Cystatin C, a measure of renal function, as prognostic risk marker in acute heart failure : Studies on the cardiorenal syndrome

Acute heart failure (AHF) is a complex syndrome associated with exceptionally high mortality. Still, characteristics and prognostic factors of contemporary AHF patients have been inadequately studied. Kidney function has emerged as a very powerful prognostic risk factor in cardiovascular disease. This is believed to be the consequence of an interaction between the heart and kidneys, also termed the cardiorenal syndrome, the mechanisms of which are not fully understood. Renal insufficiency is common in heart failure and of particular interest for predicting outcome in AHF. Cystatin C (CysC) is a marker of glomerular filtration rate with properties making it a prospective alternative to the currently used measure creatinine for assessment of renal function. The aim of this thesis is to characterize a representative cohort of patients hospitalized for AHF and to identify risk factors for poor outcome in AHF. In particular, the role of CysC as a marker of renal function is evaluated, including examination of the value of CysC as a predictor of mortality in AHF. The FINN-AKVA (Finnish Acute Heart Failure) study is a national prospective multicenter study conducted to investigate the clinical presentation, aetiology and treatment of, as well as concomitant diseases and outcome in, AHF. Patients hospitalized for AHF were enrolled in the FINN-AKVA study, and mortality was followed for 12 months. The mean age of patients with AHF is 75 years and they frequently have both cardiovascular and non-cardiovascular co-morbidities. The mortality after hospitalization for AHF is high, rising to 27% by 12 months. The present study shows that renal dysfunction is very common in AHF. CysC detects impaired renal function in forty percent of patients. Renal function, measured by CysC, is one of the strongest predictors of mortality independently of other prognostic risk markers, such as age, gender, co-morbidities and systolic blood pressure on admission. Moreover, in patients with normal creatinine values, elevated CysC is associated with a marked increase in mortality. Acute kidney injury, defined as an increase in CysC within 48 hours of hospital admission, occurs in a significant proportion of patients and is associated with increased short- and mid-term mortality. The results suggest that CysC can be used for risk stratification in AHF. Markers of inflammation are elevated both in heart failure and in chronic kidney disease, and inflammation is one of the mechanisms thought to mediate heart-kidney interactions in the cardiorenal syndrome. Inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) correlate very differently to markers of cardiac stress and renal function. In particular, TNF-α showed a robust correlation to CysC, but was not associated with levels of NT-proBNP, a marker of hemodynamic cardiac stress. Compared to CysC, the inflammatory markers were not strongly related to mortality in AHF. In conclusion, patients with AHF are elderly with multiple co-morbidities, and renal dysfunction is very common. CysC demonstrates good diagnostic properties both in identifying impaired renal function and acute kidney injury in patients with AHF. CysC, as a measure of renal function, is also a powerful prognostic marker in AHF. CysC shows promise as a marker for assessment of kidney function and risk stratification in patients hospitalized for AHF.

Worksite Fitness Policy in an Intellectual Capital Framework

In a framework of Intellectual Capital (IC), the effects and interactions of a Worksite Fitness Program (WFP) policy was studied with a multidisciplinary approach. In a preliminary study, indicators for physical activity (PAI), physical fitness (PFI), activity in WFP on a regular (WFPI) and on a events basis (WFPE) were created in line with positive findings regarding the associations between physical activity and fitness patterns and sick leave, perceived health, and self-assessed work ability. The intensity of physical activity was found to be the most important variable to predict positive associations with the above mentioned wellness parameters. In four case study follow-up settings, the effects and interactions of physical activity and fitness patterns and the company’s WFP-policy on different elements of IC were studied. Qualitative methods were applied in constructing indicators and a descriptive IC measure for each case company. In cross-sectional and follow-up settings, several findings with respect to IC were found regarding physical activity in general and activity in WFP in particular. Findings were relatively strong in health and wellness related indicators in Human Capital, where, as also in Structural Capital indicators such as the company climate and employee-superior relationship, revealed positive associations. Physical activity patterns were found to act in minor role in Relational Capital. Overall, WFP was seen to be an integrated part of Structural Capital. From the viewpoint of Worksite Fitness Program as a phenomenon, this study positioned WFP as an active element of Intellectual Capital. The literature in the field of WFP emphasizes the role of WFP as an instrument to activate employees in physical activity, and thus promote their health and wellbeing. With the wider perspective the active and long range WFP policy can support a company’s Structural and Relational Capital in line with the fundamental role it has on Human Capital.

Monietnisten ihmisten etninen identiteetti suomalaisessa viitekehyksessä : kosmopoliittisuutta, monikulttuurisuutta ja itsensä etsimistä

The purpose of this thesis was to understand the experiences of the multiethnic people in Finland. This study explored the different aspects of the ethnic identity development process. Thesis was done in two phases. First phase studied the question of how is the ethnic identity developed in Finnish context and what aspects had affected their ethnic identity process. The second phase explored questions as what kind of ethnic identity form the multiethnic people have in Finland and do they have developed cosmopolitan global identities. The aim of this qualitative study was not to empirically measure or define the multiethnic identity, but to open new perspectives of the life and experiences through narrative research. Intention of this thesis was to give voice to small stories of the minority people that are so often shadowed by the big stories of the male of the majority. The first phase of this study included narratives from four multiethnic women. The narratives answered to questions who am I and where do I come from. The second phase data collection was made with narrative forms to 12 self-identified multiethnic persons. The multiethnic people were from three backgrounds: ones with parents from different ethnic backgrounds, Finnish who had lived long time abroad and people from non-Finnish backgraound who had lived in Finland for a long time. The analyzing was made by analyzing the narratives with content analysis that based on the theory of the multiethnic people and by narrative analyzing where short narratives were created of each person. In conclusion the multiethnic identity was found to be a continuous process that lasted through lifetime. Different aspects affected the identification process, including family dynamics, social mirroring and belonging. The variety of different ethnic options in multiethnic person identity process, lacking family support for the both ethnic identities and the feeling of otherness experienced by the multiethnic people in Finland cause additional challenges to the ethnic identity process and results in some cases cultural homelessness. On the other hand the variety of cultural contexts brings flexibility to negotiate between different cultures and languages resulting to positive hybrid identity for some of the multiethnic people. Hybrid identity was sub grouped to cosmopolitan identity and multicultural identity.

Talouskäsitysten vaikutus hallituksen suosioon Puolassa 2006–2007

Tutkimuksessa tarkastellaan äänestäjien talouskäsitysten vaikutusta hallituksen suosioon Puolassa vuosina 2006 ja 2007. Tutkimusasetelma juontaa juurensa poliittisten suhdannevaihteluiden teoriaan, jonka mukaan poliitikot pyrkivät manipuloimaan taloutta vaalien alla tullakseen uudelleen valituiksi. Vastuullisuushypoteesin mukaan äänestäjät palkitsevat poliitikot hyvästä taloustilanteesta. Näin ollen mikäli äänestäjät ovat tyytyväisiä talouteen he äänestävät hallitusta. Mikäli eivät, he äänestävät oppositiota. Miten äänestäjät sitten tekevät arvionsa taloudesta? Tutkielmassa selvitetään vaikuttiko äänestäjien mielipiteisiin käsitys nykyisestä vai tulevaisuuden taloustilanteesta. Käsitys nykyisestä taloustilanteesta perustuu havaintoihin jo toteutuneesta talouspolitiikasta. Tätä käsitystä kutsutaan retrospektiiviseksi näkemykseksi. Prospektiiviset talousnäkemykset koostuvat näkemyksestä ja odotuksista talouden tulevasta tilasta ja uskosta hallituksen kykyyn tarjota paras vaihtoehto suotuisalle talouskehitykselle. Aikaulottuvuuden lisäksi tutkielmassa testataan, vaikuttaako äänestäjiin enemmän heidän oma taloustilanteensa vai näkemys yleisestä talouden tilanteesta. Mikäli hallituksen suosio perustuu näkemyksiin henkilökohtaisen talouden tilasta, ovat äänestäjät egotrooppisia. Mikäli kannatuspäätös perustuu näkemykseen kansantalouden tilasta, ovat äänestäjät puolestaan sosiotrooppisia. Aineistona tutkielmassa käytetään uusinta saatavilla olevaa Puolan mielipidetiedustelun (Centrum Badania Opinii Publicznej) keräämää kyselyaineistoa vuosilta 2006 ja 2007. Tutkielmassa on yhdistetty kyselyaineistot 22:n kuukauden ajalta. Aineistoa on analysoitu logistisen regressioanalyysin menetelmin. Tutkielman perusteella talousnäkemyksistä suurin vaikutus hallituksen suosioon on äänestäjien näkemyksillä kansantalouden tulevaisuuden tilasta. Henkilökohtaisen talouden osalta positiiviset tulevaisuudennäkymät vaikuttavat positiivisesti myös hallituksen kannatukseen. Retrospektiivinen arvio henkilökohtaisesta taloudesta toimii kuitenkin teorian vastaisesti; oman taloudellisen tilanteen hyväksi arvioineiden todennäköisyys kannatta hallitusta oli pienempää kuin niillä, jotka arvioivat oman taloustilanteensa huonoksi. Kontrollimuuttujiksi valittiin joukko aiemmassa tutkimuksessa äänestyskäyttäytymiseen Puolassa vaikuttaneita tekijöitä. Näitä olivat ikä, sukupuoli, koulutus, asuinpaikka, näkemys työllisyystilanteesta, ideologinen sijoittuminen oikeisto–vasemmisto-akselilla sekä uskonnollisuus. Kontrollimuuttujista merkitseviksi osoittautuivat uskonnollisuus, oikeisto–vasemmisto-ideologia, koulutus, asuinpaikka sekä ikä. Kun edellä mainitut taustamuuttujat on kontrolloitu, taloustekijät selittävät noin viidesosan hallituksen kannatuksen todennäköisyyden vaihtelusta.

A new method for modulating the activity of parvalbumin-positive neurons and cerebellar Purkinje cells in vivo

Neurons can be divided into various classes according to their location, morphology, neurochemical identity and electrical properties. They form complex interconnected networks with precise roles for each cell type. GABAergic neurons expressing the calcium-binding protein parvalbumin (Pv) are mainly interneurons, which serve a coordinating function. Pv-cells modulate the activity of principal cells with high temporal precision. Abnormalities of Pv-interneuron activity in cortical areas have been linked to neuropsychiatric illnesses such as schizophrenia. Cerebellar Purkinje cells are known to be central to motor learning. They are the sole output from the layered cerebellar cortex to deep cerebellar nuclei. There are still many open questions about the precise role of Pv-neurons and Purkinje cells, many of which could be answered if one could achieve rapid, reversible cell-type specific modulation of the activity of these neurons and observe the subsequent changes at the whole-animal level. The aim of these studies was to develop a novel method for the modulation of Pv-neurons and Purkinje cells in vivo and to use this method to investigate the significance of inhibition in these neuronal types with a variety of behavioral experiments in addition to tissue autoradiography, electrophysiology and immunohistochemistry. The GABA(A) receptor γ2 subunit was ablated from Pv-neurons and Purkinje cells in four separate mouse lines. Pv-Δγ2 mice had wide-ranging behavioral alterations and increased GABA-insensitive binding indicative of an altered GABA(A) receptor composition, particularly in midbrain areas. PC-Δγ2 mice experienced little or no motor impairment despite the lack of inhibition in Purkinje cells. In Pv-Δγ2-partial rescue mice, a reversal of motor and cognitive deficits was observed in addition to restoration of the wild-type γ2F77 subunit to the reticular nucleus of thalamus and the cerebellar molecular layer. In PC-Δγ2-swap mice, zolpidem sensitivity was restored to Purkinje cells and the administration of systemic zolpidem evoked a transient motor impairment. On the basis of these results, it is concluded that this new method of cell-type specific modulation is a feasible way to modulate the activity of selected neuronal types. The importance of Purkinje cells to motor control supports previous studies, and the crucial involvement of Pv-neurons in a range of behavioral modalities is confirmed.

Consumers' attitudes towards food prices

High food prices can be a barrier to healthy eating because some of the food products may be perceived as expensive. Understanding the role of price in food purchase situations is important, but only a few studies document attitudes towards expensiveness or cheapness in foods. In this thesis, the role of food price in food choice and consumers attitudes towards food prices were investigated and the aim was to measure the food price attitudes. Food price attitudes were hypothesized to have an impact on consumers willingness to pay judgements and their willingness to buy premium-priced food products. First, using qualitative data consisting of 40 thematic interviews the experiences of the expensiveness and cheapness in foods were explored by using functional food products as a target product category. Second, a Food Price Attitude Scale was developed using four quantitative surveys representing Finnish consumers (2001 N=1158; 2002 N=1156; 2004a N=1113; 2004b N=1027). Food price attitudes were confirmed to compose a multidimensional construct and consumers may perceive positive and negative attitudes towards both high and low food prices. Finnish consumers were clustered into four groups based on their food price attitudes. In the first group, 29% of respondents were negative towards high food prices and they were willing to seek low food prices, whereas respondents in another group (22%) were positive towards high food prices. Additionally, in the third group consumers (17%) were willing to pay for high quality but still looked for low food prices. In the fourth group, consumers (32%) were willing to look for low food prices, unwilling to pay for high quality, but high-priced food was appreciated if offered to others. It was found in qualitative data that consumers willingness to accept high prices in foods was connected to price fairness and to justifications. Feelings of fairness or unfairness might be a core element of food price attitudes. Using quantitative methods, it was confirmed that positive attitudes towards high food prices in terms of high quality enhanced consumers willingness to buy food products with certain benefits (e.g., a health claim). Additionally, the favourable attitude towards low food prices lowered the willingness to pay estimates. This type of tendency, however, can create a possible bias in small convenient samples. In the food price-related research, it is advisable to take into account food price attitudes as possible background variables. The Food Price Attitude Scale needs further development to increase construct validity even though, in the present study, it was shown to be a reliable measure with good predictive and discriminant validity. The theoretical and managerial implications of the results for a better understanding of the role of price in consumers food purchases are discussed.

Income inequality in the process of economic development : An empirical approach

This thesis studies the effect of income inequality on economic growth. This is done by analyzing panel data from several countries with both short and long time dimensions of the data. Two of the chapters study the direct effect of inequality on growth, and one chapter also looks at the possible indirect effect of inequality on growth by assessing the effect of inequality on savings. In Chapter two, the effect of inequality on growth is studied by using a panel of 70 countries and a new EHII2008 inequality measure. Chapter contributes on two problems that panel econometric studies on the economic effect of inequality have recently encountered: the comparability problem associated with the commonly used Deininger and Squire s Gini index, and the problem relating to the estimation of group-related elasticities in panel data. In this study, a simple way to 'bypass' vagueness related to the use of parametric methods to estimate group-related parameters is presented. The idea is to estimate the group-related elasticities implicitly using a set of group-related instrumental variables. The estimation results with new data and method indicate that the relationship between income inequality and growth is likely to be non-linear. Chapter three incorporates the EHII2.1 inequality measure and a panel with annual time series observations from 38 countries to test the existence of long-run equilibrium relation(s) between inequality and the level of GDP. Panel unit root tests indicate that both the logarithmic EHII2.1 inequality measure and the logarithmic GDP per capita series are I(1) nonstationary processes. They are also found to be cointegrated of order one, which implies that there is a long-run equilibrium relation between them. The long-run growth elasticity of inequality is found to be negative in the middle-income and rich economies, but the results for poor economies are inconclusive. In the fourth Chapter, macroeconomic data on nine developed economies spanning across four decades starting from the year 1960 is used to study the effect of the changes in the top income share to national and private savings. The income share of the top 1 % of population is used as proxy for the distribution of income. The effect of inequality on private savings is found to be positive in the Nordic and Central-European countries, but for the Anglo-Saxon countries the direction of the effect (positive vs. negative) remains somewhat ambiguous. Inequality is found to have an effect national savings only in the Nordic countries, where it is positive.

Literature Review: Investigating Drug Transport at the Blood-Brain Barrier and the Effects of P-glycoprotein on the Brain Distribution of Drugs.

The blood-brain barrier (BBB) is a unique barrier that strictly regulates the entry of endogenous substrates and xenobiotics into the brain. This is due to its tight junctions and the array of transporters and metabolic enzymes that are expressed. The determination of brain concentrations in vivo is difficult, laborious and expensive which means that there is interest in developing predictive tools of brain distribution. Predicting brain concentrations is important even in early drug development to ensure efficacy of central nervous system (CNS) targeted drugs and safety of non-CNS drugs. The literature review covers the most common current in vitro, in vivo and in silico methods of studying transport into the brain, concentrating on transporter effects. The consequences of efflux mediated by p-glycoprotein, the most widely characterized transporter expressed at the BBB, is also discussed. The aim of the experimental study was to build a pharmacokinetic (PK) model to describe p-glycoprotein substrate drug concentrations in the brain using commonly measured in vivo parameters of brain distribution. The possibility of replacing in vivo parameter values with their in vitro counterparts was also studied. All data for the study was taken from the literature. A simple 2-compartment PK model was built using the Stella™ software. Brain concentrations of morphine, loperamide and quinidine were simulated and compared with published studies. Correlation of in vitro measured efflux ratio (ER) from different studies was evaluated in addition to studying correlation between in vitro and in vivo measured ER. A Stella™ model was also constructed to simulate an in vitro transcellular monolayer experiment, to study the sensitivity of measured ER to changes in passive permeability and Michaelis-Menten kinetic parameter values. Interspecies differences in rats and mice were investigated with regards to brain permeability and drug binding in brain tissue. Although the PK brain model was able to capture the concentration-time profiles for all 3 compounds in both brain and plasma and performed fairly well for morphine, for quinidine it underestimated and for loperamide it overestimated brain concentrations. Because the ratio of concentrations in brain and blood is dependent on the ER, it is suggested that the variable values cited for this parameter and its inaccuracy could be one explanation for the failure of predictions. Validation of the model with more compounds is needed to draw further conclusions. In vitro ER showed variable correlation between studies, indicating variability due to experimental factors such as test concentration, but overall differences were small. Good correlation between in vitro and in vivo ER at low concentrations supports the possibility of using of in vitro ER in the PK model. The in vitro simulation illustrated that in the simulation setting, efflux is significant only with low passive permeability, which highlights the fact that the cell model used to measure ER must have low enough paracellular permeability to correctly mimic the in vivo situation.