Evaluation of the Biocompatibility of Poly (ortho ester), Copolymer of ε-caprolactone/D,L-lactide and the Composite of Copolymer of ε-caprolactone/D,L-lactide and Tricalciumphosphate as Bone Filling Material

The purpose of this series of studies was to evaluate the biocompatibility of poly (ortho) ester (POE), copolymer of ε-caprolactone and D,L-lactide [P (ε-CL/DL-LA)] and the composite of P(ε-CL/DL-LA) and tricalciumphosphate (TCP) as bone filling material in bone defects. Tissue reactions and resorption times of two solid POE-implants (POE 140 and POE 46) with different methods of sterilization (gamma- and ethylene oxide sterilization), P(ε-CL/DL-LA)(40/60 w/w) in paste form and 50/50 w/w composite of 40/60 w/w P(ε-CL/DL-LA) and TCP and 27/73 w/w composite of 60/40 w/w P(ε-CL/DL-LA) and TCP were examined in experimental animals. The follow-up times were from one week to 52 weeks. The bone samples were evaluated histologically and the soft tissue samples histologically, immunohistochemically and electronmicroscopically. The results showed that the resorption time of gamma sterilized POE 140 was eight weeks and ethylene oxide sterilized POE 140 13 weeks in bone. The resorption time of POE 46 was more than 24 weeks. The gamma sterilized rods started to erode from the surface faster than ethylene oxide sterilized rods for both POEs. Inflammation in bone was from slight to moderate with POE 140 and moderate with POE 46. No highly fluorescent layer of tenascin or fibronectin was found in the soft tissue. Bone healing at the sites of implantation was slower than at control sites with the copolymer in small bone defects. The resorption time for the copolymer was over one year. Inflammation in bone was mostly moderate. Bone healing at the sites of implantation was also slower than at the control sites with the composite in small and large mandibular bone defects. Bone formation had ceased at both sites by the end of follow-up in large mandibular bone defects. The ultrastructure of the connective tissue was normal during the period of observation. It can be concluded that the method of sterilization influenced the resorption time of both POEs. Gamma sterilized POE 140 could have been suitable material for filling small bone defects, whereas the degradation times of solid EO-sterilized POE 140 and POE 46 were too slow to be considered as bone filling material. Solid material is difficult to contour, which can be considered as a disadvantage. The composites were excellent to handle, but the degradation time of the polymer and the composites were too slow. Therefore, the copolymer and the composite can not be recommended as bone filling material.

Isänmaamme keisari : Eliitin kansallisen identiteetin murros ja suomalaisen isänmaan rakentuminen autonomian ajan alussa

The emperor of our fatherland The changing national identity of the elite and the construction of the Finnish fatherland at the beginning of the autonomy This study addresses the question of changing national identity of the elite at the beginning of the autonomy (1808 1814) in Finland. Russia had conquered Finland from Sweden, but Finland was not incorporated into the Russian Empire. Instead, it was governed as separately administered area, and Finland retained its own (laws of the realm of Sweden) laws. The inclusion in the Russian Empire compelled the elite of Finland to deliberate their national identity; they had to determine whether they remained Swedes or became Finns or Russians. The elite chose to become Finns, which may seem obvious from the nowadays perspective, but it cannot be taken for granted that the Swedish speaking and noble elite converted their local Finnish identity into a new national identity. The basis of this study is constructive in a sense that identity is not seen as stable and constant. Theoretical background lies on Stuart Hall s writings on national identity, which offer good practical methods to study national identity. According to Hall identity is based mainly on difference , difference to others . In practice this means how elite began to define themselves in contrast to Swedes and Russians. The Finnish national identity was constructed in contrast to Swedes due to the political reasons. In order to avoid Russians suspicions Finns had to diverge from Sweden. Sweden had also gone trough coup d état, which was disliked by the elite of Finland. However, the attitudes of the elite towards Sweden remained somewhat ambiguous. Even if it was politically and rationally thinking wisest to draw away from Sweden, emotionally it was difficult. Russia, on the other hand, had been for centuries the archenemy of the Finns as well as all the Swedes. The fear of the Russians was mainly imaginary. Russians were seen as cruel barbarians who hated and resented Finns. The Finnish national identity was constructed above all in contrast to the Russians, for the difference to Russia was seen as a precondition for the existence of Finland. Respectively, the new position of Finland also required approaching towards Russia, which was in its nature very pragmatic. The elite contrived to get rid off its prejudice against Russians on intellectual level, but not on emotional level. At the beginning of the autonomy the primary loyalty of the elite was directed into the Finnish fatherland and its habitants. This was a radical ideological change, because traditionally the loyalty of the elite had focused on monarch and monarch s realm. However, the role of Alexander I was crucial. According to the elite the emperor had granted them a new fatherland. The former native country (Finland) was seen as a new fatherland instead of Sweden. The loyalty of the elite to the emperor generated from the reciprocal gratitude; Alexander I had treated their native country so mercifully. The elite felt strong personal responsibility for Finland s existence. The elite believed that the future of Finland rested on their shoulders. Alexander I had given them fatherland, but it was in the hands of the elite to construct the Finnish state and national spirit. The study of the Finnish national identity brings forth also that the national identity was constructed by emphasizing Finns civic rights. The civic rights were essential part of the construction of the Finnish national identity, for the difference between Finns and Russians was based on Finns own laws and privileges, which the emperor of the Russia had ensured.

Nutrition and Nutritional Care of Elderly People in Finnish Nursing Homes and Hospitals

Background: Malnutrition is a common problem for residents of nursing homes and long-term care hospitals. It has a negative influence on elderly residents and patients health and quality of life. Nutritional care seems to have a positive effect on elderly individuals nutritional status and well-being. Studies of Finnish elderly people s nutrition and nutritional care in institutions are scarce. Objectives: The primary aim was to investigate the nutritional status and its associated factors of elderly nursing home residents and long-term care patients in Finland. In particular, to find out, if the nursing or nutritional care factors are associated with the nutritional status, and how do carers and nurses recognize malnutrition. A further aim was to assess the energy and nutrient intake of the residents of dementia wards. A final objective was to find out, if the nutrition training of professionals leads to changes in their knowledge and further translate into better nutrition for the aged residents of dementia wards. Subjects and methods: The residents (n=2114) and patients (n=1043) nutritional status was assessed in all studies using the Mini Nutritional Assessment test (MNA). Information was gathered in a questionnaire on residents and patients daily routines providing nutritional care. Residents energy and nutrient intake (n=23; n=21) in dementia wards were determined over three days by the precise weighing method. Constructive learning theory was the basis for educating the professionals (n=28). A half-structured questionnaire was used to assess professionals learning. Studies I-IV were cross-sectional studies whereas study V was an intervention study. Results: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. According to the MNA, 11% to 57% of the studied elderly people suffered from malnutrition, and 40-89% were at risk of malnutrition, whereas only 0-16% had a good nutritional status. Resident- and patient-related factors such as dementia, impaired ADL (Activities of Daily Living), swallowing difficulties and constipation mainly explained the malnutrition, but also some nutritional care related factors, such as eating less than half of the offered food portion and not receiving snacks were also related to malnutrition. The intake of energy and some nutrients by the residents of dementia wards were lower than those recommended, although the offered food contained enough energy and nutrients. The proportion of residents receiving vitamin D supplementation was low, although there is a recommendation and known benefits for the adequate intake of vitamin D. Nurses recognized malnutrition poorly, only one in four (26.7%) of the actual cases. Keeping and analysing food diaries and reflecting on nutritional issues in small group discussions were effective training methods for professionals. The nutrition education of professionals had a positive impact on the energy and protein intake, BMIs, and the MNA scores of some residents in dementia wards. Conclusions: Malnutrition was common among elderly residents and patients living in nursing homes and hospitals in Finland. Although residents- and patient related factors mainly explained malnutrition, nurses recognized malnutrition poorly and nutritional care possibilities were in minor use. Professionals nutrition education had a positive impact on the nutrition of elderly residents. Further studies describing successful nutritional care and nutrition education of professionals are needed.