Juverhälsoproblem orsakade av Streptococcus agalactiae på stora mjölkgårdar med mjölkningsrobot

Streptococcus agalactiae –juverinflammation var tidigare ett stort problem i många länder, inklusive Finland. I och med förbättrad mjölkningshygien och antibiotikabehandlingar har bakterien så gott som eradikerats från mjölkbesättningarna. Nu verkar bakterien i viss mån ha kommit tillbaka till våra stora mjölkgårdar. Avhandlingens experimentella del utfördes på en mjölkgård, med ca 180 mjölkande och tre mjölkningsrobotar, som haft problem med Str. agalactiae. Man hoppades utreda hur stort problemet på gården var samt möjliga smittovägar. Man undersökte också möjligheten att använda mjölkningsrobotens automatiska provtagningsutrustning för provtagning av bakteriella prov. PCRmetoden jämfördes med konventionell odling vid diagnostik av juverinflammationer orsakade av Str. agalactiae. På gården gick man igenom anteckningar samt hälso- och seminkort för att få en bild över situationen. Man gjorde en uppföljning av mjölkningen för tolv kor vid den ena mjölkningsroboten. Man tog 47 stycken kospecifika mjölkprov samt ett prov från mjölktanken. Mjölkprov i tre serier både mjölkade för hand och direkt från mjölkuppsamlaren på mjölkningsroboten togs. Man tog sammanlagt 23 renlighetsprov från mjölkningsroboten, tre från den automatiska provtagningsutrustningen samt två från djurskötarnas händer. Från den automatiska provtagningsutrustningen togs även ett genomsköljningsprov. Av mjölkprov som tidigare tagits på gården hade man hittat Str. agalactiae i ca 17%. I denna studie hittades Str. agalactiae i tre kospecifika mjölkprov, vilket motsvarar en prevalens på ca 2%. Vid uppföljningen av mjölkningarna upptäcktes inget alarmerande, men spenarnas hälsa samt tommjölkningar är något som bör följas upp. Av renlighetsproven hittades Str. agalactiae i ett prov taget från borsthållaren. Svaren från mjölkproven tagna i serier tyder på att den automatiska provtagningsutrustningen inte går att använda till bakteriella prov, eftersom mjölken från en Str. agalactiae –infekterad ko verkar påverka resultatet också hos följande kor. Resultatet är väntat, eftersom mjölkprov alltid skall tas aseptiskt och det går inte med den automatiska provtagningsutrustningen så som den i dagsläget är utvecklad. Från sju av nio mjölkprov, där man hittat Str. agalactiae med PCR-metoden, hittades bakterien också med konventionell odling. Från tankmjölksprovet kunde man inte hitta Str. agalactiae med konventionell odling. PCR-metoden verkar enligt den här studien vara mer känslig att upptäcka Str. agalactiae jämfört med konventionell odling.

Population projection for Namibia 2011-2020 - With an estimation of the impact of HIV/AIDS

This study presents a population projection for Namibia for years 2011–2020. In many countries of sub-Saharan Africa, including Namibia, the population growth is still continuing even though the fertility rates have declined. However, many of these countries suffer from a large HIV epidemic that is slowing down the population growth. In Namibia, the epidemic has been severe. Therefore, it is important to assess the effect of HIV/AIDS on the population of Namibia in the future. Demographic research on Namibia has not been very extensive, and data on population is not widely available. According to the studies made, fertility has been shown to be generally declining and mortality has been significantly increasing due to AIDS. Previous population projections predict population growth for Namibia in the near future, yet HIV/AIDS is affecting the future population developments. For the projection constructed in this study, data on population is taken from the two most recent censuses, from 1991 and 2001. Data on HIV is available from HIV Sentinel Surveys 1992–2008, which test pregnant women for HIV in antenatal clinics. Additional data are collected from different sources and recent studies. The projection is made with software (EPP and Spectrum) specially designed for developing countries with scarce data. The projection includes two main scenarios which have different assumptions concerning the development of the HIV epidemic. In addition, two hypothetical scenarios are made: the first considering the case where HIV epidemic would never have existed and the second considering the case where HIV treatment would never have existed. The results indicate population growth for Namibia. Population in the 2001 census was 1.83 million and is projected to result in 2.38/2.39 million in 2020 in the first two scenarios. Without HIV, population would be 2.61 million and without treatment 2.30 million in 2020. Urban population is growing faster than rural. Even though AIDS is increasing mortality, the past high fertility rates still keep young adult age groups quite large. The HIV epidemic shows to be slowing down, but it is still increasing the mortality of the working-aged population. The initiation of HIV treatment in 2004 in the public sector seems to have had an effect on many projected indicators, diminishing the impact of HIV on the population. For example, the rise of mortality is slowing down.

Äldres upplevelser av att flytta till ett servicehus

Många äldre är med om en förändring i deras hemmiljö. Ofta sker denna förändring då den äldre inte klarar av att bo hemma längre. Jag är intresserad av hur äldre upplever denna förändring och om flytten påverkar känslan av att anpassa sig till ett nytt hem. Jag är också intresserad av att undersöka vad den omgivande miljön betyder för den äldre och om hurudana känslor ett miljöombyte väcker hos den äldre. Jag har undersökt detta genom att hålla en diskussionsgrupp för äldre som bor på det finskspråkiga, kommunala servicehuset i Östra centrum. Diskussionsgruppen träffades en gång i veckan under en tidsperiod på två månader. Fyra äldre deltog aktivt i diskussionsgruppen. Som forskningsmetod har jag använt mig av narrativa livsberättelser. Jag bad de äldre i diskussionsgruppen om skrivna livsberättelser. Som forskningsmaterial användes dessutom de äldres skrivna dikter och tankar, både nya men också gamla texter. Jag använde mig av narrativ analys enligt det paradigmatiska tänkandet. Jag fann sex olika huvudteman i mitt material: hemmets betydelse, miljöns betydelse, upplevelsen av att flytta till ett servicehus, sociala samverkan, vården och upplevelsen av ålderdom. De äldre i min undersökning uppgav att miljöns betydelse hade ökat för dem efter att de flyttade till servicehuset. De äldre uppskattade särskilt känslan av lugn och stillhet då de vistades ute i naturen. Hemmets betydelse hade däremot sjunkit totalt. Ingen av de äldre uppgav lägenheten på servicehuset vara ett hem för dem, utan främst använde de ordet rum. Upplevelsen av att flytta till servicehuset hade för dem flesta i diskussionsgruppen varit positiv. Det som de äldre uppgav att de längtade mest efter på servicehuset handlade förutom små konkreta saker främst om dagliga hemsysslor. De äldre kände sig också ensamma och en orsak till detta var att den sociala samverkan uppgavs vara mycket fattig på servicehuset. De viktigaste källorna som jag har använt i denna undersökning är doktorsavhandlingarna av Anni Vilkko, Omaelämänkerta kohtaamispaikkana. Naisen elämän kerronta ja luenta (1997) och Annukka Klemola, Omasta kodista hoitokotiin. Etnografia keskipohjalaisten vanhusten siirtymävaiheesta (2006). Jag har också utgått från Sinikka Hakonens Kirjoittaminen merkityksellistää elämää (2003).

Modification of ventricular repolarization in silent long QT syndrome mutation carriers

Congenital long QT syndrome (LQTS) is a familial disorder characterized by ventricular repolarization that makes carriers vulnerable to malignant ventricular tachycardia and sudden cardiac death. The three main subtypes (LQT1, LQT2 and LQT3) constitute 95% of cases. The disorder is characterized by a prolonged QT interval in electrocardiograms (ECG), but a considerable portion are silent carriers presenting normal (QTc < 440 ms) or borderline (QTc < 470 ms) QT interval. Genetic testing is available only for 60-70% of patients. A number of pharmaceutical compounds also affect ventricular repolarization, causing a clinically similar disorder called acquired long QT syndrome. LQTS carriers - who already have impaired ventricular repolarization - are especially vulnerable. In this thesis, asymptomatic genotyped LQTS mutation carriers with non-diagnostic resting ECG were studied. The body surface potential mapping (BSPM) system was utilized for ECG recording, and signals were analyzed with an automated analysis program. QT interval length, and the end part of the T wave, the Tpe interval, was studied during exercise stress testing and an epinephrine bolus test. In the latter, T wave morphology was also analyzed. The effect of cetirizine was studied in LQTS carriers and also with supra- therapeutic dose in healthy volunteers. At rest, LQTS mutation carriers had a slightly longer heart rate adjusted QTc interval than healthy subjects (427 ± 31 ms and 379 ± 26 ms; p<0.001), but significant overlapping existed. LQT2 mutation carriers had a conspicuously long Tpe-interval (113 ± 24 ms; compared to 79 ± 11 ms in LQT1, 81 ± 17 ms in LQT3 and 78 ± 10 ms in controls; p<0.001). In exercise stress tests, LQT1 mutation carriers exhibit a long QT interval at high heart rates and during recovery, whereas LQT2 mutation carriers have a long Tpe interval at the beginning of exercise and at the end of recovery at low heart rates. LQT3 mutation carriers exhibit prominent shortening of both QT and Tpe intervals during exercise. A small epinephrine bolus revealed disturbed repolarization, especially in LQT2 mutation carriers, who developed prolonged Tpe intervals. A higher epinephrine bolus caused abnormal T waves with a different T wave profile in LQTS mutation carriers compared to healthy controls. These effects were seen in LQT3 as well, a group that may easily escape other provocative tests. In the cetirizine test, the QT and Tpe intervals were not prolonged in LQTS mutation carriers or in healthy controls. Subtype-specific findings in exercise test and epinephrine bolus test help to diagnose silent LQTS mutation carriers and to guide subtype-specific treatments. The Tpe interval, which signifies the repolarization process, seems to be a sensitive marker of disturbed repolarization along with the QT interval, which signifies the end of repolarization. This method may be used in studying compounds that are suspected to affect repolarization. Cetirizine did not adversely alter ventricular repolarization and would not be pro-arrhythmic in common LQT1 and LQT2 subtypes when used at its recommended doses.

Improving outcome of childhood bacterial meningitis by simplified treatment : Experience from Angola

Background Acute bacterial meningitis (BM) continues to be an important cause of childhood mortality and morbidity, especially in developing countries. Prognostic scales and the identification of risk factors for adverse outcome both aid in assessing disease severity. New antimicrobial agents or adjunctive treatments - except for oral glycerol - have essentially failed to improve BM prognosis. A retrospective observational analysis found paracetamol beneficial in adult bacteraemic patients, and some experts recommend slow β-lactam infusion. We examined these treatments in a prospective, double-blind, placebo-controlled clinical trial. Patients and methods A retrospective analysis included 555 children treated for BM in 2004 in the infectious disease ward of the Paediatric Hospital of Luanda, Angola. Our prospective study randomised 723 children into four groups, to receive a combination of cefotaxime infusion or boluses every 6 hours for the first 24 hours and oral paracetamol or placebo for 48 hours. The primary endpoints were 1) death or severe neurological sequelae (SeNeSe), and 2) deafness. Results In the retrospective study, the mortality of children with blood transfusion was 23% (30 of 128) vs. without blood transfusion 39% (109 of 282; p=0.004). In the prospective study, 272 (38%) of the children died. Of those 451 surviving, 68 (15%) showed SeNeSe, and 12% (45 of 374) were deaf. Whereas no difference between treatment groups was observable in primary endpoints, the early mortality in the infusion-paracetamol group was lower, with the difference (Fisher s exact test) from the other groups at 24, 48, and 72 hours being significant (p=0.041, 0.0005, and 0.005, respectively). Prognostic factors for adverse outcomes were impaired consciousness, dyspnoea, seizures, delayed presentation, and absence of electricity at home (Simple Luanda Scale, SLS); the Bayesian Luanda Scale (BLS) also included abnormally low or high blood glucose. Conclusions New studies concerning the possible beneficial effect of blood transfusion, and concerning longer treatment with cefotaxime infusion and oral paracetamol, and a study to validate our simple prognostic scales are warranted.

Studies of the Human Transcriptome

Gene expression is one of the most critical factors influencing the phenotype of a cell. As a result of several technological advances, measuring gene expression levels has become one of the most common molecular biological measurements to study the behaviour of cells. The scientific community has produced enormous and constantly increasing collection of gene expression data from various human cells both from healthy and pathological conditions. However, while each of these studies is informative and enlighting in its own context and research setup, diverging methods and terminologies make it very challenging to integrate existing gene expression data to a more comprehensive view of human transcriptome function. On the other hand, bioinformatic science advances only through data integration and synthesis. The aim of this study was to develop biological and mathematical methods to overcome these challenges and to construct an integrated database of human transcriptome as well as to demonstrate its usage. Methods developed in this study can be divided in two distinct parts. First, the biological and medical annotation of the existing gene expression measurements needed to be encoded by systematic vocabularies. There was no single existing biomedical ontology or vocabulary suitable for this purpose. Thus, new annotation terminology was developed as a part of this work. Second part was to develop mathematical methods correcting the noise and systematic differences/errors in the data caused by various array generations. Additionally, there was a need to develop suitable computational methods for sample collection and archiving, unique sample identification, database structures, data retrieval and visualization. Bioinformatic methods were developed to analyze gene expression levels and putative functional associations of human genes by using the integrated gene expression data. Also a method to interpret individual gene expression profiles across all the healthy and pathological tissues of the reference database was developed. As a result of this work 9783 human gene expression samples measured by Affymetrix microarrays were integrated to form a unique human transcriptome resource GeneSapiens. This makes it possible to analyse expression levels of 17330 genes across 175 types of healthy and pathological human tissues. Application of this resource to interpret individual gene expression measurements allowed identification of tissue of origin with 92.0% accuracy among 44 healthy tissue types. Systematic analysis of transcriptional activity levels of 459 kinase genes was performed across 44 healthy and 55 pathological tissue types and a genome wide analysis of kinase gene co-expression networks was done. This analysis revealed biologically and medically interesting data on putative kinase gene functions in health and disease. Finally, we developed a method for alignment of gene expression profiles (AGEP) to perform analysis for individual patient samples to pinpoint gene- and pathway-specific changes in the test sample in relation to the reference transcriptome database. We also showed how large-scale gene expression data resources can be used to quantitatively characterize changes in the transcriptomic program of differentiating stem cells. Taken together, these studies indicate the power of systematic bioinformatic analyses to infer biological and medical insights from existing published datasets as well as to facilitate the interpretation of new molecular profiling data from individual patients.