation (Sand et al. 2014). Therefore, disruption of the thyroid hormone functions could impact overall growth and development of an infant. To maintain homeostasis, raised T3 and T4 levels send negative feedback to pituitary to reduce TSH secretion (Sand et al. 2014). According to Preston et al. (2018) normal or elevated T3 levels could result in unstable or decreased TSH levels. Consistently, according to the observations made by Tsai and the co-workers (2017), prenatal exposure to PFOS was associated with higher TSH levels and with lower T4 levels (Tsai et al. 2017). Also, maternal TSH levels were inversely associated with fetal T4 levels but, not with fetal TSH levels (Kato et al. 2016). However, the effect of PFAS on T4 level, as observed by different authors, is not consistent. An association of decreased T4 level in infants due to prenatal exposure to PFOS (Kim et al. 2011, Tsai et al. 2017) and PFOA (de Cock et al. 2014, Preston et al. 2016) was reported. Also, less common PFAS, such as PFTrDA (Kim et al. 2011) were shown to decrease infant T4 levels. Particularly in case of PFAAs, their binding to thyroid binding proteins like albumin and transthyretin has been suggested thereby increasing the free T4 level in blood which is then excreted faster from the body compared to the bound T4 (Kim et al. 2011, de Cock et al. 2014). On the contrary, associations of increased T4 hormone levels due to PFOS (Shah-Kulkarni et al. 2016), PFOA (de Cock et al. 2014) and less common PFPeA (Shah-Kulkarni et al. 2016) exposures have also been noted. Similar inconsistencies were noted in association with TSH levels. PFOS has been observed to increase TSH levels (Kato et al. 2016, Tsai et al. 2017). However, PFOA has been associated with both increased (Kim et al. 2011), as well as decreased TSH level (Kato et al. 2016, Shah- Kulkarni et al. 2016, Preston et al. 2018), In case of T3, exposure to both PFOS (Kim et al. 2011) and PFOA (Shah-Kulkarni et al. 2016) were associated with a decreased T3 level. Gender seems to also affect the PFAS association with thyroid hormone levels. Kato et al. (2016) found that increased TSH levels after PFOS exposure were more pronounced in male infants than in female infants. Similarly, Preston et al. (2014) found reduced T4 levels only in male infants following prenatal PFOA exposure. Shah-Kulkarni and coworkers (2016) observed that PFOA increased T4 and T3 levels in girl infants but decreased T3 levels in boy infants. The reasons for sexspecific results are still unclear (Preston et al. 2014), although Shah-Kulkarni and co-workers (2016) suggested that the sex-specificity could be due to estrogen-induced increase of T4 levels. Even though majority of the studies focused on the PFAS associations with thyroid hormones, some studies focused on the effects of PFAS on other hormones, such as sex hormones (Itoh et al. 2016), including estrone, estradiol, estriol, progesterone, prolactin, testosterone, dehydroepiandrosterone and inhibin B, and cortisone and cortisol hormone levels (Goudarzi et al. 2017). However, no clear associations were reported because of the prenatal PFAS exposure to the levels of these hormones. Impact of exposure to perfluoroalkyl substances on other parameters Compared to the strong association to birth weight and levels of thyroid hormones, there are much less evidence to support clear associations of PFAS exposure to other parameters, such as, neurodevelopment and immune functions (EFSA 2018, EEA 2019). The studies that have explored effects of prenatal PFAS exposure on neurodevelopment, have found associations with poorer gross-motor, fine-motor and self-help domains (Chen et al. 2013), and better impulse control with higher prenatal exposure to PFOA (Voung et al. 2018). In addition, PFOA exposure was associated with slight increase in ADHD diagnosis, whereas PFOS was associated with decrease in ADHD diagnosis (Ode et al. 2014). Studies finding associations between prenatal PFAS and immune parameters, also 126 Dosis Vol. 38 1/<strong>2022</strong> © Suomen Farmasialiitto ry
Table 1. Summary of the developmental parameters studied in relation to prenatal PFAAs exposure. Parameters Anthropometric effects Hormonal effects Effects observed Decrease in birth weight Decrease in head circumference Decrease in birth length Decrease in thyroid hormone level and TSH level Increase in thyroid hormone level and TSH level Alteration in sex hormone level Decrease in cortisol and cortisone levels References Apelberg et al. 2007 Chen et al. 2012 Li et al. 2017 Minatoya et al. 2017 Apelberg et al. 2007 Chen et al. 2012 Wang et al. 2019 Maisonet et al. 2012 Chen et al. 2017 Minatoya et al. 2017 Kim et al. 2011 de Cock et al. 2014 Kato et al. 2016 Preston et al. 2016 Shah-Kulkarni et al. 2016 Tsai et al. 2017 Shah-Kulkarni et al. 2016 de Cock et al. 2014 Kato et al. 2016 Tsai et al. 2017 Itoh et al. 2016 Goudarzi et al. 2017 Goudarzi et al. 2017 Parameters Neurodevelopment Immune system Malformations Effects observed (limited evidence) Reduced gross-motor, finemotor, self-help domains Varied observations related to ADHD Varied observations in IgE levels No associations with cases of cryptorchidism References Chen et al. 2013 Ode et al. 2014 Ashley-Martin et al. 2015 Okada et al. 2012 Jensen et al. 2014 Suomen Farmasialiitto ry © 1/<strong>2022</strong> Vol. 38 Dosis 127
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Vol. 38 Dosis 1 2022 Farmaseuttinen
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Suomen Farmasialiitto ry © 1/2022
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PÄÄKIRJOITUS Lääkkeiden rahoitu
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lakseni. Tietotarpeet ovat vielä j
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Tiivistelmä Johdanto: Suomessa hoi
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ydessä järjestettiin raportointi,
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Vuoronvaihto ja raportointi Lääkk
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Lääkehoitoprosessin vaihe Lääke
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Lääkehoitoprosessin vaihe Lääke
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tenkin huomaamatta, mikä johti lä
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tietojärjestelmään. Yleensä nä
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ammattilaiset voisivat olla mukana
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Kirjallisuus Airaksinen M, Hämeen-
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Stuijt CCM, Klopotowska JE, Kluft v
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LIITE 2: Palvelukodin lääkehoitos
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Potilasinformaation varmistaminen T
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Tiivistelmä Johdanto: Turvallinen
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Aineisto ja menetelmät Tutkimuksen
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Taulukko 1. Kyselyyn vastanneiden a
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Taulukko 3. Farmaseutin kysymät ky
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Tarpeiden ja soveltuvuuden selvitt
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duksi neuvonnaksi. Tämä tutkimus
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Kirjallisuus Alastalo N, Jyrkkä J,
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Mäkelä P, Jokinen L, Airaksinen M
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LIITE 1. Kyselylomakkeen itsehoitov
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Tiivistelmä Johdanto: Suomalainen
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muksen tarkoituksesta, tulosten hy
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Taulukko 1. Kyselyyn vastanneiden a
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Pohdinta Tämän tutkimuksen mukaan
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Lääkärin tai sairaanhoitajan suo
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Savossa sijaitsevista apteekeista,
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Kirjallisuus Alastalo N, Jyrkkä J,
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MacFarlane B, Matthews A, Bergin J:
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Liite 1. Kyselylomakkeen valmisteen
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5. Kuinka päädyit valitsemaan tä
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Page 121 and 122: Abstract Perfluoroalkyl substances
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