On Glucose Metabolism in Patients with the m.3243A>G Mutation

Background: The m.3243A>G mutation in mitochondrial DNA is the most common cause for mitochondrial diabetes. In addition, unexpected deaths related to the m.3243A>G associate with encephalopathy and cardiomyopathy. Failing mitochondrial respiratory chain in neurons, myocytes and beta cells is considered to underlie the multiorgan manifestations of the m.3243A>G. Aims: The primary aim of the study was to characterize the organ-specific glucose metabolism in patients with m.3243A>G and secondly, to study patients with or without signs of diabetes, cardiomyopathy or encephalopathy. The insulin-stimulated glucose metabolism in brain, heart, skeletal muscle, adipose tissue and liver were measured with 2-deoxy-2-[18F]fluoro-α-D-glucose in 15 patients and 14 controls. Brain oxygen metabolism was assessed with [15O]oxygen and insulin secretion was modelled based on oral glucose tolerance test. Results: The glucose oxidation in brain was globally decreased in patients with or without clinical encephalopathy. The insulin-stimulated glucose influx to skeletal muscle and adipose tissue was decreased in patients with or without diabetes as the hepatic glucose metabolism was normal. Impaired beta cell function and myocardial glucose uptake were associated with the high m.3243A>G heteroplasmy. Conclusions: This cross-sectional study suggests that: 1) The ability of insulin to stimulate glucose metabolism in skeletal muscle and adipose tissue is weakened before the beta cell failure results in mitochondrial diabetes. 2) Glucose oxidation defect is detected in otherwise unaffected cerebral regions in patients with the m.3243A>G, thus it likely precedes the clinical encephalopathy. 3) Uneconomical glucose hypometabolism during hyperinsulinemia contributes to the cardiac vulnerability in patients with high m.3243A>G heteroplasmy

Nursing Ethics Education in Finland from the Perspective of Codes of Ethics

The purpose of this study was to analyze nursing ethics education from the perspective of nurses’ codes of ethics in the basic nursing education programmes in polytechnics in Finland with the following research questions: What is known about nurses’ codes in practice and education, what contents of the codes are taught, what teaching and evaluation methods are used, which demographic variables are associated with the teaching, what is nurse educators’ adequacy of knowledge to teach the codes and nursing students’ knowledge of and ability to apply the codes, and what are participants’ opinions of the need and applicability of the codes, and their importance in nursing ethics education. The aim of the study was to identify strengths and possible problem areas in teaching of the codes and nursing ethics in general. The knowledge gained from this study can be used for developing nursing ethics curricula and teaching of ethics in theory and practice. The data collection was targeted to all polytechnics in Finland providing basic nursing education (i.e. Bachelor of Health Care). The target groups were all nurse educators teaching ethics and all graduating nursing students in the academic year of 2006. A total of 183 educators and 214 students from 24 polytechnics participated. The data was collected using a structured questionnaire with four open-ended questions, designed for this study. The data was analysed by SPSS (14.0) and the open-ended questions by inductive content analysis. Descriptive statistics were used to summarize the data. Inferential statistics were used to estimate the differences between the participant groups. The reliability of the questionnaire was estimated with Cronbach’s coefficient alpha. The literature review revealed that empirical research on the codes was scarce, and minimal in the area of education. Teaching of nurses’ codes themselves and the embedded ethical concepts was extensive, teaching of the functions of the codes and related laws and agreements was moderate, but teaching of the codes of other health care professions was modest. Issues related to the nurse-patient relationship were emphasised. Wider social dimensions of the codes were less emphasized. Educators’ and students’ descriptions of teaching emphasized mainly the same teaching contents, but there were statistically significant differences between the groups in that educators assessed their teaching to be more extensive than what students had perceived it had been. T he use of teaching and evaluation methods was rather narrow and conventional. However, educators’ and students’ descriptions of the used methods differed statistically significantly. Students’ knowledge of the codes and their ability to apply them in practice was assessed as mediocre by educators and by students themselves. Most educators assessed their own knowledge of the codes as adequate to teach the codes, as did most of the students. Educators who regarded their knowledge as adequate taught the codes more extensively than those who assessed their knowledge as less adequate. Also students who assessed their educators’ knowledge as adequate perceived the teaching of the codes to be more extensive. Otherwise educators’ and students’ demographic variables had little association with their descriptions of the teaching. According to the participants, nurses need their own codes, and they are also regarded as applicable in practice. The codes are an important element in nursing ethics education, but their teaching needs development. Further research should focus on the organization of ethics teaching in the curricula, the teaching process, and on the evaluation of the effectiveness of ethics education and on educators’ competence. Also the meaning and functions of the codes at all levels of nursing deserve attention. More versatile use of research methods would be beneficial in gaining new knowledge.

Reglering och förvaltning av produktions- och slaktdjurs välbefinnande : en offentligrättslig undersökning

Djur och djurskyddet hör till ett rättsligt regleringsområde som inte varit föremål för omfattande rättsvetenskaplig forskning i vårt land även om intresset för djurs välbefinnande ökat både i samhället och inom EU. Avhandlingen har avfattats som en artikelavhandling och är en offentligrättslig studie om djurskyddslagstiftningen och förvaltningen av djurskyddsärenden i Finland. Tematiken har behandlats både ur djurens och djurens ägares eller innehavares synvinkel med utgångspunkt i djurskyddslagstiftningen och förvaltningen av djurskyddsärenden i Finland. Forskningen är fokuserad huvudsakligen på skyddet av och välbefinnandet hos produktions- och slaktdjur även om bland annat de begrepp som granskas också berör andra djurkategorier. De övergripande frågeställningarna i avhandlingen är två. För det första, vad är det som avses med djurs välbefinnande och skydd i regleringen av djurskyddet och för det andra, hur realiseras dessa i djurskyddsmyndigheternas förvaltningsverksamhet? I forskningen presenteras och diskuteras bland annat en ny begreppskonstruktion: djurs rättsliga välbefinnande. Den empiriska delen i avhandlingen omfattar förvaltningsverksamheten inom området av djurskydd under åren 1996–2006. Sammanlagt 10468 dokument som upprättats av djurskyddsmyndigheten i samband med verkställandet av djurskyddsövervakning ingår i undersökningen. Forskningen utmynnar i en åtgärdsförteckning med förslag till utvecklingen av området för djurskydd.

Strategiaan sitoutuminen - Case: Lappeenrannan kaupungin kasvatus- ja opetustoimi

Tutkimuksen tavoitteena oli saada kokonaiskuva siitä, kuinka sitoutunut Lappeenrannan kaupungin kasvatus- ja opetustoimen henkilöstö on kaupungin strategiaan ja etenkin siihen sisältyvään toimialan omaan strategiaan. Tutkimuksessa selvitettiin strategian toimeenpanoa hankaloittavat asiat ja esitettiin näihin konkreettisia kehittämisehdotuksia. Tutkimusmenetelminäkäytettiin johtotasolle suunnattua teemahaastattelua ja muulle henkilöstölle suunnattua kyselylomaketta. Tutkimuksen perusteella Lappeenrannan kaupungin johto ja kasvatus- ja opetustoimen johto ovat hyvin sitoutuneita strategiatyöhön, mutta etenkin ei-esimiesasemassa olevan henkilöstön strategiatietämyksessä on puutteita. Henkilöstö on halukas vaikuttamaan strategisiin asioihin, mutta monet kokevat, ettei heillä ole tarpeeksi vaikutusmahdollisuuksia. Kuitenkin toimipisteiden tavoitteet ovat hyvin sopusoinnussa toimialan strategisten tavoitteiden kanssa ja ne ohjaavat henkilöstön työntekoa, joten kasvatus- ja opetustoimessa toimitaan strategian mukaisesti. Päivittäinen työnteko koetaan siltiraskaaksi muun muassa siksi, ettei omalla työllä ja strategialla nähdä aina riittävästi yhteyttä. Erityisesti määräaikaiset työntekijät kokevat vaikeaksi sitoutua strategiaan.